Dissociative Disorders- Exam 2

Question 1

____ intense, irrational fear of a particular object or situation

Answer 1

phobia

Question 2

What pt population are phobias more common in?

Answer 2

young women

Question 3

What is the criteria for a phobia?

Answer 3

Persistent (6+ months) of marked fear/anxiety about a specific
object or situation

Phobic object/situation almost always causes immediate fear/anxiety

Phobic object/situation is actively avoided or endured with intense fear or anxiety

Fear/anxiety is out of proportion to the actual danger posed by object/situation

Fear/anxiety or avoidance causes distress or functional impairment

Syndrome is not better explained by another mental disorder

Question 4

What is first line treatment for phobias? 2nd?

Answer 4

CBT with exposure

INfrequently encountered: PRN treatment with BZD

Frequently encountered stimulus: SSRI/SNRI

Question 5

____ segregation of any group of mental processes from the rest of someone’s psychological activity. Often associated with ____

Answer 5

dissociation

psychological trauma as part of the unconscious defense mechanism

Question 6

What are the 5 core symptoms of dissociative disorders?

Answer 6

amnesia

depersonalization

derealization

identity confusion

identity alteration

Question 7

What is depersonalization?

Answer 7

Sense of detachment or disconnection from one’s self

Feeling like a stranger in one’s own body, or like part of your body does not belong to you
Feeling detached from emotions, or like a “robot” or on “autopilot”

Question 8

What is derealization?

Answer 8

Sense of disconnection from familiar people or one’s surrounding

Close relatives or friends, one’s home or workplace may seem unreal or unfamiliar

“watching myself carry out reality”

Question 9

____ Sense of acting like a different person some of the time

Answer 9

identity alteration

Question 10

_____ potentially reversible memory impairment that primarily affects autobiographical memory. Give an example

Answer 10

dissociative amnesia

Cannot recall personal information
Typically affects memories of a traumatic or stressful nature, but can also impact other memories

Question 11

_____ - sudden unexpected travel or wandering in a dissociated state, with subsequent dissociative amnesia for the episode

Answer 11

dissociative fugue

Question 12

When is dissociative amnesia most often seen?

Answer 12

most often seen in late adolescence/early adulthood

both men and women

Question 13

**What are some comorbidities with dissociative amnesia?

Answer 13

MDD (up to 60%), bipolar, substance abuse, other anxiety disorders

Question 14

____ inability to recall important autobiographical information, usually of a traumatic or stressful nature, inconsistent with ordinary forgetting.

___ is for a specific event

___ is for identity and life history

Answer 14

dissociative amnesia

localized/selective amnesia

generalized amnesia

Question 15

What are some types of dissociative amnesia?

Answer 15

localized
continuous
generalized
selective
systematized

Question 16

What is the treatment for dissociative amnesia? give first line then other.

Answer 16

1st line: phase oriented therapy

CBT
Hypnosis
Group therapy

Pharmacotherapy - no use in treatmentPharmacotherapy - no use in treatment

Question 17

Transient Depersonalization/Derealization Disorder last ____. up to ___ % What kinds of patient is this common in?

Answer 17

last 12 months, 20%

Common in patients with a hx of seizures or migraines; psychedelic drugs, medications, head injury

Question 18

Lifetime, Depersonalization / Derealization Disorder about ___% What gender?

Answer 18

1-3%

equally common in men and women

Question 19

What are risk factors for DDD?

Answer 19

acute or chronic trauma, substance abuse, psychiatric disorders, Depression, anxiety, OCD, avoidant or borderline personality disorder

Question 20

_____ etiology is possible serotonergic involvement, response to traumatic stress, ego defense mechanism in the face of major negative life events

Answer 20

Depersonalization / Derealization Disorder

Question 21

**What is the criteria for DDD?

Answer 21

The presence of persistent or recurrent experiences of depersonalization, derealization, or both:

-Depersonalization - experiences of unreality, detachment, or being an outside observer with respect to one’s thoughts, feelings, sensations, body, or actions¹

-Derealization - Experiences of unreality or detachment with respect to surroundings²

During the depersonalization/derealization, reality testing remains intact (aka can respond normally when prompted)

Question 22

What is the treatment for DDD?

Answer 22

Months of treatment!!

Psychotherapy (mixed results): stress management and relaxation techniques

SSRIs may be helpful

Question 23

Dissociative Identity Disorder is characterized by ??

Answer 23

Characterized by the presence of two or more “selves” or “personalities” with distinct memories, thoughts, opinions, and goals

Question 24

What pt population is most at risk for DID?

Answer 24

women in their 20-30s, with a comorbidity of PTSD, depression, substance abuse, personality disorders usually with a childhood trauma

Question 25

Define the criteria for DID?

Answer 25

Presence of two or more distinct identities or personality states, each with its own relatively enduring pattern of perceiving, relating to, and thinking about the environment and itself Amnesia must occur Gaps in recall of everyday events, personal information, and/or traumatic events Syndrome causes distress and/or functional impairment Disturbance is not part of normal cultural or religious practices Ex. an “imaginary friend” is not considered indicative of a separate personality state alone

Question 26

What is the treatment for DID?

Answer 26

**Psychotherapy meds aimed at managing major symptoms ECT: for refractory mood disorders

Question 27

Define Impulse Control Disorder

Answer 27

Characterized by inability to resist the impulse, desire, or drive to perform a particular act that is obviously harmful to self, others, or both Act is preceded by mounting tension and/or anticipatory pleasure Completing action results in immediate gratification and relief Action is followed by remorse, guilt, self-reproach, dread Individuals are often secretive about activity

Question 28

How are impulse control disorders and OCD different?

Answer 28

Impulse control disorders they want to do (blank) activity vs OCD they DO NOT want to do it but feel the need to do it anyway

Question 29

What are the s/s of pathologic gambling? How many signs do you need?

Answer 29

Persistent and recurrent maladaptive gambling behaviors 5 or more of the following: Preoccupation with gambling Need to gamble with increasing amounts of money to get desired excitement Repeated unsuccessful efforts to reduce or stop gambling Restless or irritable when trying to reduce or stop gambling Gambles to improve mood or escape from problems After losing money, returns another day to win the money back Lies to others to conceal the extent of gambling Has committed illegal acts to finance gambling Jeopardizes or loses relationships, jobs, or opportunities because of gambling Relies on others to provide money to relieve a situation caused by gambling

Question 30

Tension or anxiety immediately before pulling out hair, or when resisting the urge is _____. What will happen next?

Answer 30

Trichotillomania Pleasure, gratification, or relief when pulling hair

Question 31

Kleptomania is the recurrent theft of items (needed/not needed) for personal use or monetary value

Answer 31

not needed feel pleasure, gratification or relief when stealing

Question 32

What are the key points of pyromania? What is the major one?

Answer 32

purposeful fire setting Tension or anxiety immediately before setting fire, or when resisting the urge Pleasure, gratification, or relief when setting fires, or when witnessing or participating in their aftermath fascination with fire **NOT for monetary gain, no real reason other than they want to/due to impaired judgement

Question 33

What is the treatment for Kleptomania?

Answer 33

psychotherapy with SSRI or lithium

Question 34

What is the treatment for pyromania?

Answer 34

psychotherapy and early intervention programs

Question 35

What is the treatment for pathologic gambling?

Answer 35

psychotherapy and SSRIs or Naltrexone, Naloxone

Question 36

What is the treatment for trichotillomania?

Answer 36

Clomipramine (Anafranil) **SSRIs not strongly shown to be beneficial

Question 37

Define Intermittent Explosive Disorder. Do patients show regret?

Answer 37

Discrete episodes of losing control of aggressive impulses Can result in serious assault, property destruction Aggressiveness is grossly out of proportion for any stressor which may have precipitated the episode Symptoms appear and remit spontaneously and quickly Between episodes… **Patients show genuine regret or self-reproach** No generalized impulsivity or aggressiveness

Question 38

genetic predisposition; exposure to abuse/violence as a child; narcissistic defence mechanism Also see decreased serotonergic activity Increased rates of brain inflammation, hx of T. gondii infection What am I?

Answer 38

Intermittent Explosive Disorder

Question 39

**What is the criteria for Intermittent Explosive Disorder? How old?

Answer 39

Presence of recurrent behavioral outbursts representing a failure to control aggressive impulses, as manifested by either of the following: Verbal or physical aggression towards property, animals, or other individuals, occurring twice weekly on average for a period of 3 months; the aggression does not result in damage or destruction of property or physical injury OR 3+ behavioral outbursts involving damage/destruction of property or physical injury against animals or other individuals occurring within a 12-month period The magnitude of aggressiveness during the outbursts is grossly out of proportion to the provocation or any precipitating stressors The aggressive outbursts are not premeditated and are not committed to achieve a tangible objective Chronological age is at least 6 years (or equivalent developmental level)

Question 40

_____ is common in the elderly so will need to rule out demenita/delirium

Answer 40

Intermittent Explosive Disorder

Question 41

What is the treatment for Intermittent Explosive Disorder?

Answer 41

Psychotherapy and meds group and family therapy is helpful (sometimes these patients have problems setting limits with therapists and may have outburst in therapy) Meds: SSRIs, trazodone, buspirone lithium, carbamazepine, valproate/divalproex, phenytoin, gabapentin may be helpful antipsychotics, beta blockers, calcium channel blockers

Question 42

How is Oppositional Defiant Disorder classified?

Answer 42

Enduring pattern of negativistic, hostile, disobedient behavior Frequently argue with adults and authority figures Often angry, resentful, easily annoyed Inability to take responsibility for mistakes: places blame on others for their own transgressions or omissions often have problems with peer relationships and in school DO NOT display much physical aggression or violent behavior: more verbal aggression, reactive to rules and overt (shouting)

Question 43

What are the 3 major subtypes of ODD?

Answer 43

Angry/Irritable Argumentative/Defiant Vindictive

Question 44

What type of ODD? _____ often lose their tempers; easily annoyed; feel angry most of the time

Answer 44

angry/irritable

Question 45

What type of ODD? _____ in addition to clashing with authority, tend to engage in vengeful and spiteful behavior

Answer 45

Vindictive

Question 46

What type of ODD? _____ habitually argue with authority figures; actively refuse to comply with requests; intentionally break rules; purposely annoy others

Answer 46

Argumentative/Defiant

Question 47

What is the ages for ODD? What gender?

Answer 47

begins as young as 3, average age at onset is 6; identified by age 14 more common in males before puberty; equal post-puberty

Question 48

What is the criteria for ODD?

Answer 48

Question 49

For a pt who is younger than 5, what is the timing for ODD? 5 and older?

Answer 49

Pt < 5 y/o - Behavior should occur on most days for a period of at least 6 months Pt 5+ y/o - Behavior should occur at least once per week for at least 6 months, unless otherwise noted

Question 50

How is the severity gauged in ODD?

Answer 50

based on the number of settings: Mild - Symptoms are confined to only one setting Moderate - Some symptoms are present in at least two settings Severe - Some symptoms are present in three or more settings

Question 51

Similar to ODD, pt shows less disregard for rules/authority specifically, behavior is not deliberately antagonistic, patients show remorse after outbursts. What am I?

Answer 51

Disruptive Mood Dysregulation Disorder

Question 52

Similar to ODD but the pt is MORE likely to have a physical aggression. What am I?

Answer 52

Conduct Disorder

Question 53

**What is first line treatment for ODD?

Answer 53

**Family therapy and individual therapy meds only indicated for comorbid conditions

Question 54

25% of the time ODD progresses to ____

Answer 54

Conduct disorder may also develop mood disorders, anxiety, ADHD or learning delays

Question 55

_____ Enduring set of behaviors in a child or adolescent that evolves over time, usually characterized by aggression and violation of the rights of others. Physical aggression, destruction of property, thefts, acts of deceit and frequent violation of age appropriate rules

Answer 55

Conduct disorder

Question 56

What are some psychosocial factors that point to conduct disorder?

Answer 56

Childhood maltreatment Harsh or punitive parenting Family discord Lack of appropriate parental supervision Lack of social competence Low socioeconomic level

Question 57

What is the MC pt with conduct disorder?

Answer 57

4-12x more common in males typically starts in adolescence comorb: ADHD, substance use, anxiety disorders (including PTSD), mood disorders, learning disorders Risk factors: impulsivity, poor parental supervision, harsh/punitive parental discipline, low IQ, poor school performance; regular alcohol use

Question 58

What is the criteria for conduct disorder? **How many criteria in what time frame?

Answer 58

Pattern of behavior in which the basic rights of others or major age-appropriate societal norms or rules are violated, as determined by **3+ of the following 15 criteria in the past 12 months (at least 1 in the past 6 months)**: Often bullies, threatens, or intimidates others Often initiates physical fights Has used a weapon that can cause serious physical harm to others Has been physically cruel to people Has been physically cruel to animals Has stolen while confronting a victim Has forced someone into sexual activity Has deliberately set a fire with intent to cause serious damage Has deliberately destroyed others’ property (other than by fire setting) Has broken into someone else’s house, building, or car Often lies to obtain goods or favors or to avoid obligations Has stolen items of nontrivial value without confronting a victim Often stays out a night despite parental prohibitions, beginning before age 13 years Has run away from home overnight at least twice, or once without returning for a lengthy period Is often truant from school, beginning before age 13 years

Question 59

What are the different types of onset for conduct disorder? Explain

Answer 59

Childhood-onset type - At least one symptom present prior to age 10 Adolescent-onset type - No symptoms present prior to age 10 Unspecified onset - Unable to clarify age at onset of symptoms

Question 60

What is the severity of conduct disorder based on?

Answer 60

Mild: few extra conduct criteria other than the ones required to make the dx cause **relatively minor harm to others** Moderate: more criteria and **intermediate harm to others** (stealing w/o confronting a victim, vandalism) Severe: many extra criteria and **considerable harm to others**

Question 61

____ is subtype of conduct disorder. What is the criteria?

Answer 61

Conduct disorder with limited prosocial emotions must display 2+ of the following traits persistently for over 1 year, in multiple relationships and settings (need multiple information sources to verify): Lack of remorse of guilt (lack of concern about consequences) Lack of empathy unconcerned about performance: blames others shallow or deficient affect (do not express feelings or emotions)

Question 62

⅓ to ½ of all children with ADHD have comorbid ____! When are they often seen together?

Answer 62

ODD males, children with divorced parents, and children with low socioeconomic status

Question 63

What is the treatment for conduct disorder?

Answer 63

psychotherapy: the earlier the better (kindergarden) reinforcement of positive, prosocial behaviors Meds: Risperidone, SSRIs, anticonvulsants treat other comorbities (ADHD)

Question 64

Psychotherapy for Conduct disorder, helps more with ____ symptoms than ___ symptoms

Answer 64

overt (aggression) than covert (lying, stealing)