Personality Disorders and Psychopathy, Exams of Nursing

Download Personality Disorders and Psychopathy and more Exams Nursing in PDF only on Docsity! Page 1 NSG 526(Exam 1)With Complete Solution Latest Update.2024 Assured Success Personality disorder - Correct answer Pattern of inner experience and behavior that deviates from expectations of the individual's culture Personality disorder manifested in two or more of: - Correct answer - Cognition - Affectivity - Interpersonal functioning - Impulse control Antisocial Personality Disorder - Correct answer Pattern of disregard for and violation of the rights of others occurring since age 15 years (primary defined by BEHAVIOR) - *Behavior component of psychopathy* Need 3 or more for APD: - Correct answer - Illegal behavior - Deceitfulness - Impulsivity - Aggressiveness - Reckless disregard for safety - Irresponsibility - Lack of remorse Narcissistic Personality Disorder (3 main constructs) - Correct answer Pattern of grandiosity, need for admiration, lack of empathy - Beginning by early adulthood and present in a variety of contexts Need 5 or more for Narcissistic PD: - Correct answer - Grandiose sense of self-importance - Fantasies of brilliance - Believes "special" or unique - Needs excessive admiration - Entitled - Interpersonally exploitative - Lacks empathy - Envious of others - Arrogant/haughty behaviors P a g e 1 | 15 Page 2 Psychopathy as a personality contruct - Correct answer - Not in the DSM-V, but clearly defined and demonstrated cluster of personality traits - Similar to ASPD but emphasis on interpersonal/affective traits Reliable assessment of construct - Correct answer Hare's Psychopathy Checklist = gold standard Psychopathy and ASPD in forensic populations: - Correct answer - Most psychopaths are ASPD (15- 25% of all offenders) - Most ASPD not psychopaths (50-80% of all offenders) Cleckley's Psychopathic Criteria (main 3 out of 16) - Correct answer 1. Superficial charm and good "intelligence" 2. Absence of delusions and other signs of irrational thinking 3. Absence of "nervousness" or psychoneurotic manifestations *Inadequately motivated antisocial behavior What is not on Cleckley's list? - Correct answer Violence (Should be considered an exception and not a rule) Mask of Sanity - Correct answer Appear normal, but is a grave form of psychopathy that exerts a pervasive and disruptive influence on adjustment PCL-R Checklist (Hare's) - Correct answer - Involves clinical interview AND collateral information - General population scores 6 - 20 items (0-2 score) - 0-40 continuum - High psychopathy = 30+ - Average inmate = "22" Factor One: Interpersonal - Correct answer 1. Glibness and superficial charm 2. Grandiose sense of self worth 3. Pathological lying 4. Conning-maipulative Factor One: Affective - Correct answer 1. Lack of guilt and remorse P a g e 2 | 15 Page 5 Childhood maltreatment vs. psychopathy - Correct answer Predicts the *severity* of psychopathology and APD - Link strongest for physical abuse and antisocial facet of psychopathy Witnessing domestic violence as a child associated with: - Correct answer Is significantly associated with overall level of psychopathy - Strongest relationship with interpersonal/affective facets (PRIMARY) Survival Analysis female vs. male - Correct answer -High risk offenders -Females more likely to drop faster than males Lykken's Low Fear Hypothesis - Correct answer 1. People with primary psychopathy are born with below average levels of fearfulness (low fear IQ) 2. Fearlessness os psychopathic individuals makes them difficult to socialize - Ex. as infant it is normal to have a fear of being abandoned - INFLUENTIAL THEORY Distal and proximal cause of Low fear hypothesis - Correct answer Distal cause: low fear --> poor fear conditioning Proximal cause: Poor passive avoidance Low Fear Hypothesis: Weak attachment - Correct answer - Children seek reassurance from parents to reduce fear - Increased "social monitoring" to maintain parents approval - *Low fear weakens attachment by reducing motivation to seek approval* Hare and Quin tone and skin conductance - Correct answer - Different tones => electric shock or not - Measured electrodermal and HR responses - Result: Psychopaths LOW skin conductance (no physiological response) compared to non-psychopaths Passive Avoidance Learning (main ideas) - Correct answer - Learning to avoid aversive stimuli (punishment) - Not engaging in a behavior to avoid negative consequences P a g e 5 | 15 Page 6 Lykken's Mental Maze Task - Correct answer - Control group learned the latent task to avoid "shocked choices at each step" - Psychopaths slightly decreased but level off at 20% punished errors Emotion Modulated Startle - Correct answer - Psychopaths blinked less for unpleasant pictures compared to control group - Shows they are less startled by unpleasant pictures - *Factor 1* psychopaths showing abnormal result (interpersonal deficits) Amygdala function - Correct answer Emotional responses: - Fear - Threat - Arousal - Aggression Blair's Integrated Emotion Systems (IES) - Correct answer - Testing to see if it is fear vs. emotion processing deficits - Neutral and negative slides shown - Amygdala and Orbitofrontal cortex Results from Emotional Slides study - Correct answer - Psychopaths have *too little* activation in the amygdala and OFC (uses emotions to make decisions) - Have *too much* activation in the Anterior Superior Temporal gyrus (attention region) Possibilities from the Emotional Slides Study - Correct answer - Emotional words and pictures have little neurobiological impact on psychopaths - Systems that process emotion are insufficiently activated - Emotional material is "not emotional" for them - Psychopaths employ non-limbic regions to process emotional material (more like a second language) Newman's Response Modulation Model - Correct answer - Psychopaths characterized by a response modulation deficit that interferes with their ability to use secondary (non-dominant info) to regulate goal- directed behavior - "Over-selective attention" proccess - Not picking up on cues to change self-regulation behaviors P a g e 6 | 15 Page 7 What type of tasks test the Response Modulation model? - Correct answer Passive avoidance tasks (how people learn to avoid what they see coming) Newman Card playing task - Correct answer Monetary rewards and punishments -As task continues risk of loss increases How long did the participants play when it should be clear they are losing money? Results of Card Playing task: - Correct answer - Non-psychpaths change behavior so they don't loose all money in game - Psychopaths don't stop playing game because only focused on getting money reward -- Don't respond to punishment and peripheral cues => never understand how to win the game Card task just focusing on winning (response and reflectivity) - Correct answer Psychopaths respond quicker and don't take the time to think - making more errors and not learning how to play the game Passive avoidance task: Money and numbers - Correct answer - Psychopaths commit more errors (don't learn "bad" numbers) - Non-psychopaths commit fewer errors after learning "bad" numbers Slowing down passive avoidance task? - Correct answer Psychopaths commit fewer errors General hypothesis for passive avoidance task in relation to response modulation - Correct answer Principal behavioral, cognitive, affective, and neural correlates of psychopathy will be *moderated* by their focus of attention Response modulation hypothesis - Correct answer Deficit that interferes with ability to use secondary or non-dominant information to regulate goal-directed behavior - Limits a person's ability to use context for behavior because the info is not integrated with their current attentional focus - Response modulation causes us to REFLECT Why a failure in self-regulation? - Correct answer Deficit on tasks due to focus on reward and failure to attend to losses - OVER-SELECTIVE ATTENTION ON REWARDS results in this P a g e 7 | 15 Page 10 Pseudopsychopathy - Correct answer -Damage to vmPFC -Causes primary psychopathic traits The trolley paradox - Correct answer -Utilitarian: Push stranger off bridge to save 5 lives -Non-Utilitarian: Pull lever to kill one man instead of 5 Trolley paradox results: - Correct answer -Neurological patient data look similar to primary psychopath data Ultimatum Game (unfair offer result) - Correct answer vmPFC lesion and primary psychopaths less likely to accept an unfair offer Dictator game - Correct answer -vmPFC and primary psychopaths are less likely to offer money Primary psychopathy is NOT influenced by: - Correct answer Abuse does not influence this vmPFC involved in: - Correct answer -Emotion regulation -socio-moral decision making vmPFC and amygdala are connected by the: - Correct answer Uncinate Fasciculus Psychopaths and amygdala connectivity - Correct answer Psychopaths have reduced vmPFC- amygdala connectivity in the RIGHT side Sentencing considerations - Correct answer 1. Aggravating factor--> longer sentence (future danger, lack of remorse) 2. Mitigating factor--> shorter sentence (History of abuse, emotional problems, remorse) 3 ways for MRI data on psychopathy to become more relevant for legal system - Correct answer 1. Demonstrate neurological defect at level of individual 2. Demonstrate improved risk assessment (likelihood of violence) 3. Demonstrate amenability to treatment P a g e 10 | 15 Page 11 Judges are sentencing more _________ factors with a biomechanism present - Correct answer Mitigating Somatic Marker Hypothesis - Correct answer Emotional-related signals assist cognitive processes even when they are non-conscious How are Somatic Markers created? - Correct answer -During the process of education and socialization through the connection between certain types of stimuli and certain types of affective states -They guide behavior by acting as an automated alarm system Imagine self vs. imagining other in Moral Decision Making - Correct answer -Psychopath associated with an atypical pattern of brain activation involving abnormal connectivity from anterior insula and amygdala to OFC and vmPFC WHEN IMAGINING OTHER Data from Moral Decision making - Correct answer -vmPFC increased activity during moral vs. non- moral in non-psychopaths but not in psychopaths -Atypical pattern of brain activation and connectivity from anterior insula and amygdala to OFC and vmPFC Where do somatic markers appear? - Correct answer In the vmPFC Risk/Need/Responsivity problem - Correct answer 1. Risk: What level of risk? 2. Need: what do we treat? 3. Responsivity: How do we treat this individual offender? When does risk assessment occur? - Correct answer After violence and after legal intervention PCL-R: an accidental risk tool - Correct answer -PCL-R not a comprehensive tool -Provides one component of a comprehensive violence risk assessment -Good predictor of violent and general recidivism Factor ____ is a stronger predictor of recidivism than factor ____ - Correct answer 2, 1 Factor ___ is better predictor of instrumental violence - Correct answer 1 P a g e 11 | 15 Page 12 Key points about PCL-R - Correct answer -Not and was not designed to be COMPREHENSIVE risk tool -One component of a comprehensive violence risk assessment -V-RAG better than PCL-R alone V-RAG (violent risk assessment guide) - Correct answer V-RAG + PCL-R = improved ability if incorporated other risk items -Enhances risk prediction Once a psychopath always a psychopath? - Correct answer -PCL-R not usually used with juveniles -Harsh label -Many show traits but change in early childhood -Aging in prison correlated with PCL-R scores reducing Most people high in psychopathy are NOT ________ - Correct answer Murderers Psychopathy in Community samples: - Correct answer -Approx. 5% with broader definition of psychopathy Are clinical evaluations highly reliable? - Correct answer - Well-trained examiners needed - Evaluators can be manipulated and distracted by high psychopathy individual You get less accurate information in an _____________ setting - Correct answer Adversarial (e.g. the courtroom) You get more accurate information with __________ setting - Correct answer Confidential Can we feel the presence of someone high in psychopathy? - Correct answer -Females > Males -Primitive autonomic fear response to an "intraspecies predator" -Empathy research says there is a "mirror" response Risk, Need. Responsivity model goals: - Correct answer -Reduce recidivism and severity of violence -Appeal to their self-interest to use strengths in non-criminal manner -Cognitive behavioral models P a g e 12 | 15