Unit 1 - Introduction To Psychology: I-What Is Psychology

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Unit 1 - Introduction to psychology

Communication and Psychology
Goals:
1. To acquire the basic knowledge about human behavior.
2. Introduce the terminology of Psychology.
3. Get knowledge about the structure and development of personality.
4. Identify the developmental stages.
5. Analyze social aspects that influence human behavior in health and disease.
6. To know the psychological aspects of the disease process
7. Get awareness of the importance of stress as a component of disease.
I- WHAT IS PSYCHOLOGY
- Psychology is the study of the mind and behavior.
- It deals with mental illness (Stress, instability, problems, depression, anxiety, trauma,
emotions, unhappy) and is used to describe, explain, predict and control → Finding
the best ways to deal with problems
- Psychologist ≠ Psychiatrist: A psychiatrist is a doctor, he can prescribe medicines,
whereas a psychologist tries to cure only with words.
II- MENTAL HEALTH AND MENTAL DISEASE

• Mental Disorder: Behavioral or psychological pattern that occurs in an individual and
that is associated with present distress (e.g., a painful symptom) or disability (i.e.,
impairment in one or more important areas of functioning) or with a significantly
increased risk of suffering death, pain, disability, or an important loss of freedom.
→ Disorder ≠ illness: a disorder has unknown etiology (cause)
• Health: “A state of complete physical, mental and social wellbeing and not merely the
absence of disease or infirmity”
• Mental Health: “A state of well being in which the individual realizes his or her own
abilities, can cope with the normal stresses of life, can work productively and fruitfully,
and is able to make a contribution to his or her community”. (Satisfied with themselves -
Positive Relationships - Deal with life challenges)
III- MENTAL DISORDER’S CLASSIFICATION

1. DSM-5 (from american psychiatric association) 2. CIE-10 (from the WHO)
Com & psycho - Unit 1 1

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Unit 2 - Psychological Functions

Com & Psycho
• What is psychology?
- Science of human mental functions and behaviors and their underlying
physiological and biological processes
- Scientific study of both individuals and groups
• What is it for?
- To explain relationship human-world
- To understand human complexity
- To distinguish healthy vs. pathological traits
- To get self-knowledge
Psychological functions are INTERDEPENDENT.
I- CONSCIOUSNESS & ATTENTION

A- Consciousness
- Ability to recognize our experiences and the world around us
- Allows to process information and be aware of:
- External Reality (perceptions)
- Inner Reality (emotions and feelings)
B- Sleep
• Rhythm of two cycles: awake (vigilance) and sleep (dream)
1. Normal state: Vigilance

- State of Clarity to focus mental activity on a given object
- Characterized by ATTENTION
- Always selective
- Types of Attention:
- Voluntary Focus: effort of a person to concentrate mental activity in something or
situation
- Involuntary Focus: occurs when a strong stimulus raises the immediate attention
(environmental stimulus)
2. Alternative State: Dream (oniric

state)
- Opposite state to Vigilance (daytime
activity)
- State of Resting (we spend a 1/3 of
our lives sleeping!)
- Complex brain activity
- Wake-Sleep is a Circacian Rythm
Com & Psycho - Unit 2 1

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• Stages and types of sleep:
Stage 5 → Where we sleep (REM = rapid eye
movement)
• Functions of sleep:
Physiological:
- Body and brain regeneration (i.e., muscle relaxation)
- Production of hormones (i.e., growth hormones)
- Conservation of energy
Psychological:
- Information processing
- Reorganization of memory
- Dreams
• Sleeping disorders:
1. Parasominas: affects the way we sleep → Minor disorders
- Sleepwalking (walking)
- Somniloqui (talking)
- Nightmares
- Enuresis (bedwetting)
2. Dyssomnias: difficulty to initiate or maintain the sleep

- Insomnia (Sleeplessness)
- Hypersomnia (Excessive daytime sleepiness)
- Apnea (Breathlessness)
C- Attention
- State of focused awareness on specific perceptual informations
- Discriminate between irrelevant data, enables desired data to be distributed to other
mental processes (i.e., sensation, perception)
• Attention disorders:
1. Aprosexia: Inability to sustain attention
2. Hyperprosexia: Excessive and transitory focus
3. Hypoprosexia: Reduced ability to concentrate or attend
- Distrability: sudden changes and instability
- Tiredness: does not reach level of attention
II- SENSATION & PERCEPTION

• How do we picture the external reality in our minds?
1) Involves physical senses (i.e., sight, smell, hearing): SENSATION
2) Involves cognitive processes, interpreting them: PERCEPTION
Organization, identification, and interpretation of sensory information →

understanding the environment

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A- Perception processes
- Sensation (by sensory organ)
- Organization (by nervous system, depends on brain capacity,
function of sensory organs, cognition, interests, emotion)
- Identification (by experiences, expectations, mood, emotions,
cognition)
B- Sensory threshold
- Absolute threshold: Minimum stimulation is necessary to detect a specific stimulus
→ Is it the same for everyone?
- Theory of the stimulus detection:
- It does not exist a unique threshold
- It is influenced by experiences, expectations, motivation and tiredness.
→ Can we detect stimulus below the absolute threshold? Subliminal Stimulation

- We can process information without being aware of it (sublimal stimulation)
- The stronger the stimulus, the higher the change to be perceived
C- How do we perceive colors?

- We can perceive 2,000,000 different colors!
- Cones: responsible for chromatic colors
- Rods: responsible for achromatic colors
• Disorders
- Monochromasia: color only as a gradation of intensity
- Dichromasia: only 2 of 3 types of cones (i.e., red-green blindness)
- Color blindness: no cones
C- How does our brain organize sensations

- GESTALT: organized group / shape (“The whole is more than the sum of
its parts”: FIRST LAW)
1. Shape perception
- Figure-Ground
- Proximity: we like to group nearby figures together
- Similarity - Closure - Continuity

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2. Depth Perception
- The ability to see objects in three dimensions although images that strike
the retina are two-dimensonal
- It allow us to calculate the distance between objects
D- Perception depends on the correct application of perception laws?

- Perceptual Set: psychological factors that determine how
you perceive your environment
- Influenced by:
- Expectations (mammal or bird)
- Context (easter eggs → bunny)
- Culture (emotions, experiences)
To sum up:
- Perception is universal, but processing is subjective
- Brightness, shape, size, and position are necessary for a bigger picture → the whole is
more than the sum of its parts
III- MEMORY
Ability to acquire, retain and use information, to revive
or bring awareness to past event
A- How do we recall?

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1. Codification
2. Store
3. Remembrance
- Sensory register: large capacity, briefly available

- Short-term/working memory: limited capacity
- Long-term memory: associative network, retrieval of stored
information by retrieval cues
B- Types of memory
• Atkinson y Shiffrin's Multi-store Model • Cohen & Squire (1980) LTM System
(1968)
1. Repetitions
2. Think critically (questioning, arguments...)
3. Give information a personal meaning
4. Use mnemonics (“Never Eat Salty Worms“)
5. Avoid interference
IV- LEARNING
A- Definition
- Change of behavior (relatively stable) that is produced by experience
- Result of new knowledge and skills
What can we learn? Knowledge, Skills, Behavior
B- Types of learning: How do we learn?

1. Cognitive Learning
2. Associative Learning (Conditioning)

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• Classical conditioning:
• Operant conditioning:
Association between a response and
consequence leads to Operant Conditioning: Behavior
pattern caused by reward or punishment
- Reward: stimulus increases the likelihood of response  
1. Positive: presentation of a stimulus 
2. Negative: removal of an unpleasant stimulus 
3. Primary: biologically important (food, water)  
4. Secondary: learned (praise, money …)
- Punishment: negative event reduces the response
- Positive Reinforcement: a rat was awarded with food when he
pressed the lever
- Negative Reinforcement: a rat was able to turn off electric
shocks produced by the floor by pressing the lever (avoidance
and scape learning)
3. Observational Learning
Acquisition of new behaviors by imitating an
observing process
V- INTELLIGENCE
Definition: Mental abilities
and tools that, well applied, are used to adapt to daily life challenges
• Functions:
- Acquire, recall and use knowledge
- Understand specific and abstract concepts
- Understand relationship between objects, actions or ideas
- Learn from experience
- Ability to argue and overcome obstacles by thinking process
• Human Intelligence is capable of:

- Abstract
- Plan ahead
- Memorize not just the experienced information but heard information
- Reasoning: human asks himself and tries to answer WHY?
- Be self-conscious
- Judge
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• How do we measure it?
- 1904: First test. Identify children with mental retardation. Binet & Simon Scale (mental
age)
- Intelligence Quotient:
• Types of intelligence:
- 1904. Spearman. G Factor and S Factor
- 1968. Cattell y Horn
- Fluid: ability to acquire new concepts and to adapt to new
situations: problem solving, abstract thinking, etc.(decreases
with age)
- Cristallized: ability to use learnt mental skills,
accumulated knowledge (increases with age)
- 1983. Gardner. Multiple
intelligences:
- 1995. Goleman. Emotional
Intelligence (To Know, To
Comprehend, To Manage, To
Motivate, Establish relations):
« the intelligence consists not only in the

knowledge but also in the skill to apply
the knowledge into practice » - Aristotle
VI- THINKING AND LANGUAGE

A- Thinking
Activity which is characterized by a deep study of the topic,
and by which we seek a meaning to each life experiences
→ PURPOSE: to make a good grasp of reality and to know what is true
Depends on: Consciousness - Attention - Memory - Intellectual level - Mental health
• Types of thinking:
1) Realistic or logical thinking: follows the laws of logic and adapts to
objective reality; aspires to the knowledge of the truth
2) Imaginary, magical or pre- logical thinking: fantasy
- Mental grouping of objects → form concepts
- Establishing a relationship between two or more concepts
- Problem solving: Heuristics (trial and error; diagnosis of exclusion); Algorithms

(analytical process to test all alternatives)
• Reasoning:
a) Induction: reasoning from single facts to laws. (We see some handsome men in
Spain, so we generalize (induction) that all handsome men are in Spain. )
b) Deduction: reasoning from a general truth to a particular truth (All handsome men are
in Spain. Mike is handsome. So Mike is Spanish.)
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B- Language
- Complex system of communication
- Sounds (or gestures), which expresses specific meanings
- Is organized according to certain rules (grammar)
• Functions:
- Allows communication
- It allows us to speak in future or past
- Depends on history and culture
- Differentiates humans from other animals
• Types of Communication:
- Verbal
- Non verbal:
- Kinesics: Facial expression or Body language
- Proximity or distance between interlocutors
- Paralanguage: quality and voice rythm. Voice inflections and silences
VII- INSTINCTS AND TENDANCIES

- Instinct: natural impulse, biological behavioral model,
its purpose is survival of species.
- Tendency: impulse that appears as a need response
when interacting with the world.
VIII- AFFECTIVITY
• Definition:
- Human quality characterized by the ability to feel internal and external reality
- Subjective and Personal evaluation of the experiences
- Characterized by psychological processes: Emotions and Feelings

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Unit 3 - Psychopathology
Com & Psycho
• Psychopathology is:
- Scientific study of mental disorders: Tries to understand the disorder’s genetic,
biological, psychological, and social causes (Classification of schemes)
I- CONSCIOUSNESS
A- Disorders of degree of awareness
- HYPER vigilance: Rise of level of awareness (PTSD, Post Traumatic Stress Disorder)
- HYPO vigilance: Progressive deterioration of the awareness clarity
- Drowsiness: State of apathy (indifference) with slow responses and
disorientation. Constant stimuli are needed to stay awake.
- Daze: Slight decreased clarity of awareness and vigilance. Slower psychic activity.
Blurred vision of environment. No attention nor response to simple demands.
- Sopor: Most of the time is spent sleeping. Intense stimuli are required to change
this. Slow, regular and deep breathing. Reduction in muscle tone and reflexes.
- Coma: Greatest depth of unconsciousness. No sense of painful stimuli
B- Disorders of quality of awareness

- Confusion: Disorientation in time, space and person with light headedness (daze)
- Delirium: Psychological state characterized by disorientation and confusion in all
spheres. It is associated with anxiety, fear, illusions and hallucinations, and it often
occurs in infections, metabolic and toxic disorders
Dissociative disorders:
- Altered Self Consciousness, depersonalization: Periods of feeling disconnected or
detached from one's body and thoughts but without losing contact with reality
- Altered Consciousness of the External World, Derealization: Alteration in the
perception or experience of the external world so it seems unreal (Like if they were
in a dream or if a glass wall separates them from their surroundings)
C- Disorders of body awareness

• Phantom Limb Syndrome
- Experience of body parts after amputation: The missing limb is felt as real
- Majority of the sensations are painful (aching, tickling, itching)
- Reason: Many nerve endings are terminated at the residual limb → inflammation →
nonsense signals to brain → brain interprets them as pain
• Autoscopy (« self-watcher »)
- Disembodiment: an apparent location of the self outside one's
body
- Impression of seeing the world from an elevated and distanced
(or extracorporeal) but egocentric visuo-spatial perspective

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• Anosognosia (« non awareness of disease »)
- Experience of disappearance of the body itself: Deficit of self-awareness
resulting from physiological brain damages
- Participants are not aware of their disability
• Body Dysmorphia
- Experience of a deformation of the body, overrated default, ugliness, disharmony
- Leads to a wish to change physical appearance: seek of plastic surgery,
dermatological treatment, cosmetic modification BUT outcome usually does not resolve
the symptoms
• Cotard's Syndrome
- Delusion of being dead, denial of self-existence
- Experience of disappearance of some internal organs (putrefying)
- Prevents patient from making sense of external reality
- Characterized by depression and hypochondria, appears often within schizophrenia
II- ATTENTION
- Aprosexia: Inability to sustain attention
- Hyperprosexia: Excessive and transitory focus
- Hypoprosexia: Reduced ability to concentrate or attend
- Distrability: sudden changes and instability
- Tiredness: does not reach level of attention
III- AFFECTIVITY
A- Mood disorders
Euthymia: Normal mood, non-depressed and positive mood (thymia = mind, mood…/ eu=
good)
• Hypothymia: pathologic sadness

- Depressive mood: The patient feels loneliness, fear, lack of affectivity...
- Main symptom of depression
- ≠ Normal sadness:
- Adequate to the origin stimuli
- Short duration without negative or remarkable effects
• Euphoria: pathologic happiness

- Excessive happiness not adequate to reality (Mania symptom)
- The euphoric patient feels optimistic, satisfied and talkative but can be grumpy and
sensitive in a sudden
• Dysthymia: bad state of mind

- Chronic mood disorder similar to depression, but less strong and longer-lasting  
symptoms (at least two years)
- Very subtle ! Diagnosis is difficult
- Low energy, drive, and pleasure accompanied with low self-esteem
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- Avoiding of stress and possibilities for failure, even suicidal behavior
- Reasons: genetic predisposition, stress and social isolation (lack of support)
- 3 Types:
- SAD Dysthymia: Experience of sadness, sorrow, grief, loneliness, lack of emotional
resonance, and psychic inhibition (Depressed Mood)
- COLD Dysthymia « Feeling of feeling nothing »: No emotion, no joy, no pain, no
sympathy, no interest (Indifference)
- MANIC Dysthymia: Characterized by euphoria or exaltation (Intense feelings of joy)
• Anxiety
- Characterized by feelings of anxiety (worry about future events) or fear (reaction to
current events)
- Feeling of worry, nervousness, or unease about something with an uncertain outcome
• Distress
- Vague discomfort with physical effects: suffocating feeling, tightness, sweating,
palpitations,etc.
- A state of physical strain (tension), especially difficulty in breathing
• Dysphoria
- Profound state of unease (= malaise) or dissatisfaction
- Long-term dysphoric states → suicide risk
B- Disorders of emotional response

Parathymia: Disorder showing an affect-incogruent behavior and expression
- Apathy: Absence or suppression of passion, emotion, or excitement leading to a

decreased emotional response
- Affective Lability: Complete loss of control of emotions, easy crying. Abnormal
involuntary crying, laughing, or other emotional displays. It occurs especially in
depression, feeble-minded, elderly, and children
- Irritability: Abnormal or excessive sensitivity to stimuli. Intense expression of
emotions, especially anger or frustration
- Emotional inconsistency: Abnormal behavior regarding consistency (= coherence) of
expected and shown emotion: a neutral event can cause an emotional explosion, a
sad event a crisis of laughter. Occurs especially in schizophrenics
- Affective ambivalence: Appearance of opposite feelings simultaneously (e.g., love-
hate)
- Anhedonia: Inability to experience pleasure
- Alexithymia « no words for mood »: Inability to identify and describe
emotions in the self. Difficulty in distinguishing and appreciating the
emotions of others, which is thought to lead to unempathic and ineffective
emotional responding
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IV- LANGUAGE
They are generally caused by neurological, mechanical, or psychological causes
A- Phonation and articulation disorders

- Aphonia: Inability to produce voice as a result of bilateral disruption of nerves
- Dysphonia: Inability to produce voice sounds using the vocal organs
- Dysarthria: Difficulty when articulating
- Dyslalia: Speech defect caused by malformation or imperfect distribution of nerves
to the organs of articulation (as the tongue). It affects pronunciation
B- Changes of expression
- Aphasia: Disorder in which the patient is unable to use language; caused by damage
to the brain
- Sensory Aphasia: Poor auditory comprehension, intact repetition. The patient
does not understand what it's said (Wernicke's Area)
- Motor Aphasia: The patient can not perform the necessary movements to speak
(Broca's Area)
- Paraphasia: Characterized by the production of unintended syllables, words, or
phrases during the effort to speak (unrelated concepts)
- Perseveration: Involuntary repetition of the last word (palilalia) or last syllable
(logoclonia).
- Echolalia: Automatic repetition of the last phrase/word heard (common in autism).
- Verbigeration: Constant or obsessive repetition of meaningless words or phrases
(schizophrenia)
C- Quantitative changes
- Mutism: Complete absence of verbal expression
- Selective Mutism: Selective absence of verbal expression; refers to a specific
topic, group of people, situation, ...
- Verbosity/Logorrhea: Increased verbal expression (manic state, alcohol intoxication)
D- Conversation disorders
- Approximate answers: These persons appear to have no difficulty in understanding
questions asked, but appear to provide incorrect answers deliberately.
- Soliloquy/Monologue: Non communicative language. The act of talking to one self.
A discourse by a person who is talking to himself or herself or is disregardful of or
oblivious to any hearers present (often used as a device in drama to disclose a
character's innermost thoughts: Hamlet’s soliloquy begins with “To be or not to be.”)
E- Rhythm and tone changes

- Monotone Language: no inflections
- Stuttering: To speak or say something, especially the first part of a word, with
difficulty, for example pausing before it or repeating it several times. 2 types:
- Clonic: Persistent repetition of syllables or words
- Tonic: Blocks the initiation of the diction of a word

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V- PERCEPTION
A- Perceptual disruptions: distorted perceptions of reality
1. Changes in the intensity (esthesia = sensation / algesia = pain)
- Hyperesthesia: Increased intensity of sensations (auditory or visual stimuli, during
delirium, poisoning, psychosis)
- Hypoesthesia: Decreased intensity of sensations (bland taste, less pain: attenuated
perceptions)
- Anestesia: Complete lack of perception of the stimuli intensity
- Hyperalgesia: Exaggerated painful response to a normal painful stimulus
- Hypoalgesia: Decreased sensitivity to painful stimulus
- Analgesia: Loss of sensation of pain by an interruption of the nervous system
pathway between sense organ and brain
2. Changes in the quality (Opsis = vision)

Color vision dysfunctions: Visual distortions, produced by toxic substances that color
perceptions (specific color vision)
• Objects can be seen:
- Yellow: Xanthropsias (Van Gogh → yellow filter)
- Green: Clorosias
- Red: Erithropsias
3. Changes in the Kind (visual perception)

Metamorphopsia: Visual disorder that makes see objects of form and dimensions
different to the real.
- Dysmegalopsia: change in the size perception

(Dys: bad, Mega: big; Opsis: seeing)
- Macropsias: enlarged scale (objects appear
larger → person feel smaller)
- Micropsias: reduced scale (objects appear
smaller)
- Dysmorphopsias: Change in the shape perception
(wavy objects)
- Pelopsia: Objects appear nearer
- Teleopsia: Objects appear further away
→ AIWS: Alice in Wonderland Syndrome

- Disorienting neurological condition that affects perception. People experience size
distortion such as micropsia, macropsia, pelopsia, or teleopsia.
- Primarily targets children
- Patients suffering from AIWS experience distorted time, space, and body image
- The episodes are predominantly short in duration, often less than an hour, and occur
up to several times a day, with unpredictable onset of symptoms.
- Triggers: migraine, stress, brain tumors, drugs (particularly cough medicine), epilepsy,
and infections.

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4. Changes in the emotional perception (dissociative disorders)
- Strangeness: feel and see the affective element as unknown, weird
- Derealization (external)
- Depersonalization (internal)
- Warmness: increase of affection (alcohol or cannabis)
5. Illusions
- Distortion of the visual sense (not pathologic)
- The stimuli of the perceived object gets mixed with a mental
image, resulting in a false perception.
- There is always an external object that stimulates but is miss
interpreted (miss interpretation of a true sensation)
- Types:
- Completion illusion: by sudden distraction (say
“hello” to a strange or complete words)
- Affective illusion: by intense emotional state.
Distortion of the situation or objects. Sense of
Presence (fear shadow → someone)
- Pareidolia illusion: by fantasy. Projecting a
specific image on top of a vague image.
(imagination: clouds or hidden messages in music)
B- Perceptive delusions: new perceptual experience

1. Hallucinations: perception without object
- False perceptions living with normal perceptions
- Difference between Hallucinations and Perceptions is that H come from the inside
• Types of hallucinations:
AUDITORY: clarity of consciousness, intensive and real
- Basic: Acoasmas
- Complex: Phonemas (Thought Echo, Echo of Reading, Imperative Hallucinations)
- Depression and Schizophrenia (Second person (“you are a coward”/ Third person “he
doesn't know how to talk) )
- Alcoholic hallucinosis (threats)

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VISUAL
- Basic: Photomas (non-formed: light, color, shape)
- Complex (human figures, animals, objects): Lilliputian hallucination (smaller things),
Alucinaciones gulliverianas (large human figures), Autoscopic Hallucination
(phantom mirror, see oneself)
- Delirium tremens; Intoxication by alcohol (do not appear suddenly, global confusion,
severe and chronic)
- Schizophrenia
OLFACTORY
- Unpleasant smell (not frequent)
- Schizophrenia; depression; injuries to the temporal lobe
GUSTATORY
- Perception of taste without stimuli (not frequent)
- Hysteria, Schizophrenia, chronic alcoholis, mania, major depression, Epilepsy
TACTILE HALLUCINATIONS (Proprioceptive)

- Perception of tactile sensory input without a stimulus
- Active (DT, touching nonexistent object) or Passive (something or someone touches,
burns, grabs him)
- Thermic: abnormal and extreme perception of cold and heat
- Hydric: perception of fluids
- Paresthesias: tingling sensation or someone touching
- Formication: sensation of animals crawling under the skin (cocaine intoxication)
2. Variants of hallucinatory experience

- Pseudo-hallucinations: (Auditory and visual) Same sensory elements than
hallucinations. Person recognizes are unreal. Appear linked to situations where
decreases clarity of consciousness
- Hypnagogic Hallucination (when sleeping)
- Hypnopompic Hallucination (when waking up)
- Functional Hallucination: Produced by an external stimulus and at the same time
perceived a hallucination (hearing God's voice and alarm clock)
- Extracampine Hallucination: Out of the visual field. The patient can see someone
sitting behind him when looking in front.
- Negative Hallucination: Opposite to a Hallucination. The patient does not perceive
something real.
VI- MEMORY
A- Quantitative changes
• By Excess: Hypermnesia
- Increased ability to recall → Exaggerated accumulation of information
- e.g., delirious people who speak fluently in a language they had not use for up to 50 or
more years and apparently had forgotten
- The idiot savant: remembering every detail of landscapes
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• By Default: Hypoamnesias
- Decreased capacity to recall → Absent or decreased memory
- Inability to recall past and to create new memories after a traumatic event (Long-
term memories remain intact )
- Occurs in traumatic brain injury, cerebral chronic diseases, epileptic twilight states,
alcohol intoxication
• Absence: Amnesia
- Lacunar: Specific period of time
- Retrograde: Previous period of time
- Anterograde: Consecutive period of time
B- Qualitative changes
Paramnesias: Falsification of memories
- Confabulations: Unintentional falsification. The patient uses false memories to fill

memory gaps.
- Fantastic Pseudology (« pseudologos »): common in Hysteria. Compulsive lying by
lack of affection. The patient is conscious that he is lying but exaggerates real stories
ending in lies he believes in. Long period of time.
- "Déjà vu": Something is recognized as familiar although never seen before.
- "Jamais vu": Something is proclaimed as something new, although it is something
that had been known before but forgotten completely.
- Capgras' Syndrome: Delusion that a known person/pet has been replaced by an
identical-looking impostor.
- Verkenung Phenomenon: false recognition. The patient confuses unknown people
as family or friends (Positive Verkenung) or does not recognize family or friends
(Negative Verkenung)

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Unit 4.1 - Personality

Com & Psycho
I- INTRODUCTION
• Personality:
- Is an individual’s characteristic pattern of thinking, feeling, and acting
- It distinguishes one person from another and persists over time and situations
« Set of traits and psychological mechanisms owned by the individual, organized and
relatively durable, which influence interactions and adaptations to the environment, both
intrapsychic and physical and social. » - Larsen & Buss, 2002.
- Personality: A person’s internally based characteristic way of acting and thinking

- Character: Personal characteristics that have been judged or evaluated
- Temperament: Inborn aspects of personality, including sensitivity, moods, and
arousals
- Personality Trait: Stable qualities that a person shows
- Personality Type: People who have several traits in common
- Personality Theory: System of concepts, assumptions, and principles proposed to
explain personality
• Personality theories:
- Psychoanalytic perspective: Focus on the unconsciousness
- Humanistic perspective: Focus on subjective experiences and personal growth
- Trait perspective: Attempt to learn what traits make up personality and how they
relate to actual behavior
- Social-cognitive perspective: Attributes differences in personality to socialization,
expectations, and mental processes
II- PSYCHOANALYTIC PERSPECTIVE

- Development is determined by early childhood
- Majority of personality is formed before age 6
- Personality develops in stages; everyone goes through same stages
in same order
- Attitudes, experiences, and thoughts are largely influenced by
irrational drives, that in turn are unconscious
- Technique that reduces anxiety arising from unacceptable or
potentially harmful impulses → defense mechanisms
• Defense mechanism: (7: Défendre Sa Reine en Protection Rapprochée ou Rapide Regards)

- Repression: Banishing of anxiety-arousing thoughts, feelings, and memories from
consciousness (involuntary forgetting)
- Regression: Falling back into an early less demanding and safe state of mental/
physical development (acting younger for our behaviors to be socially accepted)
- Projection: Attributing threatening, socially unacceptable impulse to others
Com & Psycho - Unit 4.1 1

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- Reaction formation: Ego unconsciously switches unacceptable impulses into their
opposites, often obsessive (e.g. little boy annoying a girl because he likes her)
- Sublimation: Expression of anxiety in socially acceptable ways (e.g. boxers)
- Rationalization: Convincing oneself that all is good through faulty and false reasoning
- Displacement: Shifting of sexual or aggressive impulses toward a more acceptable or
less threatening object or person
- Conflicts between conscious and unconscious can lead to mental or emotional

disturbances (e.g., neurosis, neurotic traits, anxiety, depression)
- To avoid this → bringing things to the conscious mind via therapeutic intervention
A- Psychoanalysis
- Thoughts and actions are influenced by unconscious motives and conflicts
- Psychoanalysis is a technique to treat psychological disorders by interpreting
unconscious tensions
Ex: Free Association: Free talking without a specific content → Exploration of the
unconscious
Jung’s Word Association Test: Test contains some words the person is expected to
respond with any other word that comes to the mind. Answer needs to be made as quickly
as possible. Long delay or strange answer → something is going on here…
B- Structure of the human mind

- Ego: Conscious part of personality that mediates among the id,
superego & reality. Aim: Satisfying the id’s desires in ways that
will realistically bring pleasure
- Superego: Presents internalized ideals, conscience & aspirations
- Id: Tries to satisfy basic sexual and aggressive drives. Operates
on the pleasure principle & needs immediate gratification
• Cause of Anxiety
Ego is caught between superego’s desires for moral behavior and
id’s desires for immediate gratification
- Neurotic Anxiety: Caused by id impulses that the ego can barely control
- Moral Anxiety: Comes from threats of punishment from the superego
• Personality Development
- Personality develops in stages; everyone goes
through same stages in same order
- Majority of personality is formed before age 6  
- Id’s pleasure-seeking energies focus on distinct

erogenous zones (area on body capable of
producing pleasure)
- During phallic stage child notices opposite sex parent that can lead to Oedipus
Complex – A boy’s sexual desires toward his mother – Jealous of the rival father
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C- Measuring the unconscious?
- Projective Test: Personality test that provides ambiguous stimuli designed to trigger
projection of one’s inner dynamics
- Thematic Apperception Test (TAT; Murray, 1943): Projective test in which people
express their inner feelings and interests through the stories they make up about
ambiguous scenes
III- HUMANISTIC PERSPECTIVE

• Abraham Maslow (1908-1970), Self-actualization:
- Strong desire to realize own full potential, to reach
a level of self-actualization
- Emphasis of the positive potential of human beings
• Carl Rogers (1902-1987)

- Self-actualization + environment enables growth
- Environment provides individual with
- genuineness (openness and self-disclosure)
- acceptance (being seen with unconditional positive regard)
- empathy (being listened to and understood)
• Five characteristics of a fully functioning person: (To Function One Cares For Everything)
1. Open to experience: Accepts positive and negative emotions
2. Existential living: Makes different experiences as they occur in life, avoids prejudging,
and lives in the present
3. Trust feelings: Trusts own feeling, instincts and gut-reactions. Believes that own
decisions are the right ones
4. Creativity: Thinks creative and takes risks to make new experiences
5. Fulfilled life: Person is happy and satisfied with life and always looks for new
challenges and experiences
• Two basic needs that are important during development:

1. Unconditional Positive Regard: Attitude of total acceptance toward another person
2. Self-Concept: All thoughts and feelings about self
IV- TRAIT PERSPECTIVE

- Characteristic pattern of behavior
- Stable in time, long-lasting
- Disposition to feel and act
- Assessed by self-report inventories and peer reports
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• Gordon Allport:
- Central traits: basic to an individual's personality (e.g., introvert person)
- Secondary traits: more peripheral (e.g., musician)
- Common traits: vary from culture to culture (e.g., polite person)
• Raymond Cattell:
- Two-tiered personality structure with 16 primary factors and 5 secondary factors
- Personality is that which permits a prediction of what a person will do in a given
situation
• Type A and Type B personality theory (Meyer Friedman)

- Type A: Intense, hard-driving personalities; need for stress
- Type B: Relaxed, less competitive personalities
- Type AB mix
• Hans Eysenck: 3 statistically independent factors in personality

- Introversion versus Extroversion
- Emotionally Stable versus Unstable (neurotic)
- Impulse Control versus Psychotic
→ Hans Eysenck’s Theory, continued: First 2 factors create 4 combinations
- Melancholic (introverted + unstable): sad, gloomy
- Choleric (extroverted + unstable): hot- tempered, irritable
- Phlegmatic (introverted + stable): lazy, calm
- Sanguine (extroverted + stable): cheerful, hopeful
• Raymond Cattell: Source & Surface Traits → Two basic categories of traits:
- Surface Traits: Features that make up the visible areas of personality (e.g., musician)
- Source Traits: Underlying characteristics of a personality (e.g., introvert)
→ Big 5: Five-dimension personality model
- Openness to Experience: Tendency to be independent and
interested in new experiences
- Conscientiousness: Tendency to be organized, careful, and
disciplined vs. disorganized, careless, and impulsive
- Extraversion: Tendency to be sociable, fun- loving, and affectionate
- Agreeableness: Tendency to be softhearted, trusting, and helpful
- Neuroticism: Tendency to be anxious, insecure, and self-pitying
V- SOCIAL-COGNITIVE PERSPECTIVE
• Assumptions:
1. People are active agents
2. Combines behavioral and humanistic approaches
3. Emphasizes cognitive and social processes
4. Behavior is situation specific
5. Reciprocal determinism (behavior is influenced by
interaction between persons and social context)
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• Julian Rotter: Locus of control → Behavior depends on ...
1. Behavior potential: Likelihood of a particular behavior in a specific situation
2. Outcome expectancies: Implicit judgments about behavior; subjective probability that
a given behavior will lead to a particular outcome
3. Reinforcement value: Desirability of outcome; depends on psychological needs
(status, dominance, independence, protection, love and affection, physical comfort)
4. Psychological situation: Unique experience of the environment
• Learned helplessness:
• Harry Stack Sullivan

- Personality changes as a function of relationships with others → social self
- Illusion of individuality: No single, fixed personality, but sum of individual tendencies
and social situation
• Individualism: giving priority to one’s

own goals over group goals and
defining one’s identity in terms of
personal attributes rather than group
identifications
• Collectivism: giving priority to the

goals of one’s group (often one’s
extended family or work group) and
defining one’s identity accordingly
• Bobo Doll Study (Bandura, 1965; 1977)

1. Group1 = aggression rewarded with sweets
2. Group2 = aggression punished with hits
3. Group3 = aggression without consequences
→ Results:
- Group 1 & 3 showed increased aggressive behavior
- Group 2 showed less aggressive behavior
When imitation of the aggressive potential was said to be rewarded, all subjects showed
increased imitation → All subjects learned the behavior but differ in imitating because of
the consequences
• Delay of gratification (Bandura & Mischel, 1965; 1986)

Ability to resist the temptation for an immediate reward and wait for a later reward
(larger or more enduring reward)

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VI- ELEMENTS OF PERSONALITY
A- Constitution/ Biotype
- Morphological characteristics
- Individual somatic (body related) constitution distinguishes subjects
B- Temperament
- Deep-rooted psychological traits, which are mostly unconscious, very difficult to
change and often expressed automatically
- Manifests early in life and remain stable throughout life
- Involves automatic responses
e.g., perseverance, search for novelty, harm avoidance
C- Character
- Set of personality characteristics
- Values, goals, coping strategies, and beliefs about oneself and the environment
- Result of self-awareness and individually chosen objectives and values
- Modified throughout life, maturity
- Affects voluntary intentions and personal and social effectiveness
- Ability for self-direction (individual can control, regulate, and adapt behavior according
to own goals and values)
- Ability for cooperation (empathy, compassion, and social tolerance; having ethical and
moral principles)
- Ability for transcendence (setting of boundaries or barriers)
D- Intelligence
• Cattell (1970): Fluid versus Crystallized Intelligence
- Fluid intelligence: Ability to solve abstract relational problems that have not been
explicitly taught and are free of cultural influences, e.g. verbal analogies, memory for
lists
- Crystallized intelligence: Ability to solve problems that depend on knowledge
acquired in school or through other experiences, e.g., general information, word
comprehension
• Sternberg: Intelligence is ...

- the cognitive ability to learn from experience
- to reason well
- to remember important information
- to cope with the demands of daily living
→ Intelligence is comprised of 3 aspects/
abilities:
1. Internal world of information processing (analytic)
2. Experience and past learning (creative)
3. External world of adapting, shaping, and selecting real-world environments (practical)
→ Expands the definition of intelligence in terms of the ability to modificate or select the
environment
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→ Sternberg’s Adaptive Behavior Checklist
• Alfred Binet
- Tried to identify mentally retarded children →
Development of the first IQ test
- IQ = Mental Age (score) / Chronological Age * 100
- Mean = 100, Standard Deviation = 15
- 130+ = Gifted, 145+ = Genius
→ IQ’s Tests:
- Intelligence is a tricky concept and is not as easily defined as one might think
- Testing is difficult
- Multiple Choice: Easy to administer, difficult to find good distracter items
- Likert Scale: Item in which you rate on a scale your level of agreement
- Free response: Need a coding scheme
- The Wechsler Scales

- The WPPSI-III (Wechsler Preschool and
Primary Scale of Intelligence-Revised, 2-7
years)
- The WISC-IV (Wechsler Intelligence Scale for
Children, 6-16 years)
→ Prediction of IQ tests:
- IQ and scholastic achievement: IQ predicts
academic achievement
- IQ and occupational success: IQ and job prestige, performance

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Unit 4.2 - Personality Disorders

Com & Psycho
I- INTRODUCTION
A- Definition
- Inflexible mental disorders characterized by maladaptive patterns of cognition,
behavior, and inner experience
- Exhibited across many contexts
- Develop early
B- Characteristics
- Suffering of the consequences of behavior for oneself and others
- Unawareness of having a disorder
- Blaming others for own problems (projection) → Interpersonal relation issues
- Difficulty in flexible and adaptive responding to environmental changes and demands
of life
- Insufficient capacity to react to stress
C- Risk factors
- Separation / loss of loved ones
- Mental disorders in parents (especially in Borderline)
- Abnormal relationship with parents (neglect or hypercontrol)
- Family structure (emotional expression, hypercontrol,…)
- Psychological trauma (physical and/or sexual abuse)
- Lack of sense of belonging, standards, reference values
- Difficulty in developing social roles, social networks, mate choice
- Very strong personality traits associated with temperamental characteristics (genetic)
- Experiences of negative feedback to maladaptive behavior (influences of parenting
style and family atmosphere)
D- Classification

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II- CLUSTER A (ODD DISORDERS)
A- Paranoid
Characterized by a pattern of irrational suspicion and mistrust of others, interpreting
motivations as malevolent
• Characteristics
1. Fear that others will take advantage of them
2. Fear that they will get hurt or be cheated.
3. Concern and doubts about the loyalty or trustworthiness of friends and partners
4. Inability to trust others by fear that the information they share be used against them
5. Distrust in various things that are threatening
6. Assumption that spouse or partner is cheating
7. Permanent anxiety
8. Investigative attitude (i.e., they check everything)
9. Isolation
10. Aggressive reactions
11. Justifying sense
12. Photographic memory
13. Inability to forgive
B- Schizoid
Characterized by a lack of interest and detachment from social relationships, apathy,
and restricted emotional expression
• Characteristics
1. Do not enjoy personal relationships, including being part of a family
2. Choose almost always solitary activities
3. Little or no interest in having sexual experiences with another person
4. Do not have close friends or others than close relatives
5. Indifferent to praise or criticism of others
6. Emotional coldness, detachment
C- Schizotypal
Characterized by a pattern of extreme discomfort interacting socially, and distorted
cognitions and perceptions
• Characteristics
1. Weird beliefs/thinking that influences behavior and is inconsistent with norms (e.g.,
belief in clairvoyance, telepathy, or sixth sense)
2. Bizarre fantasies
3. Unusual perceptual experiences, including bodily illusions
4. Rare thinking and speech (unclear/vague, circumstantial, metaphorical, or stereotyped)
5. Paranoid thoughts/suspiciousness
6. Inappropriate or restricted affectivity
7. Unusual or eccentric behavior or appearance
8. Do not have close friends or others than close relatives
9. Excessive social anxiety (even in family context) that tends to be associated with
paranoid fears rather than negative judgments about self
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III- CLUSTER B (DRAMATIC, EMOTIONAL OR ERRATIC DISORDERS)
A- Antisocial
Characterized by a pervasive pattern of disregard for and violation of the rights of
others, lack of empathy, bloated self-image, manipulative and impulsive behavior
• Characteristics
1. Inability to conform to social norms/lawful behavior
2. Dishonesty indicated by repeated lying
3. Impulsivity or failure to plan ahead
4. Aggression indicated by repeated physical fights
5. Reckless disregard for their safety or that of others
6. Persistent irresponsibility indicated by repeated failure to sustain consistent work
behavior or honor financial obligations
7. Lack of remorse/sorrow
B- Borderline
Characterized by a pervasive pattern of instability in relationships, self-image, identity,
behavior and affects often leading to self-harm and impulsivity
• Characteristics
1. A pattern of unstable and intense interpersonal relationships characterized by
alternating between extremes of idealization and devaluation
2. Identity disturbance: unstable self-image or sense of self
3. Impulsivity in at least two areas that are potentially selfdamaging (e.g., sex, substance
abuse, reckless driving, excessive drinking or eating)
4. Recurrent suicidal attempts or threats, or self-mutilating behavior
5. Affective instability due to a marked reactivity of mood (intense episodic
dissatisfaction or anxiety usually lasting a few hours)
6. Chronic feelings of emptiness
7. Inappropriate, intense anger or difficulty controlling anger (frequent displays of
physical fights)
8. Temporary paranoid ideas related to stress
C- Histronic
Characterized by a pervasive pattern of attention-seeking behavior and excessive
emotions
• Characteristics
1. Uncomfortable in situations where own is not the center of attention
2. Interaction with others is often characterized by a sexually provocative or seductive
behavior
3. Superficial and rapidly changing emotional expression
4. Constantly use of physical appearance to draw attention to self
5. Excessively subjective talking and lacking in detail
6. Self-dramatization
7. Easily influenced by others or by circumstances
8. Consideration of relationships more intimate than they actually are

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D- Narcisstic
Characterized by a pervasive pattern of grandiosity, need for admiration, and a lack of
empathy
• Characteristics
1. Grandiose sense of self-importance (i.e., imagination of exaggerated achievements
and capabilities)
2. Fantasies of unlimited success, power, brilliance, beauty, or imagined love
3. Fantasies of being special and unique
4. Need for admiration
5. Snobbish
6. Lack of empathy
7. Envious of others or believes that others are envious of self
8. Arrogant or haughty/proud behaviors or attitudes
9. Take advantage of others to achieve own goals
IV- CLUSTER C (ANXIOUS OR FEARFUL DISORDERS)

A- Avoidance
Characterized by a pervasive feelings of social inhibition and inadequacy, extreme
sensitivity to negative evaluation
• Characteristics
1. Avoidance of work or activities that involve significant interpersonal contact
because of fear of criticism, disapproval, or rejection
2. Avoidance of contact to others, even intimate relationships because of fear of being
shamed or less worth
3. Fear of being criticized or rejected in social situations
4. Experience of self as being socially inappropriated, personally uninteresting
5. No personal risks or engaging in new activities
B- Dependent
Characterized by a pervasive psychological need to be cared for by other people
• Characteristics
1. Problems with making everyday decisions without others
2. Need for others to assume responsibility for major areas of own lives
3. Problems with expressing disagreement with others because of fear of loss of
support or approval
4. Problems with doing things in a own way (due to lack of confidence in own judgment
or abilities rather than a lack of motivation or energy)
5. Going too far (e.g., perform unpleasant tasks) because of the desire for protection
and support of others
6. Helplessness when alone because of fear of being unable to care of self: need for a
relationship

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C- Obsessive-compulsive
Characterized by rigid conformity to rules, perfectionism, and control to the point of
satisfaction and exclusion of leisurely activities and friendships
• Characteristics
1. It is all about rules, lists, order, organization, or schedule
2. Perfectionism that interferes with task completion (unable to finish a project that
does not meet own strict requirements)
3. Excessive dedication to work and productivity to the exclusion of leisure activities
and friendships
4. Excessive stubbornness and inflexibility in matters of morals, ethics, or values
5. Inability to throw away worn or useless items, even when they have no sentimental
value
6. Inability to delegate tasks or work with others unless they submit to exactly own way
of doing things
SUMMARY: EXAMPLES
1. Paranoid: I am concerned!
2. Narcisstic : You like my new car? It‘s so great, like I am!
3. Dependent: Stay with me
4. Passive-Agressive: Turned the car to fill two spots
5. Borderline: Carcrash to hit the ex lover
6. Antisocial: Blocks other cars
7. Histrionic: Anyone seen my beautiful car?
8. Obsessive: Perfectly alined with the parking space
9. Avoidant: Hides in the corner
10. Schizoid: Can not tolerate other cars closely
11. Schizotypal: Intergalactic place, came with Dark Vader

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Unit 4.3 - Psychotic Disorders

Communication and Psycho
I- INTRODUCTION
- Schizophrenia (ancient Greek “split“, “soul“): Not multiple personalities, but missing
coordination of emotional, cognitive, and volitional processes.
- 1% prevalence.
- Mental disorder characterized by abnormal social behavior and failure to recognize
what is real.
- Symptoms: false beliefs, unclear or confused thinking, hallucinations (acoustical),
reduced social engagement and emotional expression, and inactivity.
• Genetics
- Vulnerability to schizophrenia is likely inherited.
- Heritability is probably 60-(90) %.
- Schizophrenia probably involves dysfunction of many genes.
- Individuals whose fathers were over 45 years of age when born are 2-3 times more
likely to develop schizophrenia.
II- CLINICAL FEATURES

A- Delusions
- Paranoid / persecutory
- External locus of control: A person with an external locus of control is more likely to
believe that his or her fate is determined by chance or outside forces that are beyond their
own personal control. This strategy can be healthy sometimes. Like when dealing with
failure or disaster, but can also be harmful in that it can lead to feeling of helplessness and
loss of personal control.
- Thought withdrawal: thought withdrawal is the delusional belief that thoughts have been
'taken out' of the patient's mind.
- Jealousy, Guilt, Grandiosity.
B- Hallucination
- Experience of sensory events without environmental input:
• Auditory
• Visual
• Olfactory
• Somatic/tactile
• Gustatory
C- Behavior
- Bizarre dress, appearance
- Poor impulse control
- Anger expressions
- Inappropriate behavior

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D- Mood and affect

- Inappropriate affect
- Low affect
- Incongruent affect
- Isolation or dissociation of affect
III- POSITIVE Vs. NEGATIVE SYMPTOMS
A- Positive symptoms
-> Amplify normal experiences and behavior), symptom Cluster
- Delusions: “The Basic Characteristics of Madness” Misrepresentations of reality;
e.g., delusions of being followed.
- Hallucinations: Experience of sensory events without environmental input. Can involve
all senses, but auditory hallucinations are the most common
- Behavioral dyscontrol
- Thought disorder
B- Negative symptoms
(missing of usually existing psychological functions), symptom cluster
contribute to poor quality of life and functional abilities, and are less responsive to
medication.
- Affective flattening: less emotional expression.
- Alogia: a relative absence of speech.
- Avolition (or apathy): inability to initiate and persist in activities.
- Anhedonia: inability to experience pleasure or engage in pleasurable activities.
- Attentional impairment
- Flat affect: less emotion expression.
- Type I – Positive symptoms: good response to medication,

optimistic prognosis, and absence of intellectual impairment.
- Type II – Negative symptoms: poor response to medication,
pessimistic prognosis, and intellectual impairments.
IV- SUBTYPES OF SCHIZOPHRENIA
- Paranoid Type:
• Intact cognitive skills and affect, and do not show disorganized behavior
• Hallucinations and delusions
- Disorganized Type:
• Marked disruptions in speech and behavior, flat or inappropriate affect –
• Hallucinations and delusions
• This type develops early, tends to be chronic
- Catatonic Type:
• Show unusual motor responses and odd attitudes (e.g., echolalia)
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• This subtype tends to be severe and quite rare
- Residual Type:
• Less extreme residual symptoms (e.g., odd beliefs)
Course of Schizophrenia
- Prodrome: Unspecific symptoms (anxieties, sleep disturbances, depression, social

withdrawal)
- Psychotic episode: Positive symptoms are predominant
- Residual phase: Negative symptoms are predominant
- Usually several acute episodes

- Mostly limitations also in between acute episodes
A-
B-
C-
V- SOME FACTS AND STATISTICS

- Onset and prevalence
• 1% population
• Usually develops in early adulthood, but can emerge at any time
- Schizophrenia is chronic
• Most suffer from moderate-to-severe impairment throughout their lives
• Life expectancy in people with schizophrenia is slightly less than average
- Affects males and females about equally
- Strong genetic component
A- Genetic influence
Family Studies:
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- Individuals inherit a tendency for schizophrenia, not a specific form of schizophrenia.
- Schizophrenia in the family increases risk for schizophrenia in other family members.
Twin Studies:
- Risk of schizophrenia in monozygotic twins is 48%, in dizygotic twins is 17%.
B- Neurobiologie influence
- Structural and functional abnormalities in the brain.
- Dopamin hypothesis: hyperactivity of dopaminergic system (associated with positive
symptoms).
- Viral infections during early prenatal development.
C- Psychological and social influence
The Role of Stress

- May activate underlying vulnerability and/or increase risk of relapse.
Family Interactions
- Ineffective communication patterns in the family is associated with relapse.
The Role of Psychological Factors

- Psychological factors likely exert only a minimal effect in producing schizophrenia.
VI- DIAGNOSIS AND MEDIAL TREATMENT
A- Diagnosis
- Assessment by others Very important.
- Self-assessment For subjectively experienced limitations.
- Assessment of triggering and upholding conditions.
- Behavioral analyses for typically problematic situations.
B- Treatment
• Antipsychotic medications
- Medication is often the first line of treatment for schizophrenia.
- Began in the 1950s.
- Most medications reduce or eliminate the positive symptoms of schizophrenia (delusions,
hallucinations, difficult behavior and thoughts).
• Psychosocial treatment
- Community care programs
- Social and living skills training
- Behavioral family therapy
- Occupational rehabilitation

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VII- OTHER PSYCHOTIC DISORDERS
• Schizophreniform Disorder
- Schizophrenic symptoms for less than 6 months
- Associated with good functioning; most resume normal lives
• Schizoaffective Disorder
- Symptoms of schizophrenia and mood disorder (e.g., bipolar disorder)
- Prognosis is similar for people with schizophrenia
- Such persons do not tend to get better on their own
• Delusional Disorder (see later)

- Delusions that are contrary to reality (grandiose, jealous, persecutory, and somatic)
- Further negative symptoms of schizophrenia
- This condition is extremely rare
• Brief Psychotic Disorder

- Experience of one or more positive symptoms of schizophrenia
- Usually results from extreme stress or trauma
- Lasts less than one month
• Schizotypal Personality Disorder

- May reflect a less severe form of schizophrenia
Schizophrenia and Psychosis: An Overview
Schizophrenia vs. Psychosis

- Psychotic behavior – Cluster of disorders characterized by hallucinations and/or loss of
contact with reality
- Schizophrenia – A type of psychosis with disturbed thought, perception, language,
emotion, and behavior
Psychosis symptoms
- Delusions, hallucinations (acoustical), loss of reality, disorganized thinking and behavior,
inner restlessness.
- Symptoms are part of schizophrenia but also part of depression, mania, brain tumor.
Psychotic disorders- Delusional disorders
- Patient cannot tell what is real from what is imagined.

- Patient is confronted with delusions, thought disorder, mood disorder.
Non-bizarre delusions: Fixed false beliefs that involve situations that could potentially
occur in real life (e.g., being followed or poisoned).
- Preoccupation with delusions can be disruptive to their overall lives.
- But behavior does not generally seem odd or bizarre.
• Types of delusion
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- Erotomanic: Patient believes that another person, often someone important or famous,
is in love with him or her; patient might attempt to contact the object of the delusion (e.g.,
stalking behavior).
- Grandiose: Patient has an over-inflated sense of worth, power, knowledge, or identity;
patient thinks he has a great talent or has made an important discovery.
- Jealous: Patient believes that his or her spouse is unfaithful.
- Persecutory: Patient believes that he is being mistreated, or that someone is planning to
harm him.
- Somatic: Patient believes that he or she has a physical defect or medical problem.
- Mixed: Patient have two or more of the types of delusions listed above.
• Treatment
- Difficult to treat because patients often have poor insight and do not recognize that a
psychiatric problem exists.
- Medication and psychotherapy.
- Half of patients treated with antipsychotic medications show at least partial improvement.

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A-
B-
C-

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Unit 5 - Developmental psychology

Communication and psychology
I- FEATURES OF DEVELOPMENTAL PSYCHOLOGY

Developmental psychology is a branch of psychology that studies how people grow and
change over the course of life
A- Objectives: why do scientists study developmental psychology?

1. To describe changes that typically occur across the life span.
2. To explain these changes.
3. To predict developmental changes.
4. To be able to use their knowledge to intervene in the course of events in order to
control them
B- Premise: What is development?

- Common/ Different characteristics
- Multiple causes
- Equal endings
C- Topic of focus
Development = Age-related changes in the structure and behavior occurring in humans
throughout the life:
- Descriptive
- Stages rather than ages
- Certain changes happen at certain ages
• Developmental stages:
- Childhood:
- Infant/ Babies (0-1)
- Early Childhood (1-5)
- School-aged children (5-10 girls, -12 boys)
- Adolescence: (Until 20)
- Adulthood:
- Early (20-30)
- Mid (30-45)
- Late (45-60)
- Old age
• Characteristics of development: (Plus Cet Horrible Rhythme Cumulatif)

- Rhythmic: Regulated, with rhythm.
- Cumulative: Successive addition, accumulation
- Holistic: Relating to a whole instead of a separation into parts.
- Plasticity: Offers the ability to adapt to different situation
- Context: Different way of behaving depending on each person

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D- Factors in development: What leads to development?
• Maturation:
- Automatic unfolding of biological potential
- Endogenous
• Learning:
- Permanent modification in behavior that results from the individual’s experience in the
environment.
- Exogenous
→ Our DNA can be modified, everything is not static (e.g. influence by drugs)
« It is the interaction between heredity and environment that gives an individual her or
his unique characteristics. »
→ Study about twins separated: they grow up different even though they have the same
DNA because environmental factor is really important.
E- Domains of development
- Physical: organ structures and functions; musculo-skeletal, and neurological features;
motor skills.
- Cognitive: mental activity. (PIAGET)
- Socio-emotional: personality, emotions and relationships.
II- DEVELOPMENTAL STAGES

A- Childhood
• INFANT/ BABIES (0-1)
- Sleeping age (0-2 months): 9/10 of the day, baby is sleeping → Some consider that,
because of that, pregnancy is not 9 months, but 10 or 11
- Discover-the-world age
1. Physical and motor skills development
- Reflexes: involuntary movements or actions
- Survival: breathing/ feeding.
- Normal brain activity.
1. Grasp reflex
2. Moro reflex (fear of falling)
3. Step reflex
→ Apgar score: since 1953, just
after birth (Reste Reflechir Pour Skier Musclé)
2. Cognitive development: Sensory-motor stage (L’Intelligence Optimale en Depend)

- Object permanence: knowing that an object still exists, even if it is hidden
- Depth perception: visual ability to perceive the world in three dimensions
- Language development: pre-linguistic phase (laughing, crying, verbal play, babbling,
syllable variation)
- Identifying the facial emotions: due to the fact that we all experience those emotions

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3. Socio-Emotional development:
- Positive emotions: Reflexive smile → Social Smile in an 8-Month-Old Infant
- Negative emotions: Anger or sadness and Fear (Stranger wariness & Separation
anxiety → Due to the fear of being separated with our mother, person who protects us)
- Identifying emotions in others: Discrimination of facial expressions (5 months) and
Matching emotions (4-7 months)
• Attachement:
- A deep and enduring emotional bond that connects one person to another across time
and space (Ainsworth, 1973; Bowlby, 1969).
- Infants show their attachment through proximity-seeking behaviors
- Evidence of attachment: actions such as approaching, following, and climbing into the
lap.
→ We might think that a baby that have a shelter and is well fed has everything, but it
really needs love in order to survive: the attachment has to be built in a positive way
Types of attachment:
- Secure:
- It is a relationship of trust and confidence.
- Provides a secure base for exploration of the environment.
- It is likely to develop when parents respond to their infant’s needs reliably and
sensitively
- Insecure:
- Avoidant attachment: A pattern of insecure attachment in which infants seem somewhat
indifferent toward their caregivers and may even avoid them. If they do get upset
when left alone, they are as easily comforted by a stranger as by a parent.
- Ambivalent attachment: A pattern of insecure attachment in which infants are clingy and
stay close to their caregivers rather than exploring their environment. The baby is
upset when the mother leaves and remains upset or even angry when she returns,
and is difficult to console.
- Disorganized attachment: This type of attachment occurs when the child’s’ need for
emotional closeness remains unseen or ignored. Leads to difficulties in the
regulation of emotions and social communication.
• EARLY CHILDHOOD (1-5)

1. Physical and motor skills development
- Improvement of gross and fine motor skills
2. Cognitive development: Preoperational Stage (2-6)
Symbolic Function:
Language acquisition: 1-21⁄2 years Children can create mental images of
- 1yr: Holophrasic objects and store them in their minds for
- 1⁄2yrs: two-words stage later use
- 3yr: to infinity… - Imitation
- 4yr: adult-like - Drawing
- Symbolic play (box becomes a house)
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Self-recognition (around 18 months)
• SCHOOL-AGED CHILDREN (5-10 girls 12 boys). → Late adolescence on boys

1. Physical development:
Variations in growth patterns.
2. Cognitive development: Concrete-

operational stage:
- Use logical thought or operations but can
only apply logic to physical objects.
- They can classify objects.
Self-concept: Definitions of themselves and
comparison with an ideal self.
• THE ROLE OF FAMILY

• Why?
- First group
- Learn to live together
- Social and personal support system
• How does family influence child development?

→ Family is an orchestra, each member has an instrument and the purpose is to play all
together to produce a nice music.
1. Family is the primary laboratory of values: Education, role models (Today,

responsibilities are changing targets: Parents should be positive role models because
children observe and reproduce what their parents do → are they missing?)
2. Children learn skills for establishing relationships: Roles, Rules/ Limits (Guidelines for
behaviour, self discipline, Responsibility, Enthusiasm, Frustration tolerance)
3. The members shape the child’s personality: Self-concept, Self-esteem, Confidence
• Different education approaches:

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B- Adolescence
- Transitional stage between childhood and adulthood that ends when the person has
gained responsibilities and tasks corresponding to adulthood.
→ Puberty = Responsibility
• Stages (adolescence always appears but not at the same time for everyone)
- Early adolescence (11-14)
- Mid adolescence (15-17)
- Late adolescence (18-21)
• What is it?
- Physical phenomenon
- Period in which you grow fast
- Reproductive functions achieve maturity
- Variable start: nutrition, metabolism, environment
1. Physical development
• Puberty: (physical)
- Physical growth: gain height and weight
- Hormonal changes: primary sex characteristics (testicles/ penis or ovaries/ vagina)
and secondary changes (hair, voice, skin → Differentiating boys and girls)
• How do they react to changes:

- Psychosocial context
- Patterns of thinking and feelings about sexuality
- Parent reaction
- Girls: knowledge and support → trauma
- Boys: curiosity, anguish and a certain joy
- Social conventions of society: what we are supposed to look like
→ Social context:
- BODY IMAGE: differences in the notion of « beauty » through years
- GENDER: Girls Vs Boys → Discovering the « other sex »
2. Cognitive development
Formal operations: (Piaget): hypothetical deductive reasoning.
- To reason about complex tasks and develop abstract thinking
- It is not only about the real but about the possible: future, abstract concepts.
- Check hypotheses and draw conclusions.
- Debates, theories
Adolescence egocentrism: imaginary audience (feeling like everybody is looking at you),

personal fable (no one can understand you, you’re the only one experiencing this),
invincibility fable (nothing is going to happened, my behavior is not risky)
Adolescence vulnerability → risk behaviors can be avoided with protective factors (family
protection, structured home, ability to talk to relatives)
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• Young alcohol consumption:
- Intermittent
- Alcoholic beverages with a high graduation
- Concentrated in a few hours; drunkenness
- Weekend nights
- Too much alcohol in youth: frequent drunkenness (repeated experience of amnesia),
mixing alcohol with other drugs.
→ Consequences:
- Poor school performance
- Higher risk behavior (accident, antisocial behavior, suicide attempts, unwanted sex)
- Develop an alcohol dependence syndrome at an early age
- Neuropsychological impairments: prefrontal cortex and hippocampus (planning, decision
making…)
3. Socio-emotional development
Disorientation: looking for themselves
Self-awareness and self-concept: Who am I? What are my goals? Where am I going?
• Marcia: crisis and commitment

Crisis: period of conscious decision making
Commitment: personal investment in an occupation or belief system (ideology)
- Identity dissemination: no crisis, no commitment

They have not come to ask: who am I? Nor do they have the answer to that question
- Hypothecated identity: no crisis with commitment
Adolescents who are committed to the values and beliefs of their parents, but who have
not experienced the crisis that causes them to really question and value them if they want
to follow those values or not.
- Moratoria: with crisis, no commitment
They are teenagers who experiment with different identities without staying with none.
There is a pause in the formation of the identity
- Achievement of identity with crisis and commitment
The adolescent has ideally set his own goals and values, abandoning some that parents
and society had established and adopting others. It's the goal.
• Body image and identity:

- Drastic revision
- Physical appearance: main focus of self-esteem
- The acceptance or rejection depends on self evaluation considering the social prototype
and the response of others.
- Eating disorders:
- Anorexia nervosa: Inability to maintain normal body weight, intense fear of gaining
weight, distorted body image. (Types: Restricting, Purging)
- Bulimia nervosa: Recurrent episodes of binge eating, recurrent inappropriate
compensatory behavior to prevent weight gain (Types: Purging, Non-purging)

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• How do they feel?
- Hyper-emotion
- Ambivalence
- Emotionally labile
• Socialization
- Relationship with friends: peer group (causing problems with parents who since 9 were
the main thing in a child’s life, before friends come) → Functions: support, mirror,
sounding board
- Relationship with parents: Conflicts related to autonomy and self-control, but guidance
about academics, career planning, and significant personal decisions.
4. Summing up:
- Starts with the biological changes to maturity and ends when the person takes on
the roles of the adulthood.
- Objectives: Autonomy, Identity, Life project.
C- Adulthood
• Physical aspects:
• Psychological aspects:
• Social aspects:
• Spiritual aspects:

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D- Old age
• Physical aspects:
• Psychological aspects:
The loss of the

spouse implies
• Social aspects: the adoption of
a new social
role.
PHASES:
• Spiritual aspects: Preparation,
Mourning and
grief,
Adaptation
Mini mental: exploring the mental capacity (spatiotemporal situation, short memory)

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Unit 6.1 - Communication

Communication & Psychology
I- INTRODUCTION
A- What is communication
- Communication is necessary to interact with others, exchange
information, relationships,…
- Communication is a dynamic process implying HOW you say
and WHAT you say
- Language employs symbols - words, gestures, or spoken
sounds - to represent objects and ideas
B- Strengths and weakness 

• Verbal Communication: • Written Communication:
- Strength: Role of body language/non- - Strength: A proof of a communication,
verbal communication; reaction of structure of ideas is possible, …
perceiver is available, … - Weakness: Written words are less
- Weakness: Often not obligatory… emotional, misunderstandings, … 
• What makes a good com.: Effective presenter and Active listener/ quick thinker
II- COMMUNICATION PROCESS: from source to receiver
Source: Encoding:
- Why to communicate? - Process of transferring the information into a form
- What to communicate? that can be correctly decoded at the other end
- Usefulness of the - Ability to convey the information
communication - Elimination of confusing sources (e.g. cultural
- Accuracy of the information issues, mistaken assumptions, and missing
to be communicated information)
Verbal Communication Effective decoding: The influence for receiver:

Channels: Face-To-Face - Listen actively - Prior knowledge can influence
meetings, telephones, skype, - Reading information the receiver’s understanding of
… carefully the message
Written Communication - Avoid confusion - Blockages in the receiver’s
Channels: Letters, e-Mails, - Ask question for mind
memos, reports, whats app... better understanding
- Surrounding disturbances

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A- The 4-ears model of Schulz von Thun (a communications
psychologist)
Describes the complexity of com.: what is said is not necessarily what is heard. A message
is always sent on four channels and can therefore be received on four different levels:
- Factual level: a purely objective statement is made and facts are conveyed.
- Level of self-revelation (self-disclosure): Whether consciously or unconsciously, the
sender’s statement conveys something about himself - a wish, request, invitation.
- Relational level: the message conveys what kind of relationship the speaker and the
recipient have with one another. Depending on the relationship between the two
parties, the recipient may sense esteem or disdain from the sender’s message; this is
further emphasized by gestures, facial expressions and tone.
- Appeal level: the message serves to motivate the recipient to do something, thereby
exercising influence over him. This means that the receiver senses what is expected
of him with the statement.
e.g. « There is something green in the soup » 

• 4 mouths: • 4 ears:
- Fact: There is something green - Fact: There is something green.
- Self-disclosure: You don’t know what the
- Self-disclosure: I don't know what it is. item is, and that makes you feel
uncomfortable.
- Relationship: You should know what it is. - Relationship: You think my cooking is
questionable.
- Appeal: Tell me what it is! - Appeal: Do it yourself! 
• Main reasons for misunderstandings:
- Sender mainly emphasize the appeal of the statement and the receiver can mainly
receive the relationship part of the message.
- Only verbal communication can create chaos while it reaches the last person
- Everyone’s thought process influences individual understanding → Active listener…
B- Active listening
1. Understand your own communication style
- High level of self-awareness and understanding of how others perceive you
- Avoid being a chameleon by changing with every personality you meet
- Make others comfortable by selecting appropriate behavior that suits your personality
while listening
2. Be an active listener
- People speak 100 to 175 words per minute but can listen up to 360 words per minute
- One part of human mind pays attention, so it is easy to go into mind drift
- Listen with a purpose (e.g., gain information, obtain directions, understand others,
solve problems, share interest, see how another person feels, show support, …)
- If it is difficult to concentrate then repeat the speakers words in your mind
• Improving your listening skills:
- By not being preoccupied but being open minded & non defensive
- Minimizing interruptions but asking questions
- Effective listening is: Hearing, interpreting when necessary, understanding the
message and relating to it
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3. Use non-verbal communication
Gestures - Eye contact - Posture
4. Give feedback
- Be careful and remember the 4 ears… maybe you did not get it right?
- Repeat back or summarize to ensure that you understand
- Restate what you think you heard and ask, "Have I understood you correctly? »
III- NON VERBAL COMMUNICATION: Types of body language (with PEOPLE)
- (P)OSTURES & GESTURES: How do you use hand gestures?
- If you fail to gesture while speaking, you may be perceived as boring
- A lively and animated teaching style captures students' attention, makes the
material more interesting, facilitates learning and provides a bit of entertainment
- Head nods, a form of gestures, communicate positive reinforcement and
indicate that you are listening hocher la tete montre que tu suis ( ou pas )
- (E)YE CONTACT: Different ways:
- Direct eye contact: Shows confidence
- Looking downwards: Listening carefully or guilty
- Single raised eyebrow: Doubting
- Both raised eyebrows: Admiring
- (O)RIENTATION: How do you position yourself?
- Communication with the way you walk, talk, stand and sit
- Standing erect and leaning slightly forward: approachable and friendly
- Speaking with your back turned or looking at the floor or ceiling: disinterest
- (P)RESENTATION: How do you deliver your message?
Proximity, paralinguistic (tone, rhythm, loudness…), humor
- (L)OOKS: Appearance, dress...
- (E)XPRESSIONS OF EMOTION: Are you using facial expressions to express emotion
- Smile covers the most part of facial expression
- Powerful cue that transmits: Happiness, Friendliness, Warmth, Liking, Affiliation
→ What affects communication:
- 7% Words: They are only labels, listeners put their own interpretation on them
- 38% Paralinguistic: The way in which something is said - the accent, tone and voice
modulation is important to the listener
- 55% Body language: What one looks like delivering message affects the understanding
→ Signals of discomfort: Rocking, Leg swinging, Tapping, Gaze aversion
IV- BASIS OF A FUNCTIONAL COMMUNICATION

A- Axioms: Paul Warzlawick
Five basic axioms that are necessary to have a functioning com. between individuals: If
one of these axioms is somehow disturbed, communication might fail
• Axiom 1: « One Cannot Not Communicate »
- Every behavior is a kind of communication: because behavior does not have a
counterpart (there is no anti-behavior), it is not possible to NOT communicate
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• Axiom 2: Every interaction has a content and relationship aspect
- All interactions have more information to be derived from context (mouths, ears…)
• Axiom 3: The nature of a relationship is dependent on the punctuation/
interpretation of the partners communication procedures
- Sender and receiver structure communication flow differently → own behavior is
interpreted as a reaction on the other's behavior
- Causality question: «Is she angry because of his guilt, or does he feel guilty because of her anger?»
• Axiom 4: Human communication involves both analog and digital modalities
- Use of non-verbal and digital (e.g., words) content of com. within a relationship
• Axiom 5: Communication procedures are either symmetric or complementary
- One-up: 1 communicator attempts to gain control of an exchange by dominating the
overall communication
- One-down: 1 attempts to yield/give control of an interaction or submit to someone
- One-across: 1 neutralizes a situation
When two communicators use the same style it is symmetrical (equal power), if they are
opposing one another it is complementary (differences in power)
B- Information exchange strategies

• SBAR, Communication of the following information:
- Situation: What is going on with the patient?
- Background: What is the clinical background or context?
- Assessment: What do I think the problem is?
- Recommendation: What would I recommend?
• Call-Out :
A strategy used to communicate important or critical information
- Informs all team members simultaneously, it helps them anticipate next steps
• Check-Back :
• Handoff :
- Transfer of information (in team), Optimize information
- Include an opportunity to ask questions, clarify, and confirm
- Responsibility/ Accountability
- Uncertainty, Verbal structure, Checklists, Acknowledgment
C- Client centered therapist’s method
- Frequent eye contact with the client and nodding in agreement or understanding
- Reflection, that is, paraphrasing and summarizing what a client has just said →
demonstration of empathy + possibility to check the accuracy of own perceptions
- Communicate all relevant information in a clear, brief way
V- CONCLUSION
- Be aware of the 4 ears
- Use verbal and non-verbal communication skills
- Communicate with all team members in a brief, clear, and timely format
- Seek information from all available sources, verify and share it
- Practice communication tools and strategies daily (SBAR, call-out, check-back, handoff)
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Unit 6.2 - Communication styles

- Communication style is a set of various behaviors and methods of relaying information

- The goal should always be to understand – not to be right
I- PASSIVE COMMUNICATION
- Allowing our own rights to be violated by failing to express our honest feelings
- The goal of a passive communicator is to avoid conflict
- Little risk involved - very safe.
- Little eye contact, often defers to others’ opinions, quiet
tone, may suddenly explode after being passive too long
• When Passivity is Appropriate

- When results of pushing the issue would cause problems that outweigh the benefits
- When issues are minor
- When the other individual’s position is impossible to change (e.g., the law)
II- AGGRESSIVE COMMUNICATION
- Protecting one’s own rights at the expense of others’ rights - no exceptions.
- The goal of the aggressor is to win at all costs; to be right
- Risky in terms of relationships
- Aggressive eye contact; violence or verbal abuse; lots of
energy; loud; never defers to others, or at least does not admit to
- Manipulative and controlling
• Passive-Aggressive Communication
- Give up your own rights initially, followed by manipulation and revenge later
- The goal of this style is to avoid conflict and then make the other party wish they had
seen it your way
- Avoids risk initially, risks relationships later, then acts surprised when people are mad
- Behaves passively to people’s face, then aggressively
when they are not around
- Often uses sarcasm
• When Aggression is Appropriate
- In an emergency or when there is no time to spend on a compromise
- When your opinion is based on several facts, you therefore KNOW you are right, and
there is not time to utilize assertiveness skills
III- ASSERTIVE COMMUNICATION

- Protecting your own rights without violating the rights of others
- The goal is to communicate with respect and to
understand each other; to find a solution to the
problem
- Takes a risk with others in the short run, but in the long
run relationships are much stronger

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- Eye contact maintained; listens and validates others; confident
and strong; flexible; objective and unemotional; presents wishes
clearly and respectfully
• Assertiveness skills:
Persistence
- Stay focused on the issue - do not get distracted, defensive, or start justifying yourself
- Repeat the “bottom line” to keep the conversation on track and your issues on the
table (e.g., “I understand that, however. . .”)
Objectivity
- Focus on the problem, not on the emotions that often accompany and cloud problems
- Postpone discussion if emotions cannot be contained
- Use the validation skill (next) to handle others’ emotions to focus on objective issues
Validation
- Allow people to have their experience, but try to move beyond it to a discussion about
the problem
- People’s perspectives are not the heart of issue, so validate them and get to the issue
“I can see that this upsets you, and from your perspective, I can see why. Now, what can
we do to make this better for both of us?”
Challenging False Information
- When attacked with false and negative statements, look for the gain of truth and
validate it
- Disagree, using factual information e.g., “Actually, I was at work, so that could not
have been me.”
→ Opens the door for discussion about the real problem
Pumping the Negatives
- When criticized, ask for more negative feedback e.g., “Tell me more about what is
bothering you about my report.”
- Stay task oriented, not too emotionally
Humor
- Breaks down negative emotions
- Be careful to use humor appropriately and professionally
IV- WHICH IS THE BEST STYLE?
All styles have their proper place and use but assertive communication is the healthiest
- Boundaries of all parties are respected
- Easier to problem-solve; fewer emotional outbursts
- It requires skills and a philosophy change, as well as lots of practice and hard work
- When both parties do it, no one is hurt in any way and all parties win on some level
- Every time we decide to communicate with another person, we select a style of
communication. Notice yours, and notice theirs
- Being assertive is protecting your rights without violating other
- Assertiveness allows you to face confrontation in a healthy way and without getting
overly emotional
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Unit 7 - Pain and Placebo

I- PAIN
• Definition: “Pain is an unpleasant sensory and emotional experience associated with
actual or potential tissue injury or described in terms of it »
- Pain is a subjective symptom is not a physical sign and it is the product of a: disease,
Organic injury or Expression of a patient's conflicting situation
- It is probable that there are no typical pain receptors, but there are PRESSURE,
COLD and HEAT receptors that have a double function. If these receptors are overly
stimulated, the brain reacts.
- There is an irregular distribution of receptors: Under the knee 232, Neck 228, Bend
of elbox 224, Buttocks 180, Forehead 184, Nose point 44, Foot plant 48, thumb bud 60
A- Pain components and pain functioning

- Transmitter fiber are the « Roads of pain »:
- TYPE A: Myelinated. Fibers and neurons protected in order to not to lose the
message. Very fast transmission (20m / s) → FULL, INCISIVE, BURNING
- TYPE C: NOT myelinated. Slower transmission (1m / s) → SORROW pain
- Substance P: Neurotransmitter found in the spinal cord. (Opioids)
You get a finger poked → Type A → Spinal cord → Substance P → an electrochemically
charged message is generated with « pain" → goes through 3 zones of the brain → brain
says: « feel pain » → The response is generated
B- Dimensions and Characteristics of pain

1. Dimensions
- Sensory: Nature of the stimulus that causes it. If this part does not work, "I know it
hurts, but I do not feel it."
- Cognitive: Knowledge that something hurts me. If the part of the brain in charge of this
does not work, I do not know it hurts.
- Emotional: Feelings that generate pain
- Motivational: Eliminate pain
2. Characteristics
- Pain can be a defense mechanism
- The pain is always real (Pain of psychological origin is called psychogenic pain)
- There is no quantitative correlation, the experience is different for each person
- In pain, physical and psychological factors converge
- Threshold defined by the constitution (nociceptors, SN ...) + psychological factors.!VAS
• Visual Analog Scale (VAS)
- Scale 1-10 which measures the intensity of the symptom.
- It is reliable and valid and used to see the evolution of pain
- Pain scores> 3

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3. Psychological aspects of pain
- The previous experience: If you are accustomed to much pain, before a new stimulus
→ a lot of pain
- Expectations or relief: If there is pain, but I know that I will be relieved, I will experience
it less (War wounded)
- Care centered in pain: If you are aware of the pain, it hurts more (children)
- Anticipatory anxiety: We suffer anticipating everything that is going to happen in an
event, we imagine all the details ... (vaccines)
C- Types of pain
Sharp pain
- Disappears with healing or when the stimulus disappears
- Its objective is the protection of the organism that suffers it
- Generates anxiety and the vicious circle anxiety-pain-anxiety
Chronic pain
- Persistent or intermittent pain lasting more than six months.
- Apparently it has no definite function
- Generates impotence (= impuissance) feelings
- It causes changes in lifestyle (reduction of activity level, change in sleep patterns, ..)
and alterations in the family environment (more attention and care)
- During persistent pain sometimes depressive symptoms or feelings of frustration
appear
- Difficulty to describe the pain. Confusing and ambiguous information.
- Communication and interpersonal relationships affected. Communicative content
related to pain predominates.
- Reduction of physical activity and functional activity.
- Abuse and possible dependence of analgesics and / or psychotropic drugs.  
D- Therapeutic attitude
- Understanding the patient is suffering
- Attitude interested and centered on the illness; listen to complaints
- Have good emotional control (do not be irritated by unfavorable developments)
- Adequately explain the symptoms you are suffering
- Avoid expressions such as “you have nothing, it's a matter of nerves …"
- Offer treatments aimed at relieving pain
- Establish reasonable treatment goals
- Also explore the social sphere
- Focus on functionality rather than pain (open-ended questions)

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II- THE PLACEBO EFFECT
- Paracelsus, 15th century: Medicine kills, nature heals
- Voltaire, 17th century: The art of medicine is to amuse the patient while nature cures
the illness
→ Until the early 20th century, most treatments were placebo
A- What is the placebo effect

It is an improvement in symptoms as a result of medical treatment with an inactive
substance (e.g., surgery, injection, pill)
- patient recovers without genuine medical intervention
- attributed to belief in the effectiveness of treatment
- belief mediates healing of symptoms (also measurable)
Examples of placebo: Inactive pills, drugs, or injections - Sham surgeries/ Pseudo
surgeries - Inactive medical devices - Non-effective acupuncture
B- Factors influencing efficacy

- Big branded pills in high quantity work better than smaller ones in low quantity
- The color of pills also matters (red vs. blue/green)
- Type of procedures: Surgery is better than injection; injection is better than pill
- Previous experience → How was it last time?
- Presentation → How doctor presents it / advertising / how much confidence does he
show on the product, etc.
- Patient: High need to be liked, low self-esteem, high extern locus of control
- The biggest factor is what the person believes about it!
- Context: What does the consultation and placebo look like.
C- What’s going on in the brain
Brain mechanisms are responsible for the placebo effect:
- Anticipation of symptom relief → Stimulation of brain areas
- The body’s own pain relief center releases chemicals to ease pain
- Body has inborn healing capacity, invoked through the power of belief
(Psychoneuroimmunology: Connections between mind, brain, and
immune system)
• Kiecolt Glaser (1999): Immune Function

Stressed students have a suppressed immune response → Relaxation
enhances NK (natural killer cells) activity
• Kiecolt-Glaser (1995): Stress on wound healing
Stress influences wound healing → Differences in peripheral blood
leukocytes
D- Do doctors prescribe placebo?

45% of doctors have prescribed placebos in regular
practice and 96% believe placebos can have
“therapeutic effects”

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E- Is placebo ethical?
Placebo research can be ethically justified if:
- There is a valuable, clinically relevant question to be answered by the research
- The placebo control is methodologically necessary to test the study hypothesis
- The risk of the placebo control itself has been minimized (debatable in more invasive
controls)
- The risk of a placebo control does not exceed a threshold of acceptable research risk
(Concern: withholding treatment)
- The risk of the placebo control is justified by valuable knowledge to be gained
- Disclosure (patients must be fully informed about the risks of entering a trial; if they still
agree to participate, then there is no reason to prevent them from doing so)
What when placebo harms? Nocebo: Active placebos that have a higher chance for
harm e.g., give a patient a liquid and tell them it will often induce vomiting
III- CONCLUSION
- Placebo control groups in clinical trials can be appropriate and ethically acceptable
- Using a placebo-control in clinical trials may be necessary to distinguish true effects of
an intervention
- The debate regarding surgical placebos (sham surgery) continues
- Placebos are much more than pills: They have the potential to bring about real
physiological changes
- Placebos are tied to meaning: Surgery is very powerful; presentation, beliefs, etc.
influence the power of individual placebos
- The “Meaning Response” has real clinical application: The way doctors present
things changes them; Prescribing fake drugs may actually work
• GUIDELINES TO PROMOTE TREATMENT ADHESION:

- Establish therapeutic objectives
- Negotiate changes with the patient
- Train the patient for the abilities he has to have in order to achieve objectives
- Anticipate benefits and sort out inconvenient
- Reinforce achievement and adhesion
- Assure continuity and accessibility
- Cordial treatment
- Anticipate lack of adhesion
- Know and incorporate as part of the treatment the patients goals
- Describe illness. Give information and correct errors or wrong expectations.
- Simplify treatment. Adapt it to demands and patients interest (minimum dose)

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Unit 8.1 - Mood disorders

Communication & Psycho
I- INTRODUCTION
- Mood disorders: problem behaviors that begin during
childhood and include: Anxiety, Depression, Somatic
complaints and Withdrawal behavior → Disturbance in
mood is a central feature
- Mood: Emotional state, that differs from emotions: less
specific, less intense but longer lasting (hours/ years), less
likely to be triggered by a particular stimulus, and have either
a positive or negative valence
- Children with mood disorder experience extreme, persistent, or poorly regulated
emotional states: e.g. Excessive unhappiness or swings in mood state from deep
sadness to high elation
- There are two major types of mood disorder according to DSM:
- Depressive disorders: Major Depressive Disorder (MDD)/ Dysthymic Disorder
(Dysthymia)
- Bipolar disorder: (or manic-depressive illness)
- Symptoms are: Emotional, Cognitive, Motivational-behavioral and Vegetative (nervous
system, involuntary → Physiological aspect)
II- DEPRESSIVE DISORDERS

There are 2 types of depressive mood disorders:
1) Major depressive disorder (MDD)
- Minimum week duration
- Depressed mood, loss of interest, other symptoms (e.g., sleep disturbances, negative
self-esteem, hopelessness), impaired functioning.
2) Dysthymic disorder
- Depressed mood, generally less strong but longer lasting (1 year or more), impaired
functioning.
A- Depression and development

• NO existence of depression in childhood:
- Psychoanalytic theories saw depression as anger turned inward, a result of superego
involvement (superego= presents internalized ideals, conscience & aspirations).
- As superego is not fully developed in childhood → Depression in childhood is not
possible.
• But there were children with depression → more or less acknowledged:

- Depression is not expressed in same way in childhood as adulthood:
- Indirect or hidden depression in childhood.
- “Masked depression” incorporates many possible symptoms (e.g., hyperactivity,
learning problems, aggression, bed-wetting, separation anxiety, sleep problems,
running away).
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• Manifestation of depression varies with age:
- Infants: may be passive, withdrawn, unresponsive to social contact, and lethargic.
- Preschoolers: may be introverted or inhibited.
- School-aged children: may be argumentative and aggressive, and may complain
about feeling sick.
- Adolescent: may express feelings of guilt and hopelessness, be moody or feel
misunderstood.
→ Depression not clearly recognizable using DSM within young children.
- 1940: Rene Spitz institutionalized depression in children attributed to lack of
attachment and seriously disturbed homes.
B- Major depressive disorder (MDD)

1. Generalities
- Mood represents a change from the person’s baseline.
- Impaired function: social, occupational, educational.
- Specific symptoms (at least 5 of these 9) present nearly every day:
- Depressed mood or irritable most of the day, nearly every day, as indicated by
either subjective report (e.g., individual feels sad or empty) or observation made by
others (e.g., appears tearful).
- Decreased interest or pleasure in most activities, most of each day.
- Significant weight change (5%) or change in appetite.
- Change in sleep: Insomnia or hypersomnia.
- Change in activity: Psychomotor agitation or retardation.
- Fatigue or loss of energy.
- Guilt/ worthlessness: Feelings of worthlessness or excessive/ inappropriate guilt.
- Concentration: Diminished ability to think or concentrate.
- Suicidality: Thoughts of death or suicide, or has suicide plan.
• Associated Characteristics
- Normal intelligence, although some symptoms (difficulty concentrating, loss of interest,
and slowness of thought) negatively affect intellectual functioning...
- Experience deficits and distortions in their thinking (negative beliefs, attributions of
failure, and self- critical automatic negative thoughts).
- Low or unstable self-esteem.
- Few friends or close relationships, feel lonely/ isolated, feel that others do not like them.
- Poor relations and high conflict with parents and siblings, who in turn may respond in
negative, dismissive, or harsh manner.
- Most report suicidal thinking and about 30% attempt suicide.
• Onset, course and outcome
- Most common onset (beginning meeting DSM criteria) between 13 and 15 years
- Average episode lasts about 8 months (longer if parent has MDD).
- Recurrence (70% of adolescents experience MDD within 5 years)
- Time between episodes gets progressively shorter.
- Even between episodes, many youths experience milder symptoms of depression
- 1/3 of teenagers diagnosed with MDD will develop a bipolar disorder within 5 years of
onset of depression (“bipolar switch”).
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In adulthood MDD is associated with high rates of:
- depression and other psychiatric disorders
- suicide and suicide attempts/ psychiatric and medical hospitalizations
- alcohol abuse/dependence, psychosocial impairments
- lower educational achievement and employment problems
2. Epidemiology
• Prevalence: One of the most common psychological diseases.
- 2-8% of children age 4-18 and 1-2% of preschool and school-age children.
- Overall prevalence: 3.5%.
- More than 20% over the course of the life time.
- Depression comes and goes across time.
• Comorbidity
90% of children/adolescents with MDD have co-occurring/ comorbid disorders and 50%
have 2 or more comorbid disorders. These include:
- Anxiety disorders (specific phobias, separation anxiety disorders).
- Dysthymia, behavior problems, ADHD.
- Personality disorder (with instability of interpersonal relationships, self-image, and
emotion, and marked impulsivity).
The presence of co-occurring disorder increases the risk for recurrent depression, the
duration and intensity of depressive episodes, the risk for suicide attempts but it
decreasesresponsivity to treatment
• MDD and gender: Females

- Twice as likely as males to develop MDD
- More likely to develop milder mood disorder and experience recurrent episodes
→ Females have greater orientation than males towards cooperation and sociality.  
→ Females have more thoughtful coping styles to deal with stress - especially stress
involving interpersonal loss and disruptions.
• Genetic and family risk

- Best predictor of childhood depression is high family loading → children with parent
that suffer from depression are 14 times more likely than controls to develop
depression before age 13.
- Higher when both parents have depression
- 50% to 70% of mothers of children with depression have also experienced
depression.
- Multiple regions of several chromosomes related to early onset depression have
been identified.
3. Theories of Depression
• Psychoanalytic
- Depression is result of loss of a love object.
- Loss can be actual, as in death of parent, or symbolic, as in inadequate parenting.
- Depression is the transformation of aggressive instinct into depressive affect
- Individual’s anger at love object is turned against self; issues pertaining to superego.

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• Attachment
- Depression is the result of parental separation and disturbances of attachment.
• Behavioral
- Emphasize importance of learning, environmental
consequences, skills, and deficits.
- Depression related to lack of response contingent
positive reinforcement.
- Children may also receive sympathy for their
depression.
• Cognitive
- Focus on relation between negative thinking and
mood.
- “Depressogenic cognitions”: negative perceptual and
attributional styles associated with depressive
symptoms.
- “Negative attributional style”: internal, stable, global
→ leads to “learned helplessness” and
“hopelessness”.
4. Treatment
There exist many forms of effective intervention BUT less than 1⁄2 of children with
depression receive professional help.
• Pharmacological interventions
- Tricyclic antidepressants: named after their chemical
structure (which contains three rings of atoms), they are
not as effective with adolescents as with adults.
- Selective serotonin reuptake inhibitors (SSRIs): named
after mode of action, it increases serotonin levels in the
brain. It is the pharmacological treatment of choice (But
concerns raised about effectiveness, overuse, side effects).
Serotonin:
- Hormone and neurotransmitter Serotonin plays role in many brain processes, e.g.,
regulation of mood, assessment of resource availability, learning and cognition,
dominance and submission, pain, body temperature, sleep, appetite, digestion
- Problems with the serotonin pathway can cause obsessive-compulsive disorder,
anxiety disorders, and depression.
- Most antidepressants increase serotonin levels in the brain (i.e., SSRIs).
- Serotonin is affected by many drugs (e.g., cocaine, amphetamines, LSD, alcohol)
• Psychosocial interventions
Cognitive behavioral therapy (CBT) and Interpersonal Therapy for Adolescent
Depression (IPT-A, focusing on improving communication skills in significant
relationships) are treatments of choice for adolescents → more effective than other
forms of therapy (e.g., family therapy, nondirective supportive therapy).

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Behavior therapy
- Based on idea that depression results from a lack of reinforcement due to: restricted
range of reinforcers, few available reinforcers or inadequate skills for obtaining
rewards
- Treatment focuses on increasing: pleasurable activities and events
- Provides individual with skills needed to obtain more reinforcement, including training
in social skills, assertiveness, social problem solving or conflict resolution
- Implement strategies such as: Daily monitoring or Structuring and scheduling activities
- Help individuals to: become more active, engage in reinforcing activities and solve
problems
Cognitive therapy
- Focus on negative thought processes (misattributions, negative self-monitoring, short-
term focus, excessively high performance standards, failure to self reinforce).
- What they need to learn: Identify, Challenge and Modify (replace negative thoughts
with positive ones)
→ In practice, both therapies are integrated into a single approach in which one wants to
change that negative cognitions influence negative behaviors and vice versa.
• Treatment Summary
- CBT and Interpersonal psychotherapy appear most successful
- SSRIs have been recommended as first-line of pharmac. treatment (but side effects!)
- Greater priority should be given to prevention.
C- Dysthymic disorder
1. Generalities
- Depressed mood that occurs on most days and that persist for a least 1 year.
- Symptoms: unhappiness, irritability + at least 2 additional among those:
- somatic symptoms – e.g., eating problems, sleep disturbances, low energy or
- cognitive symptoms – e.g., poor concentration, low self-esteem
(MMD: at least 5 symptoms present nearly every day for at least 2 weeks)
- Chronic but less severe than MDD → Difficult to distinguish and some people have
suggested term “chronic depressive disorder”.
- Double depression = Both, MDD and DD
• DD: Onset, Course, and Outcome
- Develops about 3 years earlier than MDD, around 11 or 12 years → often a precursor
- Extended duration (2 to 5 years).
→ Early onset and extended duration make it major problem.
- Almost all children recover but extremely high risk of developing other disorders,
including MDD, anxiety disorders, bipolar disorder, substance use disorder.
2. Prevalence and comorbidity

- Prevalence rates of DD are lower than MDD: 1% of children, 5% of teenagers
- Most common comorbid disorder – MDD: 70% of children with DD experience an
episode of MDD in the course of the disorder.
- 50% of children have other comorbidities (e.g., anxiety/ conduct disorder, ADHD).
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III- BIPOLAR DISORDERS
A- Generalities
- Manic-depressive illness/ Manic depression
- Affective disorder characterized by periods of mania (elevated mood) and periods of
depression
- Individuals moods swing from extremely happy and energized (mania) to extremely
sad (depression)
- Chronic illness; can be life-threatening
- During mania: Individual feels happy, energetic, irritable; makes decisions with little
regard to the consequences; less need for sleep
- During depression: Individual cries a lot; poor eye contact with others; negative outlook
on life
- Epidemiology of Bipolar Disorder: Prevalence = 1% of population (Males = Females)
B- Diagnosis
- Diagnosis is very complicated as a consequence of comorbidity → 70-90% of
teenagers have other disorders (e.g., ADHD, substance abuse)
- Half of bipolar children have relatives with bipolar disorder
- Risk of suicide: 6% over 20 years; 30–40% self harm
• DSM Criteria: DIGFAST acronym (at least 3 of 7

symptoms), mental status exam
- Distractible
- Increased activity/psychomotor movement
- Grandiosity/Super-hero mentality
- Flight of ideas or racing thoughts
- Activities that are dangerous or hyper sexual
- Sleep decreased
- Talkative or pressured speech
• Prioritizing treatments of symptoms

1. Treat Mania - 2. Treat Depression - 3. Anxiety and ADHD
C- Specific type of Bipolar Disorder: Cyclothymia

- Milder form of bipolar disorder
- Characterized by numerous mood swings: Periods of hypomanic symptoms that do
not meet criteria for a major hypomanic episode and Periods of mild or moderate
symptoms of depression that do not meet criteria for a major depressive episode.

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Unit 8.2 - Anxiety Disorders

I- EMOTIONAL COMPONENTS
• Five reactionnal components: (Emotional Components Are Mainly Physiologic)
- Affective Component → State of highly aversive arousal.
- Expressive Component → Anxious facial expression, trembling voice.
- Physiological Component → Increased heartbeat, blood pressure, sweating.
- Motivational Component → Higher tendency to avoid the source of anxiety (location,
test administrator,…)
- Cognitive Component → Attention towards source of anxiety, involuntary thoughts.
II- FEATURES OF ANXIETY DISORDERS

A- General considerations
- Often have an early onset: teens or early twenties
- Show 2:1 female predominance
- Increase or decrease over lifetime
- Similar to major depression regarding impairment and decreased quality of life
- Often come along with other disorders (e.g. mood disorders)
• When does anxiety become a disorder?

- It is a normal human response to objects, situations or events that are threatening
- It can be helpful and adaptive (e.g. anxiety about giving lectures!)
→ becomes disorder when out of proportion or when it significantly interferes with life
• Is anxiety always normal?

- Normal anxiety: Adequate reactions when it comes to danger (in respect to dev. stage)
→ Adaptive. Temporary / state. Inborn response but also learned
- Abnormal anxiety: Trait, Causeless, Strong and persistent impairment
B- Causes
1. Genes
- For panic/ generalized anxiety / obsessive-compulsive disorders and phobias
- Twin studies: heritability of 0.43 for panic disorder and 0.32 for generalized anxiety
2. Brain
Parts of the brain are key actors in the production of fear and
anxiety: thanks to brain imaging technology and
neurochemical techniques, we know that amygdala , thalamus
and hippocampus play significant roles in most anxiety disorders

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• Amygdala
- Almond-shaped structure deep in the brain
- Communication hub between the parts of the brain that process
incoming sensory signals and parts that interpret these signals
- Alerts the rest of the brain that a threat is present and triggers fear or anxiety response
- Stores emotional memories
- Plays a role in anxiety disorders involving very distinct fears, such as fears of dogs,
spiders, or flying
• Hippocampus
- Encodes threatening events into memories
3. Environmental factors
- Pollution
- Physical and psychological stress
- Excessive diet
C- Signs and Symptoms
- Last at least 6 months & can get worse if they are not treated
- Commonly occur along with other mental or physical illnesses, including alcohol or
substance abuse
- Different symptoms, but all symptoms cluster around excessive, irrational fear
D- Diagnosis
- Careful diagnostic evaluation to determine whether a person’s symptoms are caused
by an anxiety disorder or another problem
- If anxiety disorder is diagnosed → type of disorder or combination of disorders (e.g.,
alcoholism, depression) must be identified
- Sometimes other disorders could have such a strong effect that treating anxiety
disorder must wait until coexisting conditions are under control
E- Treatments
Sometimes people must try several different treatments or combinations of treatment
before they find the one that works for them
1. Medication
- Does not cure anxiety disorders, but keep them under control while the person
receives psychotherapy
- With proper treatment, many people with anxiety can lead normal, fulfilling lives
- Beta-blockers (propranolol), Anti-anxiety drugs (high- potency benzodiazepines) or
Antidepressants (SSRIs) → alter the levels of neurotransmitter serotonin in the
brain, which helps brain cells communicate with one another
2. Specific types of psychotherapy
Cognitive-behavioral therapy (CBT): cognitive part helps people change the thinking
patterns that support their fears, and behavioral part helps people change the way they
react to anxiety-provoking situations
3. Both
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III- DIFFERENT ANXIETY DISORDERS
A- Generalized Anxiety Disorder (GAD)
- Excessive worry about a number of events (at least for 6 months).
- Difficult in controlling the worry
- Causes significant distress or impairment.
- 3 of these symptoms: restless, nervous, irritated, easily tired, difficulty concentrating,
muscle tension, sleep disturbance
• Treatment
- Medications
- Psychoanalysis: resolve conflict between ego and id impulses
- Cognitive-behavioral therapy: apparently most useful but still shows limited success.
B- Separation Anxiety Disorder (SAD)

- Normal part of child development.
- Varies widely from child to child.
- It may end when toddlers begin to understand that parents may be out of sight, but they
will return later.
- Some children will undergo some degree of anxiety when placed in unfamiliar
situations, especially when separated from parents.
- First few months: Babies may be calmed by any loving person

- 7-14 months: Babies recognize there’s only one mom / dad, but they do not understand
when they’ll come back → “stranger anxiety”
- Toddler/preschool years: Can become anxious/ emotional when a parent leaves, but
can be distracted by activities
- Age 5: Most children are secure enough to be dropped off at child care or school without
distress.
→ Separation anxiety may be diagnosed as a disorder if symptoms persist longer

than four weeks in a child older than age 5!  
• Symptoms, red flags

The following symptoms are a problem if they interfere with a child’s functioning and
last more than four weeks:
- Nightmares about harm, danger, death, or separation.
- Excessive distress during routine separations from the parent or other family member.
- Repeated physical complaints (such as headaches or stomachaches).
- Panics if parent or other family member is late for pick-ups.
- Reluctance to go to sleep without a significant adult nearby.
- Recurrent reluctance to go to school or other places because of fear of separation.
→ In general: Problematic when anxiety is inappropriate or excessive, interferes with
normal activities, and lasts for weeks rather than days.
• Treatment
- Addressing physical symptoms
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- Identifying anxious thoughts
- Helping child understand that parent will return
- Offering possible explanations for where parent is
- One parent leaves for 15 minutes while child stays with other parent → trust with both
parents
- Plan for separation and reunion
- Promote trust/security about separation
- Distraction can work well with some kids
• Summary
- Separation anxiety is a normal stage of development
- No one can prevent it, but it is possible to prepare children for absences and develop
coping strategies
C- Obsessive-Compulsive and Related Disorders (OCD)

• Characterised by
- obsessions = recurrent and persistent thoughts; unwanted impulses or images that
cause marked anxiety or distress
- compulsions = repetitive behaviors or mental acts (compulsions may be physical or
mental)
• Reasons
- Psychoanalytical theories: attempt to suppress instinctual drives arising from the anal
stage
- Behavioral and Cognitive Theories: conditioning / modeling / memory deficits
- Biological theories:
- Brain trauma and/or neurochemical reasons
- Serotonergic dysfunction (dysfunction regarding serotonin-neurotransmitter function)
- Autoimmune-PANDAS (streptococcal infection)
- Genetic factors
D- Phobias
• Common features of all phobias
- Anxiety is out of proportion to the actual threat
- Fear or anxiety significantly interferes with routine or function

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E- Trauma and Stress-related disorders
1. Adjustment disorders
- Response to a psychosocial stressor: Development of clinically significant emotional or
behavioral symptoms
- Considerable distress
- Interfere with the person’s job, schoolwork, or social life
- Symptoms must develop within 3 months after the onset of the stressor
2. Posttraumatic Stress Disorder

7-9% of general population
Exposure to actual or threatened death, serious or sexual violence in one or more of the
following ways:
- Direct experiencing of traumatic event
- Witnessed event as it occurred to others or other person close to them
- Experiencing repeated or extreme exposure to aversive details of trauma  
IV- IN SUM
- Have you ever experienced recurrent panic attacks? (Panic disorder)
- Do you consider yourself a worrier? (Generalized anxiety disorder (GAD))
- Have you ever had anything happen that still really haunts you? (PTSD)
- Do you get thoughts stuck in your head that really bother you or need to do things over
and over like washing your hands, checking things or count? (OCD)
- When you are in a situation where people can observe you do you feel nervous and
worry that they will judge you? (Social anxiety disorder (SAD))  

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Unit 8.3 - Eating disorders

I- RISK FACTORS FOR DEVELOPING AN EATING DISORDER

Eating disorders need to be considered from a multifactorial point of view
• Personality/psychological factors
- Sense of self worth based on weight, low self-esteem
- Depression, anxiety, anger, or loneliness
- Use food as a means to feel in control
- Dichotomous & rigid thinking (everything is all good or all bad: when eating one cookie
destroys diet → eating the whole box)
- Perfectionism (Higher rate of ED. described as being overachievers)
- Inadequate coping skills
- Poor impulse control
- Nonconformity (because they are less likely to internalize the thinness standards
society has set)
- Having a feminist ideology
• Family influence/Interpersonal factors
- Troubled family and personal relationships
- Difficulty expressing emotions and feelings
- History of being teased or ridiculed based on size or weight
- History of physical or sexual abuse
• Biochemical factors
- Chemical imbalances in the neuroendocrine system: these imbalances control
hunger, appetite, digestion, sexual function, sleep, heart and kidney function, memory,
emotions, and thinking
- Serotonin and norepinephrine are decreased in acutely ill anorexia and bulimia
patients: representing a link between depression and eating disorders
- Excessive levels of cortisol in both anorexia and depression: caused by a problem that
occurs in or near the hypothalamus
• Media and Cultural factors (subcultures existing
within our society)
- Belief that being thin is the answer to all problems is
prevalent in western culture
- Bulimia can be influenced by social norms: It can be seen
as a behavior, which is learned through modeling
Crandall (1988): Sorority girls
- Peer influence is strong in the development of bulimia
- They tend to be praised for their looks → they may come
to put more of their self-worth in their appearance (operant
conditioning)
- Members who did not binge and purge at the beginning,
were doing so by the end of their first year

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The Thin-Ideal:
- The avg. model weighs 23% less than the avg. woman
- Longitudinal study from 1979-1988 showed that 69% of playboy models and 60% of
Miss America contestants met weight criteria for anorexia → change today
- Women’s bodies in the media have become increasingly thinner
- Current Western standards of female attractiveness have contributed to increases in
eating disorders (Thin Ideal: Twiggy from the 60s and Calvin Klein models)
- 55% of college women thought that they were overweight though only 6% were
- 94% of one sample of women wanted to be smaller than they currently were
- 96% thought that they were larger than the current societal ideal
- Half the women in a study said they would rather be hit by a truck than be fat
II- 3 TYPES OF EATING DISORDERS

A- Anorexia Nervosa
→ Characterized by a pursuit of thinness that leads to self-starvation
- Diana of Wales, anorexic: After her divorce, the princess confessed that she suffered
from eating disorders due to the emotional problems arising from her marriage.
- Ideal beauty: In ancient times, the ideal of feminine beauty was fat. From prehistory
(with the so-called "Venus" and the Willendorf) to the fleshy models of the painter
Rubens. Even today, in Arab culture, the beautiful woman is the thick, abundant
woman, who conveys a sense of wealth. Whereas in the West it takes the thinness.
• Holy anorexia:
- S.XIII in the Middle Ages, religious context: Santa Wilgefortis wanted to give herself to
the service of God and her father wanted to marry her to the king of Sicily. When we
refer today to the anorexia of that time we call it « holy anorexia. »
- It is unknown if these women who were taken as an example by many others had image
disorder or fear of becoming fat, which would be clear aspects of anorexia today, but
it is known that although it must be understood in its historical, cultural and religious
context, they did have weight loss due to malnutrition and vomiting. They had a lot
of vitality and hyperactivity despite the obvious lack of physical force from starvation ...
These traits coincide with today's anorexia nervosa.
• History of Nomenclature
- The term « anorexia » in medical literature is synonymous with lack of appetite
- Meaning in Greek « anorektous » is lack of appetite and certain stomach disorders
- Dr. Morton, "nervous atrophy." Body degeneration was attributed to a disturbance of
the nervous system.
- Pinel, in 1798, calls "anorexia nervosa" as a disorder of the stomach accompanied by
altered brain functions.
- It was Lasègue, in 1873, describing hysterical anorexia and its characteristics. He
suggests that rejection of food was a form of intra-family conflict between the girl and
her parents. That is, disease is attributed for the first time to social factors.
- Gull, in his final article changes" apepsia "to" anorexia "- like Lasègue - to believe that
the disorder produces a lack of appetite and not a digestive disorder.
- It denies the involvement of the uterus and therefore changes « hysterical » to
« nervous. » Defending the relationship with the nervous system. In addition, he
pointed out that the disorder could also affect males.
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• Statistics
- Eating disorders have increased threefold in the last 50 years
- 10% of the population
- 90% of the cases are young women
- 61% of college women show some sort of eating pathology
• What is Anorexia Nervosa
- Begins with individuals restricting certain foods, not unlike someone
who is dieting: Restrict high-fat foods first and food intake becomes severely limited (to
only a few select food items)
- People starve themselves, subsisting on little or no food for very long periods of time
- The fear of gaining weight or becoming fat is extremely intense
- Perceived body weight and body shape are
severely distorted: Even when drastically
underweight most individuals with this disorder will
see themselves as being overweight
- Permanent thoughts and OC tendencies related
to food: may adopt ritualistic behaviors at
mealtime (e.g., chewing each bite of food a certain
number of times) or may collect recipes or prepare
elaborate meals for others
- Extreme concern with body weight and shape
• Normal food pyramid Vs. Food pyramid of Anorexia nervosa
B- Bulimia Nervosa
→ Characterized by a cycle of bingeing followed by extreme behaviors to prevent
weight gain, such as purging/vomiting
- Qualitatively distinct from anorexia: characterized by binge eating (and vomiting )
- A binge may or may not be planned: marked by a feeling of being out of control
- The binge generally lasts until the individual is uncomfortably or painfully full
- Common triggers for a binge: Dysphoric mood (binge is a way to deal with negative
feelings), Interpersonal stressors, Intense hunger after a period of intense dieting or
fasting, Feelings related to weight, body shape, and food
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- Age at the onset of the disorder = early 20’s
- Are able to maintain a normal weight: less distortions (delusions) in body
image (as in anorexia)
- Acknowledge that there is a problem with behavior in regards to food
- Feelings of being ashamed after a binge are common: behavior is kept a
secret and most deal with the burden of hiding their problem for many
years, sometimes well into their 30’s
- Wide rage of caloric intake - what constitutes a binge
is not caloric intake, but feelings of being out of
control - such as eating one cookie, or one doughnut
- Consume up to 10,000 calories in a single day and
prefer high-calorie foods such as sweets and fast
food, BUT prefer low-calorie foods during times
between binges
Subtypes:
- Purging: self-induced vomiting as a way to get rid of extra calories they have taken in
- Non-purging: use a period of fasting and excessive exercise to make up for the binge
C- Binge-eating disorder
→ Characterized by regular bingeing, but do not engage in purging behaviors
- Finally officially recognized in the DSM
- Characterized by regular bingeing
- Similar to bulimia, however there is no purging, fasting, or excessive dieting to
compensate for the binges
- Some may eat continuously throughout the day
- Some binge on large amounts of food at once: Relieve feelings of stress, anxiety,
depression, low self-esteem
- Significantly overweight (might have history of family obesity)
III- TREATMENTS AND ASSESSMENTS
- Ideally, treatment addresses physical and psychological aspects of an eating disorder
- People with eating disorders often do not recognize or admit that they are ill: May
strongly resist treatment, Treatment may be long term
- E.D. are very complex and because of this several health practitioners may be
involved:General practitioners, Physicians, Dieticians, Psychologists, Psychiatrists,
Counselors, etc.
- Depending on the severity, an eating disorder is usually treated in an: Outpatient
setting: individual, family, and group therapy OR Inpatient/Hospital setting: for more
extreme cases
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A- Types of treatments
Medical Treatment
- Treatment of depression/anxiety that co-exists with the eating disorder
- Restoration of hormonal balance and bone density
- Encourages weight gain by inducing hunger
- Suppression of the binge-purge cycle (Antidepressants)
Individual Therapy
- Allows a trusting relationship to be formed
- Difficult issues are addressed, such as anxiety, depression, low self-esteem, low self-
confidence, difficulties with interpersonal relationships, and body image problems
- Several different approaches can be used, such as:
- Cognitive Behavioral Therapy (CBT): Focuses on personal thought processes
- Interpersonal Therapy: Addresses relationship difficulties with others
- Rational Emotive Therapy: Focuses on unhealthy or untrue beliefs
- Psychoanalysis Therapy: Focuses on past experiences, unconsciousness
Nutritional Counseling
- Dieticians or nutritionists are involved
- Teaches what a well-balanced diet looks like
- This is essential for recovery
- Useful if they lost track of what “normal eating” is
- Helps to identify fears about food and the physical consequences of not eating well
Family Therapy
- Involves parents, siblings, partner
- Family learns ways to cope and deal with E.D. issues: Educates members about it
- Can be useful for recovery to address conflict, tension, communication problems, or
difficulty expressing feelings within the family
Group Therapy
- Provides a supportive network
- Members have similar issues
- Can address many issues, including: Alternative coping strategies, Exploration of
underlying issues, Ways to change behaviors and Long-term goals
B- Treatment challenges
- Lack of motivation to change: intrinsically reinforced by the weight loss, because it
feels good to them or they may deny the existence of the problem
- Lack of insight: Because eating disorders are not really about food, underlying
psychological and emotional issues must be dealt with
- Bulimia: treatment resistance because of the shame, embarrassment, and guilt
C- Assessing ED
- Medical history, physical exam, and specific screening questions, along with other
assessment tests help to identify eating disorders.
- Physical Exam: Check weight, Blood pressure, pulse, and temperature, Heart and lungs,
Tooth enamel and gums
- Nutritional assessment/evaluation: Eating patterns…
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- Assessment should include interviews: History of body
weight, History of dieting, Eating behaviors, All weight-loss
related behaviors, Past and present stressors, Body
image perception and dissatisfaction, Screen for
depression, Self-esteem, Anxiety, Appearance, mood,
behavior, thinking, memory , Substance physical or sexual
abuse, mental disorders
- EAT (Eating Attitudes Test): 26 item self-report questionnaire broken down into 3
sub scales (Dieting, Bulimia&food preoccupation, Oral control)
- FRS (Figure Rating Scale): Widely used measure of body-size estimation
representing 9 schematic figures varying in size. Subjects choose a shape that
represents: their "ideal" figure, how they "feel" they appear,
the figure that represents "society’s ideal" female figure. It is
used to determine perception of body shape, for self and
“target” body size estimation
IV- TEETH IN EATING DISORDERS

- Cavities: Many bitter foods are consumed in binge eating
- Enamel, weakened by acid attacks of diverse origins (erosion), is thinned and
disappears, leaving exposed dentin, which is softer.
- Logically, the lesions that can be attributed to the vomiting are in the path: they mainly
affect the inner side of the teeth, on the side of the palate and begin at the confluence
between the gums and the teeth, in the incisors. Basically, the enamel completely
disappears from the inner side. The tooth is worn in a bevelled shape and loses height.
- Bulimia crises and the particular diet of people suffering from eating disorders also
expose them to gastroesophageal reflux, often at night, which causes new acid
attacks that may go unnoticed. "Lesions associated with gastroesophageal reflux are
sometimes located on one side of jaw depending on the position adopted for sleep. »
- However, injuries can also affect the outer face of the teeth, due to the important
consumption of acidic drinks. To fill the stomach or help with vomiting, some patients
swallow up to six liters of soda per day.
- Saliva of poor quality by malnutrition and in small quantity, does not manage to
neutralize the oral acidity. The lesions, first located in the prominent parts, then extend
and pierce the molars, which eventually lose size.
- Gums very affected, especially in severe anorexia: They can retract and expose the
roots to acid attacks and aggressive brushing. With the idea of being purified or not
to smell of vomiting, some patients brush their teeth ten or fifteen times a day for more
than 20 minutes!

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Unit 8.4 - Addiction

I- INTRODUCTION
A- Definitions
- Addiction: to use compulsively or uncontrollably
- Addiction potential: the tendency to develop/
produce an addiction
- Abuse: to use wrongly or improperly
- Habit: a constant, often unconscious, inclination to
perform some act, frequent repetition
- Dependence: state of being determined, influenced,
or controlled by something else; something is required
for normal physiological or psychological functioning
B- What is addiction
Addiction is a brain disease characterized by:
- Compulsive Behavior
- Continued abuse of drugs despite negative consequences
- Persistent changes in the brain’s structure and function
- Only initial decision to use drugs is voluntary
→ Disease of brain that compels a person to become obsessed
Addiction is preventable and treatable but if untreated, it can last a lifetime
C- Developmental Disease that starts in adolescence and childhood
II- CHARACTERISTICS OF DRUGS

A- Reasons to take drugs
- Cognitive/Society: environmental cues play an important role in maintaining an
addictive behavior
- Learning: drugs function as reinforcers in much the same way as do other reinforcers
(e.g., food, water, money)
- Neuroscience: Dopamine
- To feel good: Have novel feelings sensations experiences AND to share them
- To feel better: To lessen anxiety worries fears depression hopelessness
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B- What is dopamine
- Dopamine is a brain chemical involved in many different functions including movement,
motivation, reward - and addiction
- Nearly all drugs of abuse directly or indirectly increase dopamine in the pleasure and
motivation pathways (alter normal communication between neurons)
- Nerve terminal receives portion of dendrite on a neighboring neuron
- Signal → dopamine is released into synapse of second neuron
and binds to and stimulates dopamine receptors
- Dopamine is then released from the receptor and crosses back
to the first neuron where it is picked up by dopamine
transporters for re-use
C- What happens when a person takes drugs

Cocaine attaches to dopamine transporters, thereby blocking dopamine from being
taken back up by the first neuron
→ dopamine continues to stimulate receptors of the second neuron because it remains
in the synapse for a longer period of time. This is what produces cocaine’s intense
euphoria and makes it potential for abuse
Drug abuse changes brain in fundamental ways that reinforce drug taking and addiction.
These changes are difficult to undo, may last long time and can be structural or functional
- Structurally: Neuronal Dendrites make more
connections in the amphetamine exposed animal
- Functionally: Dopamine D2 receptors are decreased
by addiction as a result of repeated over-stimulation
III- CLASSIFICATION OF DRUGS

A- Depressants
(Cannabis, Heroin, Morphine, Codeine, Alcohol, Tranquilizers, Tobacco, Opiods, Xanax…)
- Slow down the activity of the brain and nervous system (slowing down the
communication between the two)
- Calm nerves, relax muscles (useful for medical purposes like insomnia)
Tranquilizers
- Minor tranquilizers act primarily as antianxiety agents
- Major tranquilizers act primarily as antipsychotic agents
- Can be taken orally or as an injectable
Cannabis Sativa (Marijuana)
- Cannabis refers to any product of the plant Cannabis sativa
- Can be smoked in hand-rolled cigarettes or joints or water pipe
- Effects: exhilaration, relaxation
- Adverse effects: heart rate increase, drowsiness, dry mouth and throat, bloodshot eyes,
impaired short-term memory, altered states of time and space, and dilated pupils
Inhalants
- Forms: glue, model cement, fingernail polish removers, cosmetics, cleaning solvents,
gasoline, paint, paint thinner, lighter fluids, antifreeze, aerosol, white correction fluid
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- Effects: a feeling of well-being, reduction of inhibitions, dizziness, illusions, time and
space distortions, feeling of floating, and an elevated mood
- Adverse effects: confusion, drunkenness, slurred speech, runny nose, tears, headache,
incoordination, nausea, vomiting, confusion, panic, irritation, tension, hyperactivity,
aggressiveness, drowsiness, stupor, respiratory depression, unconsciousness, difficulty
breathing, ulcers around mouth and nose, weight loss, nutritional disorders, death.
Tobacco
- Is the most widely abused drug
- Diseases related to smoking tobacco: heart disease, peripheral vascular disease,
cancer, chronic lung disease…
B- Stimulants
(Ecstasy, Speed, Meth/Amphetamine, Crystal Meth, Cocaine, Crack, Coffee, Steroids)
- Stimulate the brain and CNS (speeding up communication between the two)
- Increase alertness and physical activity
Cocaine
- Has gained popularity: it is the most addicting drug known today
- Can be inhaled, injected or smoked
- After the euphoria → psychological depression, nervousness, fatigue, and irritability
Amphetamines
- Appetite-suppressing effect → attractive to athletes for whom keeping a certain
weight is critical (Jockeys, Gymnasts, Wrestlers, Boxers)
- Improve alertness, however do NOT prevent fatigue, but mask it and diminish pain
thresholds → athletes are allowed to continue to compete despite injury, potentially
causing more damage
- Use leads to: dehydration, weight loss, vitamin deficiency, reduced immune system, liver
and cardiovascular disease, and psychiatric problems → Increases aggressiveness
- Can be taken orally or injected intravenously
Steroids
- Androgenic steroids: Include testosterone; primarily develop and maintain male sex
characteristics
- Anabolic steroids: Are synthetic derivatives of testosterone; promote protein
synthesis and muscular growth
- Major effects of steroid use: significant increases in strength and body mass and
increased ability to perform high-intensity training sessions
- Adverse effects of steroid use: heart disease, elevated blood pressure, liver and kidney
damage, acne, baldness, infertility, reduced sex drive, headaches, nausea, dizziness,
menstrual irregularities, voice change
- Most significant effect of steroid use is psychological: Aggressiveness, mood swings,
depression, delusions, loss of control
- Physical and psychological dependence may occur
Crystal Meth
- Major effects: sense of well-being and energy (push body faster and further), delusions
of power; they become aggressively smarter and argumentative, often interrupting other
people and finishing their sentences
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- Adverse effects: “crash” or physical and mental breakdown, decrease in feelings of
hunger → extreme weight loss, disturbed sleep patterns, hyperactivity, nausea,
increased aggressiveness and irritability, confusion, anxiety
- Long-range damage: irreversible harm, like increased heart rate and blood pressure,
irregular heartbeat, liver and lung damage, memory loss and an increasing inability to
grasp abstract thoughts
C- Hallucinogen
(LSD, Ecstasy, Magic Mushrooms, PCP (Phencyclidine))
- Interfere with brain and CNS → radical distortions of perception of reality
- Profound images, sounds, and sensations
LSD
- Is the most potent (= puissante) drug by weight
- Is often impregnated in sugar pills, blotter paper, or small gelatin squares for ingestion
- Major effects: visual hallucinations, euphoria
- Can produce profound effects on thinking, self-awareness, and emotions (body image,
terrifying thoughts and feelings, fear of losing control, panic attacks)
- Physical dependence is unlikely, however psychological is common in long-term users
Phencyclidine (PCP)
- Cannot be properly classified as a hallucinogen, stimulant, or a depressant, causing it to
be listed in a separate drug category
- Can be smoked, ingested, or injected
- Effects: euphoria,tranquilization
- Adverse reactions may: paranoia, withdrawn or isolated feeling, bizarre delusions,
increased heart rate/blood pressure, sweating, salivation, flushing, auditory/visual/time
disturbances, loss of muscle control
- Does not appear to be physically addictive, although tolerance may develop
- When smoked, users may become very psychologically dependent
- It produces a loss of feeling, sensations: Accidents causing injury are common, Violence
Psilocybin
- Ingredient in “magic mushrooms” (Ingested orally)
- Found in tropical and sub-tropical regions such as South America, Mexico, and U.S.
- Major effects: hallucinations that include magical thinking, feeling of one-ness
- Adverse effects: anxiety and panic, and motor abnormalities
D- Alcohol
- Acts (mainly) as a depressant on the central nervous system
- Is the most widely used psychoactive drug known (other than tobacco products)
- Major effects on the brain, peripheral nerves, heart and blood vessels, and the lungs
• Alcoholism
- It is the addiction to or abuse of alcohol to a degree that produces problems in one
or more of these areas: Health, Social relationships/Interpersonal relationships,
Economic status and Law (e.g., driving)
- It occurs in ALL social classes and age groups
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• Phases
- Problem drinking: Drinks to relieve stress, abstinence doesn’t cause physical symptoms
- Alcohol addiction: Abstinence produces physical symptoms
• Typical alcoholic
« Social drinker », Drinks early in day, Drinks alone or secretly, Binges accompanied by
memory loss, Chronically flushed face and palms, Anxiety with reduced intake, Problems
with family, work, law enforcement related to alcohol
• Acute Alcohol Effects:

- Hangover: Mild withdrawal with vomiting. Treatment are fluids and Medication for
headache
- Stupor-Coma - Acute Overdose: Coma, Depressed respirations, Hypotension (low blood
pressure), Hypothermia (body temperature below 35°C), Hypoglycemia (Inhibition of
protein to sugar conversion in liver (gluconeogenesis))
- Worsening of other problems: Peptic ulcer disease (stomache absces), Liver disease,
Pancreatic disease, Heart disease
IV- ABSTINENCE, PREVENTION, DIAGNOSIS AND TREATMENTS

A- Stages of abstinence syndrome
- Tremulousness/ nervousness: Shakes, Restlessness, Peaks at 24 hours, Patient may
feel “shaky” for up to 2 weeks
- Hallucinations
- Cramps: Usually in first 24 hours, May progress to status epilepticus
- Delirium tremens: 24 to 72 hours after reducing intake, Restlessness, shakes,
hallucinations, cramps, Dilated pupils, flushed face, tachycardia (heart- beating),
nausea, vomiting
B- Diagnostic: Specific problems when diagnosing abuse

- Unawareness of the negative consequences → appropriate to speak of abuse
- Feelings of shame → neglecting / playing down the problem
- Illegal → consequences by law
- Alternative sources of information: observation of behavior, interrogation of others /
institutions, biological procedures
C- Prevention Programs
• Prevention programs should enhance protective factors
- Strong family bonds: Parental monitoring and involvement
- Success in school performance
- Prosocial institutions (such as family, school, and religious organizations)
- Conventional norms about drug use
• Prevention programs should target all forms of drug use, including Interactive
Skills-Based Training
- Resist drugs and strengthen personal commitments against drug use
- Increase social competence
- Reinforce attitudes against drug use
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• Prevention programs should be family-focused
- Provide greater impact than parent-only or child-only programs
- Include at each stage of development and involve effective parenting skills
• Prevention programs should involve Communities and Schools
- Incorporate media campaigns and policy changes
- Strengthen norms against drug use
- Address specific nature of local drug problem
D- Treatment
• Duration
- Depends on patients problems/ needs
- Remaining in treatment for an adequate period of time
is critical for treatment effectiveness; at least 90 days
- Medical Detoxification manages physical symptoms; only first stage of addiction
treatment; alone, does little to change long-term drug use
- Participation in support programs during and following treatment can be helpful in
sustaining long-term recovery
- Recovery requires repeated episodes of treatment
- Relapses can occur during or after treatment, and signal need for treatment adjustment
• Requirements:
- Effective treatments need to be voluntary
- BUT sanctions (family, employer, criminal justice system) can increase treatment entry
- No single treatment is appropriate for all individuals; multiple courses of treatment
may be required for success
- Effective treatment attends to multiple needs of the individual, not just drug use
- Treatment must address medical, psychological, social, vocational, and legal
problems and must attend to family, work, and community
• Effectiveness:
- Goal of treatment is to return to productive functioning
- Reduces drug use and crime by 40-60% and increases employment by 40%
- Drug treatment is disease prevention (reduces likelihood of HIV infection by 6 fold in
injecting drug users)
• Extra information…
Drug use plays a prominent role in the HIV/AIDS epidemic: Disease Transmission in
Needle sharing and impaired judgment, disinhibition, leading to risky sexual behaviors
E- Vulnerability: even more important than treatment
Why do some people become addicted to drugs while others do not? It is an interaction of
a person’s biology (e.g., dopamine, genes), environment and age
- Predisposition to addiction can be attributed to genes: People with lower levels of
dopamine receptors experience more pleasurable feelings when taking drugs and
influence an person’s susceptibility to continued drug abuse
- Other factors involved: Stress, Early physical or sexual abuse, Witnessing violence,
Peers who use drugs, Drug availability
→ Vulnerability is influenced by Biology, Environment, Experiences, Peers and age

Bennouna Radia
Unit 9 - Dementia
Communication & Psycho
I- WHAT IS DEMENTIA
- Marked by a gradual loss of cognitive functioning/intellectual functioning.
- Incorporates losses of motor, emotional, and social functioning.
- It is a permanent and progressive disease → patients are unable to care for
themselves.
- Interferes with person’s normal daily activities and social relationships.
- First forgetfulness, then confusion and disorientation.

- Difficulties in: Problem solving & planning, Memory, Decision making & judgment,
Orientation in space and time, Perception.
- Personality changes: depressed and manic episodes.
• Causes and risk factors: Age, Neurological causes (see Alzheimer’s), Vascular
causes, blood pressure, Family history, Head trauma / strokes.
• Types:
1) Alzheimer’s Disease: cognitive functions (memory), judgment and reasoning,
movement coordination.
2) Vascular dementia Disease : reduces blood flow to the brain → decline in thinking.
3) Lewy Body Dementia: like Alzheimer‘s symptoms, sleeping disturbances, visual
hallucinations, muscle features (like in Parkinsonian). 
4) Parkinson‘s Disease Dementia: pb with movement, rigidity or muscle features. 
5) Frontotemporal Dementia: Affected nerve cells in the brain → changes in personality
and behavior, Difficulty with language (5% of the cases).

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• Diagnosis: Neuropsychological Exam
- Evaluates a person’s cognitive abilities (orientation in time and space, memory,
language skills, reasoning ability, attention, and social appropriateness).
- Tests involve asking a person to repeat sentences, name objects.
- Patients with Alzheimer’s are usually cooperative and attentive and show appropriate
behavior, but have a poor memory.
- Brain Imaging Tests (e.g., CT, MRI).
- EEG (electroencephalography).
- Blood/Metabolic tests (e.g., Vitamin B12deficiency).
• Treatment
- Avoiding smoking, drugs, alcohol.
- Physical exercises (→ Oxygen).
- Mental, cogitive, and social activities.
- Medication (donezpezil, memantine): improve mental processes, like memory + Slow
progression of Alzheimer‘s disease.
- Any medication has been approved during this last 10 years and they should be used as
a last resort, medication of depression may serve.
II- ALZHEIMER’S DISEASE

- Progressive disorder in which neurons degenerate/deteriorate, resulting in the loss
of cognitive functions (memory), judgment and reasoning, movement
coordination.
- Diminished blood flow.
- Affects brain functions (e.g., degeneration of cortex, hippocampus, hypothalamus,
and brain stem).
A- Neuroanatomy
• Cortex
Voluntary movement, Emotion, Planning and execution of behavior,
Intellect, Memory, Speech, Writing, Interpretation of sensations (pain,
temperature, touch, size, shape, and body part awareness) and
Understanding sounds, speech, meaning of written words
• Hippocampus
Encoding and retrieval of info (Damage = inability to retain newly learned information)
B- Symptoms
Loss of Memory, Aphasia (decreased language ability), Apraxia (decreased
ability to perform physical tasks e.g. dressing, eating), Delusions, Easily lost
and confused, Inability to learn new tasks, Loss of judgment and reason,
Social withdrawal, Visual hallucinations 
→ Slowly progressive decline. Treatment can slow the progression, NOT stop it!
C- Risk factors
- Family History / Inheritability: clear inherited pattern exists in approx. 10% of cases
- Down’s Syndrome: Nearly 100% of people who live into their 40’s (Trisomy 21)
- Head Injuries: Three times more likely to develop AD
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B- Stages
1. Early stage
• Characteristics:
Forgetfulness, Confusion and disorientation, Personality changes, Symptoms of
depression/ manic behaviors
• Interventions:
- Medication for hallucinations, delusions, agitation, anxiety, depression
- CBT (Behavioral change– reinforce good behavior, DON’T fight aggressive behavior)
- Counseling with family (Familiarity- Human contact/music/pets)
- Music Therapy:
- Music associated with positive memories will evoke a positive response (music
from late teens through early 30’s).
- Used to relieve depression
- Can help maintain cognitive and affective functioning
- Coupled with exercise and relaxation techniques
- Provides a medium for verbal/non-verbal expression
- Helps to increase or maintain social relationships (dancing, improvisation)
- Maintains positive activities (church choir, senior social dances, etc.)
2. Middle stage
• Characteristics:
Unable to remember names, Loss of short-term recall, Anxious, agitated, delusional, or
obsessive behavior, Physically or verbally aggressive, Poor personal hygiene, Disturbed
sleep, Inability to carry on a conversation (“word salad”), Disoriented to time and
place, May ask questions repeatedly
• Interventions
Music Therapy, CBT, Structured areas for mobility, Positive, loving environment
3. Late stage
• Characteristics
- Loss of verbal articulation/ motion
- Incontinence
- Extended sleep patterns
- Unresponsive to most stimuli
- Need for total assistance
- Unable to maintain caloric intake with weight loss of 10% or more
• Interventions
Medications, CBT, Music Therapy, Caring for physical need, Medical interventions, Most
activities are inaccessible but new coping strategies like meditation, relaxation, guided
imagery, hypnosis may help
B- Myths about dementia
- Severe memory loss is a natural part of aging/ Only old people can get dementia
- Alzheimer’s disease is not fatal
- Aluminium intake can cause Alzheimer
- Artificial sweeteners like aspartame can cause dementia
Bennouna Radia
Mental disorders in children

I- ADHD, Attention Deficit Hyperactivity Disorder

A- What is ADHD
- It is a neurodevelopmental disorder: When dopamine and norepinephrine
(neurotransmitters) are missing, the body is making it by moving a lot, won’t sit don’t for
a long period of time. The individual will be more likely to take drugs, love rollercoaster…
- Behaviors must appear before age 12 and continue for at least 6 months
- The symptoms must also create a real handicap in at least two areas of the child’s life.
B- Sympotms
- Inattention: it’s hard for children to focus and pay attention
- Impulsivity:
- Hyperactivity:
- Attention?
- Selective attention: the act of focusing on a particular object for a period of time,
while simultaneously ignoring irrelevant information that is also occurring (finding
Wallie: you focus only on strips)
- Maintaining attention: keeping the focus
- Divided attention: more than one source is attended → if it is not coming from the
same sense, we are able to do multiple task at once.
1. Inattention
- Fails to give close attention to details or makes careless mistakes
- Has difficulty sustaining attention. Is easily distracted
- Does not appear to listen. Struggles to follow through on instructions
- Has difficulty with organization. Avoids/ dislikes tasks requiring thinking.
- Loses things
- Is forgetful in daily activities
2. Hyperactivity
- Fidgets with hands or feet or squirms in chair.
- Has difficulty remaining seated
- Runs about or climbs excessively in children.
- Difficulty engaging in activities quietly
- Acts as if driven by a motor
3. Impulsivity
- Talks excessively
- Blurts our answers before questions have been completed
- Difficulty waiting or taking turns
Com & Psycho 1

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C- What causes ADHD?
Combination of causes:
- Genetics: highly heritable disorder, disorder of neurotransmitter function (dopamine and
norepinephrine)
- Environmental factors: perinatal factors (alcohol, smoking…), disorganized families
- Interaction between all factors
D- Symptoms change over time

(SLIDE)
20% kids with ADHD will be better growing up (with a good environment), 80% will keep
having all the symptoms during adolescence (, and out of this 80%, between 20 and 35%
will stay like this during adulthood.
II- ASD, Autism Spectrum Disorder

A- What is ASD?
• Characterized by:
- Persistent deficits in social communication and social interaction across multiple
contexts
- Restricted, repetitive patterns of behaviours, interests or activities: they need their
routine, to know what is going to happen next
- Symptoms must be present in the early developmental period
- Symptoms cause clinically significant impairment in social, occupational, or other
important areas of current functioning.
- Asperger symptoms
B- Causes
Genetics & environment
C- Prevalence
Boys face about four to five times higher risk than girls
Girls tend to have more sever symptoms and lower intelligence
RETT symptom: affects particularly girls, motor and physical developmental problems
D- Treatments
No proven cure but treating ASD early can greatly reduce symptoms and increase your
child’s ability to grow and learn new skills.
III- INTELLECTUAL DISABILITY

Disorder with onset during the developmental period that include both intellectual and
adaptive functioning deficits in conceptual, social and practical domains.
IQ: Mean = 100 (+/- 50)
Com & Psycho 2

Bennouna Radia
- Conceptual skills: language and literacy, money, time, and number concepts, and self-
direction
- Social skills: interpersonal skills, social responsibility, self-esteem, gullibility, naiveté
(i.e. wariness), social……
- Practical skills:
B-
C-
III- CEREBRAL PALSY

A-
Difficulties to do some movements depending on what are the regions of the brain
affected, no able to live by their own
Com & Psycho 3

Unit 1 - Introduction To Psychology: I-What Is Psychology

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Bennouna Radia

Unit 1 - Introduction to psychology

II- MENTAL HEALTH AND MENTAL DISEASE

III- MENTAL DISORDER’S CLASSIFICATION

Com & psycho - Unit 1 1

Unit 2 - Psychological Functions

Psychological functions are INTERDEPENDENT.

I- CONSCIOUSNESS & ATTENTION

1. Normal state: Vigilance

2. Alternative State: Dream (oniric

Com & Psycho - Unit 2 1

2. Dyssomnias: difficulty to initiate or maintain the sleep

II- SENSATION & PERCEPTION

Organization, identification, and interpretation of sensory information →

Com & Psycho - Unit 2 2

→ Can we detect stimulus below the absolute threshold? Subliminal Stimulation

C- How do we perceive colors?

C- How does our brain organize sensations

- Similarity - Closure - Continuity

Com & Psycho - Unit 2 3

D- Perception depends on the correct application of perception laws?

Com & Psycho - Unit 2 4

- Sensory register: large capacity, briefly available

B- Types of learning: How do we learn?

2. Associative Learning (Conditioning)

Com & Psycho - Unit 2 5

• Human Intelligence is capable of:

« the intelligence consists not only in the

VI- THINKING AND LANGUAGE

- Problem solving: Heuristics (trial and error; diagnosis of exclusion); Algorithms

VII- INSTINCTS AND TENDANCIES

Com & Psycho - Unit 2 8

B- Disorders of quality of awareness

C- Disorders of body awareness

Com & Psycho - Unit 3 1

• Hypothymia: pathologic sadness

• Euphoria: pathologic happiness

• Dysthymia: bad state of mind

B- Disorders of emotional response

- Apathy: Absence or suppression of passion, emotion, or excitement leading to a

A- Phonation and articulation disorders

E- Rhythm and tone changes

Com & Psycho - Unit 3 4

2. Changes in the quality (Opsis = vision)

3. Changes in the Kind (visual perception)

- Dysmegalopsia: change in the size perception

→ AIWS: Alice in Wonderland Syndrome

Com & Psycho - Unit 3 5

B- Perceptive delusions: new perceptual experience

Com & Psycho - Unit 3 6

TACTILE HALLUCINATIONS (Proprioceptive)

2. Variants of hallucinatory experience

- Confabulations: Unintentional falsification. The patient uses false memories to fill

Com & Psycho - Unit 3 8

Unit 4.1 - Personality

- Personality: A person’s internally based characteristic way of acting and thinking

II- PSYCHOANALYTIC PERSPECTIVE

• Defense mechanism: (7: Défendre Sa Reine en Protection Rapprochée ou Rapide Regards)

Com & Psycho - Unit 4.1 1

- Conflicts between conscious and unconscious can lead to mental or emotional

B- Structure of the human mind

- Id’s pleasure-seeking energies focus on distinct

III- HUMANISTIC PERSPECTIVE