Personal life

Schizophrenia DSM-IV Delusions Hallucinations Disorganized Speech Catatonic behavior Negative symptoms Subtypes Paranoid Delusions and hallucinations Catatonic Disorganized Disorganized speech & disorganized behavior Flat or inappropriate affect Undifferentiated Residual ? no psychotic, but negative left Syndromes Positive Delusions & Hallucinations Type I syndrome (Crow) Acute course, good prognosis, response to neuroleptics Negative Avolition, anhedonia-asociality, flat affect Type II syndrome Chronic, irreversible, poor response, intellectual impairment Disorganized Inappropriate affect, thought disorder, bizarre behavior Course Premorbid Prodrome Post episode

Pervasive Developmental Disorders Phenomenology & Diagnosis DSM vs. Federal guidelines Federal Guidelines Individuals with Disabilities Act ? defines autism broadly ? specify verbal and nonverbal communication and social interaction DSM-IV Autism, Asperger?s, Rett?s, Childhood Disintegrative Disorder, PDD NOS DSM-IV Criteria: Total of 6 (or more) items from 1,2, and 3 Qualitative impairment in social interaction, as manifested by at least two of following Marked impairment in multiple nonverbal behavior Failure to develop peer relationships Lack of spontaneous sharing with others Lack of social or emotional reciprocity 2) Qualitative impairment in communication ? at least 1 of: Delay in or total lack of development of spoken language

Ethical and Legal Issues Civil (Psychiatric) Commitment Involuntary placement in a psychiatric facility (2PC) Threat to oneself or others 72 hour window until hearing or due process ? convert to voluntary commitment Different than criminal commitment (not guilty by reason of insanity) (Over)Predicting Dangerousness Best predictor of future violence is past violence! Post-hoc problem ? hindsight is 20/20 General to specific Definition of dangerousness Low base-rate Unlikely to disclose direct threats of violence Difficulty predicting behavior in community based on behavior in hospital Violence and Severe Mental Illness Increased violence in severely mentally ill BUT the increased risk of violence in schizophrenia is small

Eating Disorders Anorexia Nervosa Refusal to maintain minimally normal body weight Intense fear of gaining weight or becoming fat Disturbance in way in which body weight or shape is experienced, etc. Absence of at least three consecutive menstrual cycles Specify restricting type or binge/purging type Bulimia Nervosa Recurrent episodes of binge eating Recurrent inappropriate compensatory behaviors in order to prevent weight gain Binge eating & compensatory behavior occur on average 2X/week for 3 months Self-evaluation unduly influenced by weight Doesn?t occur only during anorexia Specify: Purging type or Nonpurging type Etiology Biological factors Twin studies MZ (20-50%) DZ (>10%) Family studies Hypothalmus Modulates neurotransmitters such as serotonin and norepinephrine

Anxiety Disorders & Responses to Stress Stress & Illness Stress and the endocrine system Stress affects the endocrine system (glands that release hormones into blood) releases ACTH, stimulates cortical steroids Chronic stress can damage bodily systems Stress and the immune system Chronic stress increases levels of interleukin-6, linked to inflammation Social support and expressing emotion through writing can help Acculturative Stress Acculturation The process of adaptation by which immigrants, native groups, and ethnic minority groups adjust to the new culture or majority culture through making behavioral and attitudinal changes Acculturative stress Pressure that results from demands placed on these groups to adjust to life in mainstream culture