Midterm 2

Question 1

Reactive Attachment Disorder

Answer 1

• A Trauma and Stressor-Related Disorder
• Not interested in closeness/comforting from caregiver
• Often occurs when child has been neglected or abused early on

Question 2

Disinhibited Social Engagement Disorder

Answer 2

• A Trauma and Stressor-Related Disorder
• Child has is drawn to every person for closeness. Confused affection. Loss of selective attachment.
• Result of neglect/abuse
• Not diagnosed until 9 months or older

Question 3

Adjustment Disorders

Answer 3

• Part of Trauma and Stressor-Related Disorders
• Depressed mood, anxiety, conduct disturbance, mixed emotion
• Akin in PTSD in that a specific stressor causes psychological difficulties (eg divorce etc)

Question 4

Acute Stress Disorder

Answer 4

• One of the Trauma and Stressor-Related Disorders
• Akin to PTSD. Similar symptoms.
  
  • Negative mood, intrusive thoughts, exaggerated startle response, dissociative symptoms, derealization, depersonalization
• Different from PTSD in that it refers only to reactionfor the first month following a stressor

Question 5

Post-Traumatic Stress Disorder

Answer 5

• A trauma and Stressor-Related Disorder
• Trauma exposure: typically assault, accidents, combat
  
  • Typically experience fear, helplessness, horror (though not required)
• Symptoms:
  
  • Avoidance
  • Intrusive symptoms (re-experiencing, nightmares, flashbacks)
  • Negative cognitions and mood states
  • Emotional numbing
  • Altered physiological arousal and reactivity
• Markedly interferes with ability to function

Question 6

PTSD incidence

Answer 6

1 in 10 Canadians

Mostly combat and sexual assault

Women develop at 2x the rate (assumed to be result of systemic oppression)

Question 7

PTSD Diagnostic Criteria (DSM 5)

Answer 7

• Exposure to actual or threatened death, serious injury, or sexual violence through
  
  • Direct experience of traumatic event
  • Witnessing (in person) the event
  • Learning a traumatic event occured to loved one
  • Experiencing repeated/extreme exposure to details of trauma (counsellors, first responders etc)
• Presence of one or more intrusion symptoms
  
  • Recurrent, involuntary distressing memories
  • Recurring distressing dreams
  • Dissociative reactions (eg flashbacks) where one feels/acts as if event were recurring
  • Intense/prolongued psychological distress at exposure to internal or external cues that symbolize/resemble the event
  • Marked physiological reactions to internal or external cues that symbolize/resemble the event
• Persistent avoidance of stimuli associated with the traumatic event beginning after the event occurred displayed by:
  
  • Avoidance of distressing memories, thoughts, feelings associated with event
  • Avoidance of external reminders (people, places, conversations, activities, objects, or situations) that arouse memories, thoughts, feeligns associated with the trauma
• Negative alterations in cognitions and mood associated with event, starting or wrosening after the event occurred, as shown by 2 of:
  
  • Inability to remember parts of trauma (typically due to dissociative amnesia)
  • Persistent, exaggerated -ve beliefs about self/others/world
  • Persistent, distorted cognitions about cause/consequences of trauma leading to blame of self/others
  • Persistent -ve emotional state
  • Diminished interest or participation in significant activities
  • Feelings of detachment from others
  • Persistent inability to experience +ve emotions
• Marked alterations in arousal and reactivity associated with the event beginning or worsening after the event occurred as eviences by 2 or more of:
• Duration of B-E for more than 1 month
• Disturbance causes clinically significant distress/impairment in social, occupational, other important areas of functioning
• Disturbance is not attributed to substance use or other medical condition

Question 8

PTSD Diagnostic Criteria

-Exposure to trauma details

Answer 8

• Direct experience of traumatic event
• Witnessing (in person) the event
• Learning a traumatic event occured to loved one
• Experiencing repeated/extreme exposure to details of trauma (counsellors, first responders etc)

Question 9

PTSD Diagnostic Criteria

• Intrusion symptoms details

Answer 9

• Recurrent, involuntary distressing memories
• Recurring distressing dreams
• Dissociative reactions (eg flashbacks) where one feels/acts as if event were recurring
• Intense/prolongued psychological distress at exposure to internal or external cues that symbolize/resemble the event
• Marked physiological reactions to internal or external cues that symbolize/resemble the event

Question 10

PTSD Diagnostic criteria

• Avoidance of stimuli associated with trauma displayed by…

Answer 10

1. Avoidance of distressing memories, thoughts, feelings associated with event
2. Avoidance of external reminders (people, places, conversations, activities, objects, or situations) that arouse memories, thoughts, feeligns associated with the trauma

Question 11

PTSD Diagnostic Criteria

• Negative alterations in cognitions show by _____ or more of:

Answer 11

• 2
• Inability to remember parts of trauma (typically due to dissociative amnesia)
• Persistent, exaggerated -ve beliefs about self/others/world
• Persistent, distorted cognitions about cause/consequences of trauma leading to blame of self/others
• Persistent -ve emotional state
• Diminished interest or participation in significant activities
• Feelings of detachment from others
• Persistent inability to experience +ve emotions

Question 12

PTSD Diagnostic Criteria

Marked alterations in arousal and reactivity as evidenced by ____ or more of…

Answer 12

• 2
• irritable behaviour or outbursts of anger
• hyper vigilance
• Exaggerated startle response
• Problems with concentration
• Sleep disturbance

Question 13

Causes of PTSD

Answer 13

Generalized psycholigical vulnerability & Generalized biological vulnerability

|

Experience of trauma = true alarm

|

Learned alarm

|

Anxious apprehension of re-exeperienced emotions

|

Avoidance of numbing of emotional responses

Question 14

PTSD Treatments

Drugs

Therapy

Answer 14

1. Medications
   
   • SSRIs
2. Cognitive-behavioural treatment
   
   • Exposure, Imaginal, Graduated or massed
   • Increased +ve coping skills
     
     • So that they can cope in exposure situations
     • Managing intrusive symptoms
   • Increased social support
     
     • Train supports to help outside therapy
   • Highly effective

Question 15

Excoriation

May lead to…

Gender imbalance

Onset

Answer 15

• An Obsessive-Compulsive and Related Disorder
• Biting fingernails, skin picking
• May lead to isolation, impairment due to embarassment, may not be aware that they are doing it
• 3/4 affect are female.
• Onset at puberty
• Person periodically tries to stop

Question 16

Trichotillomania

Answer 16

• An Obsessive-Compulsive Disorder and Related Disorder
• Pulling out hair
• Shows up around early puberty
• Usually about anxiety
• Typically try to stop and are unable to
• Genetically linked
• Treated similarly to OCD

Question 17

Obsessive-Compulsive and Related Disorders

Answer 17

• Obsessive-Compulsive Disorder
• Body Dysmorphic Disorder
• Hoarding Disorder
• Trichotillomania
• Excoriation
• Substance-Induced Obsessive-Compulsive and Related Disorder
• Obsessive-Compulsive and Related Disorder Due to Another Medical Condition

Question 18

Obsessive-Compulsive Disorder

(description)

Answer 18

• Obsessions
  
  • Repetitive and persistent thoughts
  • Intrusive thoughts, images, urges
  • Attempts to resist of eliminate
• Compulsions
  
  • Reptitive behaviours/mental acts driven to perform in response to an obsession, or according to rules, which must be rigidly followed
  • Temporarily suppresses obsessions
  • Typically: checking, ordering, arranging, washing/cleaning
  • Time-consuming. Causes clinically significant distress or impairment

Question 19

OCD Diagnostic Criteria (DSM 5)

(headings)

Answer 19

1. Presence of obsessions, compulsions or both
2. Obsessions/compulsions are time-consuming (take more the 1 hr/day) or cause clinically significant distress or impairment in social, occupational, or other important areas of functioning
3. The disturbance is not attributable to the physiological effects of a substance or another medical condition

Question 20

OCD

Obsessions defined by:

Answer 20

1. Recurrent and persistent thoughts, urges, or images experienced at some time during the disturbance, as intrusive and unwanted; in most individuals, cause marked anxiety or distress
2. The person attempts to ignore or suppress such thoughts, urges, or images, or to neutralize them with some other thought or action (ie., performing a compulsion)

Question 21

OCD

Compulsions defined by:

Answer 21

1. Repetitive behaviours or mental acts that the person feels driven to perform in response to an obsession, or according to rules that must be applied rigidly
2. Compulsions aimed at preventing or reducing anxiety or distress or preventing some dreaded event; however, they do not connect in a realistic way with what they are designed to prevent

Question 22

Causes of OCD

Answer 22

• Generalized psychological vulnerability & generalized biological vulnerability >>> Stress due to life events >>> intrusive thoughts/images/impulses
• Many people are born in harsh family environments where they were made to feel as if they “screwed up”
• Understanding the difference bt wanting do do something and doing it is absent.

Question 23

OCD Treatment

Drugs

Therapy

Other options

Answer 23

• Clomipramine and SSRIs
  
  • 50-60% benefit, high relapse when discontinued
• Cognitive-behavioural therapy
  
  • Exposure and Ritual Prevention
  • Reality testing
  • Highly effective
• Psychosurgery (cingulotomy) in extreme cases

Question 24

Body Dysmorphic Disorder

Answer 24

• Preoccupation with percieved deflects or flaws in physical
• Typically unobservable to others, or slight flaws
• strong beliefs regarding unattractiveness or physical abnormalities
• Characterized by intrusive thoughts, time-consuming activities related to appearance
  
  • Checking mirrors, comparison to others
  • Efforts to improve appearance (Excessive grooming, exercising, cosmetic surgery, skin picking)

Question 25

Body Dysmorphic Disorder Diagnostic Criteria (DSM 5)

(full)

Answer 25

1. Preoccupation with 1 or more defects/flaws in physical appearance not observable or which appear slight to others
2. At some point during the course of the disorder, the individual has performed repetitive behaviours (eg mirror checking, excessive grooming, skin picking, reassurance seeking) or mental acts (eg comparing to others) in response to appearnace concerns
3. Preoccupation causes clin. sig. distress or impairment in social, occupational, or other important areas of functioning
4. Appearance preoccupation is not better explained by concerns with body fat or weight in an individual whose symptoms meet diagnostic criteria for an eating disorder

Question 26

Body Dysmorphic Disorder

Causes

Answer 26

• Causes unknown
• Similarities with OCD
• Often comorbid with OCD

Question 27

Body Dysmorphic Disorder

Treatment

Answer 27

• SSRIs, Prozac
• Exposure and response prevention therapy

Question 28

Mood disorders

Prevalence

Answer 28

• Females twice as likely to have mood disorders as males
• Typical onset is adolescence
• Depression shown across subcultures.

Question 29

Depression

(overview)

Answer 29

• Extremely depressed mood state (at least 2 wks, typically 9 months)
• Cognitive symtoms
  
  • Feeling worthless, lack of concentration
• Vegetative of somatic symptoms
• Anhedonia - loss of pleasure/interest
• Single episode unusual / recurrent episodes more common

Question 30

Major Depression Disorder Diagnostic Criteria (DSM 5)

(headings)

Answer 30

1. 5+ symptoms suring the same 2-week period, representing a change from previous functioning. At least one symptom is either depressed mood or loss of interst/pleasure.
2. Symptoms cause clinically significant distress or impairment in social, occuptional, or other important areas of functioning
3. The episode is not attributable to the physiological effects of a substance or to another medical/mental disorder
4. They has never been a manic or hypomanic episode

Question 31

Major Depressive Disorder Diagnostic Criteria

Possible defining symptoms (9)

Answer 31

1. Depressed mood all day
2. Diminished interest/pleasure in all or nearly all activities
3. Significant weight loss when not dieting or weight gain, or decrease in appetite
4. Insomnia or hypersomnia
5. Psychomotor agitation or retardation
6. Fatigue or loss of energy
7. Feelings of worthlessness or excessive guilt
8. Dimished ability to think or concentrate, indecisiveness
9. Recurring thoughts of death, recurrent suicidal ideation, attempt or plan in place

Question 32

Persistent Depressive Disorder in comparison to MDD

Answer 32

• 2+ years without being symptom free for more than 2 months
• Similar symptoms as MDD
• More chronic and severe than MDD
• Higher rates of comorbidity
• Higher rates of suicide
• Less responsive to treatment

Question 33

Persistent Depressive Disorder Diagnostic Criteria (DSM 5)

Answer 33

1. Depressed mood for most of the day, for more days than not, as reported by self of external observation, for at least 2 years
2. Presence while depressed of 2+ of:
   
   • Poor appetite or overeating
   • Insomnia or hypersomnia
   • Low energy or fatigue
   • Low self esteen
   • poor concentration or difficulty making decisions
   • Feelings of hopelessness
3. During past 2 years, never been symptom free for more than 2 months
4. No presence of manic, or hyomanic episodes or cyclothynic disorder

Question 34

Manic Episode (DSM 5 Criteria)

Answer 34

1. Abnormally and persistently elevated, expansive or irritable mood and goal-directed activity or energy lasting at least 1 week.
2. 3+ of the following have persisted (4 if only irritable mood):
   
   • Inflated self esteem/grandiostiy
   • Decreased need for sleep
   • More talkative, or pressured speech
   • Flight of ideas or subjective experience that thoughts are racing
   • Distractibility
   • Increased goal-directed activity or psychomotor agitation
   • Excessive involvement in pleasurable activities that have a high potential for painful consequences

Question 35

Hypomanic Episode

Answer 35

less severe

1. Like manic; shorter; no goal directed behaviour; no evidence of psychosis; no marked deterioration in functioning
2. • Inflated self esteem or grandiosity
   • Decreased need for sleep
   • More talkative or pressured speech
   • Flight of ideas or subjective experience of racing thoughts
   • Distractibility
   • Increased goal directed activity or psychomotor agitation (much less severe)
   • Excessive involvement in pleasurable activities that have a high potential for painful consequences.

Question 36

Premenstrual Dysphoric Disorder: DSM-5 Diagnostic Criteria

Answer 36

1. Most mentrual cycles. 5+ in final week before onset of menses. Symptoms improve within a few days after onset, becoming minimal/absent in postmenses week.
2. One or more of:
   
   • Marked affective lability (mood swings)
   • Marked irritability
   • Marked depressed mood
   • Marked anxiety, tension, and/or feelings or being on edge
3. One or more of the following must be additionally present:
   
   • Decreased interest in usual activities
   • Subjective difficulty in concentration
   • Lethargy, easily tired, lack of energy
   • Change in appetite, overeating, cravings
   • Hypersomnia or insomnia
   • Sense of being overwhelmed or out of control
   • Physical symptoms - breast tenderness/swelling, join or muscle pain, sensation of bloating or weight gain

Question 37

Disruptive Mood Dysregulation Disorder: DSM 5 Diagnostic Criteria

Answer 37

1. Severe recurrent temper outbursts (verbal and/or behavoiural) that are out of proportion to the situation
2. Temper outbursts inconsistent with developmental level
3. Temper outbursts occur, on average 3+ times a week
4. Between outbursts mood is persistently irritable or angry most of the day, nealry every day and is observable by others
5. All present for 12+ months - symptom free for no longer than 3 months
6. All present in 2 of 3 settings and severe in 1
7. Diagnosis not made prior to age 6 or after age 18
8. Typically onset is before age 10.

• Must rule out MDD or other disorder as cause of tantrums. Must also be no neurological disruptions that cause the symptoms
• In adults, would be diagnosed as antisocial disorder
• Not ADHD - emotional issue, not impulse control.

Question 38

Bipolar 1 Disorder

Description

psychosis?

Outcomes

Onset

Prognosis

Answer 38

• Alterations between full manic apisodes and major depressive episodes, meeting fell diagnostic criteria for both mania and MDD during those episodes
• May show evidence of psychosis
• Suicide common
• Average onset at age 18
• Tends to be chronic

Question 39

Bipolar 2 Disorder

Answer 39

• Alterations between hypomanic episodes and major depressive episodes, meeting full diagnostic criteria for both
• May include psychotic features
• High risk of suicide
• Average onset at 22 years
• Typically chronic
• ~10% progress to bipolar 1 disorder

Question 40

Cyclothemic Disorder

comorbidity?

Answer 40

• More chronic, but less severe version of bipolar disorder
• Hypomanic symptoms alternate with depressive symptoms (not full MDD). Can be more of either or equal distribution of both.
• Not met criteria for MDD, manic or hypomanic episodes.
• Patterns lasts for 2+ years (1 year for children and adolescents)
• Typically chronic and lifelong
• High risk for developing bipolar disorder
• Lots of comorbidity with sleep disorder, substance abuse and ADHD (in kids)

Question 41

“With psychotic features”

Answer 41

Mood congruent/incongruent hallucinations/delusions occurring during manic, hypomanic or depressive episodes

Question 42

“With anxious distress”

Answer 42

Anxiety symptoms present during manic, hypomanic or depressive episodes

Question 43

“with catatonia”

Answer 43

Marked psychomotor disturbance (severely decreased motor activity and/or engagement or excessive/peculiar motor activity.

Question 44

“with peripartum onset”

Answer 44

Mood episodes having onset either during or post pregnancy

Question 45

“with mixed features”

Answer 45

Manic symptoms present during depressive symptoms

Question 46

“With melancholic features”

Answer 46

Loss of pleasure or reactivity to pleasurable stimuli; despondancy; severe somatic symptoms (depressive episode only)

Question 47

“With Atypical features”

Answer 47

**depressive episodes

Mood reactivity

significant weight gain/loss

hypersomnia

leaden paralysis

severe rejection sensitivity

Question 48

Causes of mood disorders

Familial and genetic influences

Answer 48

• Twins tend to both experience it (especially bipolar disorder)
• Higher rates in relatives of people with bipolar and MDD
• Greater genetic vulnerability for females
• Depression and bipolar disorder seem to be inherited seperately
• Evidence for joint heritability of anxiety and depression.

Question 49

Neurobiological influences on mood disorders

NTs

Permissive hypothesis

Brain activity in Depression and Bipolar

Answer 49

• Low levels serotonin implicated only in relation to other NTs (norepinephrine and dopamine)
• Permissive hypothesis - low serotonin permits other NTs to bcm dyregulated
• Dopamine implicated in mania
• Depression - right side of brain more active than left (seen in offspring)
• Bipolar - elevated left brain activation

Question 50

Mood disorders causes

endocrine system

Answer 50

• People with endocrine disease often present with depression due to high cortisol levels.
• Use the elevated cortisol and dexamethasone suppression test
  
  • Dexamethasone suppresses cortisol secretion
  • Mood and anxiety disorder show less suppression of cortisol when given dexamethasone

Question 51

Mood Disorders: Sleep disturbance

Depression

Bipolar

Answer 51

• Quicker transition to REM
• Depression: Intensified REM, later/reduced low wave sleep
• Bipolar: insomnia/hypersomnia, can be result of sleep deprivation

Question 52

The role of stress in mood disorder

Answer 52

• Stress -> onset and relapse
• Severe life stress => poor response to treatment
• Stress => cortisol => less sleep/feelings of uncontrolability
• Diathesis Stress and gene-environment correlation models
  
  • basic genetic vulnerability and relative tendency to put themself in stressful life situations

Question 53

Learned Helplessness Theory of Depression

Answer 53

• 3 attributional styles lead to sense of hopelessness
• Internal attributions - belief that negative outcomes are one’s own fault
• Stable attributions - believing that future negative outcomes will be one’s own fault
• Global attributions - believing negative events will disrupt many life activities

Question 54

Beck’s Cognitive Theory of depression

Answer 54

• Defines depression as a tendency to interpret life events negatively
• Cognitive Errors:
  
  • Arbitrary Inference - overemphasize the negative in everything and minimalize the positive
  • Overgeneralization - generalize -ve outcomes in life to all aspects of it. Eg “I’ll never have friends because I didn’t meet one at camp”
• The Depressive Triad - tendency to think -vely about oneself, the world, the future

Question 55

Gender imbalances in mood disorders

depression prevalence trend

Answer 55

• All imabalnced except for bipolar disorder
• Likely due to socialization and resulting percieved uncontrolability
  
  • more boys depressed early on. After puberty more girls depressed andthis continues until age 65-80s where there are higher levels again in men

Question 56

Mood Disorders: Social support and relationships

Marriage

Onset

Recovery

Answer 56

• Marital dissatisfaction strongly related to depression (particularly in males)
• Extent of social support predicts late onset depression
• Good social support predicts recovery from depression
• Good relationships can help moderate disorders and help treatment, but when they end they can cause relapse

Question 57

Treatment for mood disorders

Drugs

Other Treatments

Therapy

Answer 57

• Biological:
  
  • Medications that work on NT systems (histamine, dopamine, norepinephrine)
  • Electroconvulsive treatment
• Psychological
  
  • Cognitive behavioural therapy
  • Interpersonal therapy

Question 58

Antidepressants: Tricyclics

Answer 58

Initially blocks reuptake of norepinephrine and other NTs, but -ve side effects are common (dry mouth, sex dysfunction, weight gain).

Question 59

Antidepressants: MAOs

Answer 59

• monoamine oxidase inhibitors
• Block MAO (enzyme that breaks down serotonin and norepinephrine)
• Fewer side ffects than tricyclics
• Take about 6-8 weeks to work
• Potentially fatal interactions (cold medications, cheese, red wine)

Question 60

Antidepressants: SSRIs

Answer 60

• Selective Serotonin Reuptake Inhibitors
• Prozac
• First choie at moment
• Pose no unique risks for suicide or violence
• work faster
• Negative side effects common (sleep issues, decreased sexual desire, GI upset)

Question 61

Issues with antidepressants

Answer 61

• Efficacy issues and -ve side effects in children and elderly
• nearly 50% fail to improve
• People who were suicidal may gain enough energy to follow plan through

Question 62

Lithium

Answer 62

• Bipolar disorder treatment
• Narrow therapeutic window - too little, no effect or too much, lethal
• Effective with 50%
• High rates of relapse

Question 63

Electroconvulsive therapy

Answer 63

• Mood disorder treatment
• Application of a brief electrical current results in temporary seizures
• 6-10 treatments
• Last resort
• Highly effective for severe depression (50-70%) no responding to medication improve
• Relapse common

Question 64

Mood Disorders: Cognitive Therapy

Answer 64

• Identify thinking errors and substitute more adaptive thoughts
• Correct cognitive errors and negative cognitive schemas
• Includes behavioural components
• as effective as medication. Wors well alongside medication

Question 65

Mood Disorders: psychological treatment

behavioural activation

Answer 65

• Helps depressed person make increased contact with reinforcing events.

Question 66

Mood Disorder: Psychological treatment

Interpersonal psychotherapy

Answer 66

Address interpersonal issues in relationships

Question 67

Suicide rates in Canada

3 groups

men vs women

Answer 67

• Higher in aborginal people - especially on reserve
• Increasing rates in young people - especially univeristy
• Older adults - especially after loss of spouse
• Males have higher completion rates - use more lethal methods
• Females have higher attempts

Question 68

Suicidal Ideation vs

Suicidal Gesture vs

Suicidal Attempts vs

Suicidal Completion

Answer 68

1. Thinking about hurting/killing self
2. Flirting with suicide - acts that are dangerous but not life threatening
3. Attempting
4. Completing

Question 69

Suicide Risk Factors (8)

Answer 69

1. Family history
2. Low serotonin (associated with impulsivity, instability and the tendency to overreact to situations)
3. Preexisting psychological disorder
4. Alcohol use/abuse
5. Past suicidal attempts** (big one)
6. Shameful/humiliating stressor - major change that they fear will destroy their life
7. Publicity about suicide - especially in youth. People who you see as similar to you or who you look up to
8. Serious illness or loss of spouse (especially in older men)

Question 70

Suicide: protective factors

Answer 70

• Religious affiliation that is against suicide
• Reponsibility for others (parents)
• Cognitive flexibility
• Strong social support
• Lack of precipitating events
• Hopefulness
• Treatment of psychiatric of personality disorders

Question 71

Suicide: Assessment and Treatment

Risk assessment (4)

Treatment (4)

Answer 71

• Thorough risk assessment
  
  • Ideation vs intent
  • Recent stressful events
  • Previous attempts
  • Plans, method, means and access to means of suicide
• No suicide contract
• Problem solving therapy
• Cognitive behavioural therapy
• Hospitalization

Question 72

Dissociative Identity Disorder: DSM 5 Diagnostic Criteria

Answer 72

• Disruption of identity chracterized by 2 or more distinct personality states. Discontinuity in sense of self, accompanied by alterations in affect, behaviour, consciousness, memory, perception, cognition and/or sensory/motor functioning
• Recurrent gaps in the recall of everyday events, important personal information, and/or traumatic events that are inconsistent with ordinary forgetting
• The symptoms cause clinically significant distress or impairment and are not attributable to effects of a substance or medical condition.

Question 73

Defining feature of dissociative identity disorder

Answer 73

dissociation of sertain key aspects of personality

Question 74

What are alters (Dissociative Identity disorder)

Answer 74

The different identities

Question 75

Dissociative Identity Disorder. Define:

Host

Switch

Answer 75

1. The identity that keeps other identities together
2. Transition from one personality to the another

Question 76

2 key factors in Dissociative Identity Disorder

Answer 76

1. Dissociation of certain key aspects of personality (leading to adoption of different identities, on average 15)
2. Amnesia (dissociative or fugue)

Question 77

Dissociative Identity Disorder

Statistics

genders

onset

course

comorbidity

typical causes

Answer 77

• 9 female : 1 male
• Onset in childhood >> frequency of switching decreases with age
• Lifelong, chronic course
• High comorbidity
• Often occurs with childhood sexual abuse

Question 78

Dissociative Identity Disoerder: Causes

brain

history

personality traits

Answer 78

• Biological
  
  • Biological vulnerability suspected
  • Smaller hippocampus and amygdala volume
• Severe abuse/trauma history
  
  • Natural tendency to escape or dissociate from horrific experiences
  • More likely to occur is the trauma occurs at young age
• Highly suggestible persons may be able to use DID as defense against trauma (Auto hypnotic model)

Question 79

Dissociative Identity Disorder: Treatment

Answer 79

• Goals of treatment
  
  • Reintegration of identities
  • Identify triggers that provoke memories of trauma and dissociation
  • Visualize and learn to cope with traumatic memories
• Medications may be used
  *

Question 80

Dissociative Disorders are characterize by…

Answer 80

severe alterations or detachments in identity, memory or consciousness including depersonalization and derealization

Question 81

Types of Dissociative Disorders

Answer 81

1. Dissociative Amnesia
2. Dissociative Personality Disorder
3. Depersonalization/Derealization Disorder

Question 83

Depersonalization/Derealization Disorder Description

describe

course

comorbidity

Answer 83

• Persistent, recurrent and severe/frightening feelinds of unreality and detachment
• Chronic, lifelong
• Comorbidity: anxiety and mood disorders

Question 84

Depersonalization/Derealization Disorder Causes

Answer 84

• Cognitive deficits - easily distracted, deficit to the regard of 3d objects - they don’t really see in 3d

Question 85

Dissociative Amnesia

Description

Causes

Answer 85

• Inability to recall important personal information, usually of a traumatic or stressful nature, that is inconsistent with ordinary forgetful
• Localized - can recall some events occurring for specific period of time; typically associated with trauma
• Generalized - inabilty to recall anything, including their identity; very rare
• Causes - little known, trauma and stress involved

Question 86

List of Schizophrenia and Other Psychotic Disorders

Answer 86

1. Schizophrenia
2. Schizoaffective disorder
3. Schizophreniform Disorder
4. Brief Psychotic Disorder
5. Delusional Disorder

Question 87

What is psychosis?

How is it related to Schizophrenia Spectrum Disorders?

Answer 87

• Psychosis = characterized by hallucinations and delusions; experienced in several disorders
• Some degree of psychosis is typically the defining feature of Schizophrenia Spectrum DIsorders
• Less common in other disorders

Question 88

Schizophrenia: Clinical Description

Answer 88

• Characterized by a broad spectrum of cognitive and emotional dysfunctions that include disturbances in :
  
  • Thought, language, emotion, behaviour
• Positive Symptoms: exaggerated or excess of behaviour.
• Negative Symptoms: absence of insufficiency of normal behaviour. Deficits in normal behaviour.
• Disorganized Symptoms: errative behaviours; affect speech, motor behaviour, emotional reactions.

Question 89

Schizophrenia Positive Symptoms: Delusions

Answer 89

• Characterized by gross misinterpretations of reality
• Types:
  
  • Delusions of grandeur: believing you are a famous person or religious person
  • Delusions of prosecution
  • Delusions of References: Radio example
  • Capgras Syndrome: believing that someone in your life has been replaced by a double
  • Cotard’s Syndrome: believing that part of your body has changes (eg microchip)
• Motivational or deficit

Question 90

Capgras Syndrome

Answer 90

believing that someone in your ife has been replaced by a double

delusion common in schizophrenia

Question 91

Cotard’s Syndrome

Answer 91

Believing that a part of your body has been changed (eg a microchip implanted)

Common delusion in Schizophrenia

Question 92

Schizophrenia Positive Symptoms: Hallucinations

brain activation in auditory hallucinations?

Answer 92

• Sensory experience in absense of environmental stimuli or input
• Can involve all senses
• Most common: auditory
  
  • Meta-cognition
  • Own bs. others voice
  • Broca’s area active during auditory hallucinations (production of speech)

Question 93

Schizophrenia Negative Symptoms

Answer 93

• Avolition (or apathy)
• Alogia
• Anhedonia
• Affective Flattening
• Asociality

Some or none of these may be shown

Question 94

Avolition

Answer 94

Apathy. Inability to initiate and persist in activities. Physical and emotional-cognitive

Question 95

Alogia

Answer 95

Schizophrenia negative symptom

Relative absense of speech. Inability to express yourself. Little content. Little explanation.

Question 96

Anhedonia

Answer 96

Schizophrenia positive symptom

Lack of pleasure, or indifference.

Question 97

Affective flattening

Answer 97

Shcizophrenia negative symptom

Absense of normally expected emotional responses. Frozen face but still feeling,

Question 98

Asociality

Answer 98

Schizophrenia negative symptom

Severe deficits in social functioning

Question 99

Schizophrenia Disorganized Symptoms (3)

Answer 99

1. Disorganized speech: cognitive slippage, tangentiality, loose associations or derailment
2. Disorganized Affect: inappropriate emotional behaviour
3. Disorganized Behaviour: Variety of unusual behaviours such as catatonia (freezig or excessive movement), epelalia (repeating what someone says over and over)

Question 100

Disorganized speech in schizophrenia

Answer 100

• Cognitive slippage - illogical and incoherent speech. Leaps from one idea to another, non-sensical words
• Tangentiality - going off on tangent, but logically related
• Loose associations or derailment - taking conversation in unrelated directions, frequent topic changes

Question 101

Schizophrenia Diagnostic Criteria (DSM 5)

Answer 101

1. 2 or more of the following for 1 month+
   
   • Delusions
   • Hallucinations
   • Disorganized speech
   • Grossly disorganized catatonic behaviour
   • Negative symptoms
2. Marked impairement in 1+ areas
3. Continuous signs of disturbance continue for 6+ months

Question 102

Prevalence of Schizophrenia and course

gender imbalance

prognosis

risks

onset

gender differences in outcome

Answer 102

• Prevalence = 1%, 1 : 1 gender spread
• Course = chronic. Complete recovery is rare. Can be lifetime impairment
  
  • Suicide common
  • Onset in late teens to mid 30s
  • Females have better outcomes. Later onset.
  • Males tend to get more -ve symptoms that are difficult to treat.

Question 103

Life course of schizophrenia

premorbid (3)

prodronal (6)

Answer 103

• Might see warnings of it in childhood. Difficulty adjusting to change, social ineptness, poor motor coordination
• Prodronal = psychotic like symptoms arise.
  
  • Thoughts of reference: coincidences you think are about you
  • Magical thinking and illusions
  • Hard time dealing with everyday stress
  • Social withdrawal
  • Attention problems
  • Mood symptoms
• Diagnosing in prodronal phase can prevent progression into type 1 schizo

Question 104

Schizoaffective disorder

Describe

prognosis

Answer 104

• Symptoms of both a mood disorder (depressive of bipolar) and schizophrenia
• Each disorder exists independently
  
  • Delusions/hallucinations present for 2 weeks in absnese of prominent mood disorder symptoms
  • Symptoms of mood episodes are present for majority
• Schizo symptoms come first and then the mood disorder. The mood disorder is present cyclically, making medication difficult.
• Prognosis is better than schizo but worse than mood disorders
  
  • Chronic

Question 105

Schizophreniform Disorder

Answer 105

• Schizophrenic symptoms and a noticable change in behaviour prior to onset.
• 1-6 months

Question 106

Brief psychotic disorder

Answer 106

• Sudden onset of delusions, hallucinations or disorganized speech.
• Presents like a nervous breakdown. Typically only +ve symptoms
• 1 day - 1 month

Question 107

Delusional Disorder

Answer 107

• 1 or more delusions in the absense of other schizophrenia symptoms
• Like celebrity stalkers
• 1 day - 1 month

Question 108

Causes of Schizophrenia: Genetic Influences

Answer 108

• Polygenic - many genes involved
• Severity in closer relations affects risk in relations
• Twin studies found strong genetic link and unshared environment impact.
• Deficits in smooth pursuit eye movement correlated with schizophrenia

Question 109

Causes of Schizophrenia: Neurobiological NT Influences

Answer 109

• Dopamine Hypothesis: drugs that increase dopamine, result in schizophrenic-like behaviour and v.v. But it is too simplistic
• Dopamine:
  
  • Prefrontal cortext usually has low activity of DA receptors
  • Striatum/basal ganglia: excessive activity of striatal DA receptors
  • Mesolimbic pathway: excessive activity of DA receptors
• Serotonin: involved in regulating DA neurons in mesolimbic pathway
• Glutamate: low levels of glutamate have been implicated by studies of effects of recreational drugs and post-mortem studies

Question 110

Schizophrenia Causes: Neurobiological Influences

Brain structure

Prenatal/birth differences

Answer 110

• Brain structure: enlarged ventricles. Hypofrontality (less activity there)
• Prenatal Viral Infection Exposure correlated with schizophrenia
• Birth Complications: hypoxia, fetal distress, low birth weight, prematurity are common in schizophrenia

Question 111

Schizophrenia Causes: Psychological and Social Influences

Answer 111

• Stress - vulnerability, increases relapse risk
• Family Interaction - Especially related to replapse. Highly dysfunctional communication (conflict, high emotion, criticism, hostility)
• Other psychological factors: likely very minimal in their effect on schizophrenia.

Question 112

Biological interventions for Schizophrenia

Answer 112

• Conventional antipsychotics: work with DA
  
  • Improve +ve symptoms, little effect on -ve
  • Severe side effects (that lead to compliance problems)
    
    • Extrapyramidal/Parkinson-like symptoms get increasingly worse as you take meds
      
      • Tardive dyskinesia (lip smacking, tongue protrution, shuffling, puffing cheeks)
      • Akinesia (expressionless face, looks like flat affect)
• Atypical antipsychotics: work with DA and serotonin
  
  • Improve -ve symptoms, decrease +ve symptoms
  • Fewer side effects
  • Not effective for all

Question 113

Treatment of Schizophrenia: Psychosocial Interventions

Answer 113

• Early intervention
• Behavioural intervention
• Cognitive-behavioural therapy
• Behavioral family therapy
• Social and living skills training

Question 114

Tardive dykinesia

akinesia

Answer 114

• Involuntary movements such as lip smacking, tongue protrusion, shuffling, puffing cheeks
• Expressionless face - looks like flat affect

Question 115

Compare and contras anorexia and bulimia

Answer 115

• Central thereme of extreme fear of gaining weight/drive to be thin
• Self-evaluation unduly influenced by body shape
• Inappropriate compensatory behaviours
• Health threatening -> highest mortality rates of all psychological disorders

Question 116

Compare and contrast binge eating disorder and bulimia nervosa

Answer 116

uncontrollable binge eating of large amounts of food

Question 117

Medical Consequences of Anorexia

Answer 117

• Amenorrhea - menses ceasing
• Dry skin
• Brittle hair, nails
• Sensitivity to cold temperatures
• Lanugo
• Cardiovascular problems
• Electrolyte imbalance

Question 118

Medical consequences of Bulimia

Answer 118

• Amenhorhea
• Salivary gland inlargement
• erosion of dental enamel
• electrolyte imbalance
• kidney failure
• cardiac arrhythmia
• seizures
• intestinal problems
• permanent colon damage

Question 119

Eating disorders statistics

Answer 119

• Anorexia and Bulimia - 90-95% female
  
  • Onsent age 13-15 anorexia, older for bulimia (even older in males)
• Binge eating disorder - more males
• Highest rates of eating disorders in Western countries
• Most severe in young, white females in competitive environments

Question 120

Social Dimensions of Eating Diorders

Media

Puberty

Answer 120

Media tells us we need to be thin to be happy

But there are so many high fat/sugar foods available

Girld put on fat at puberty, while boys put on muscle

Dieting trends have ramped up a lot

Question 121

Anorexia Nervosa Diagnostic Criteria (DSM 5)

Answer 121

• restriction of food intake leading to a significantly low body weight
• Intense fear of gaining weight
• Disturbance in body image, undue influence of body shape on self-evaluation, lack of recognition of the seriousness of the current low body weight
• Either:
  
  • Restricting or
  • Binge-eating/purging

Question 122

Bulimia Nervosa Diagnostic Criteria (DSM 5)

Answer 122

• Recurrent episodes of binge eating characterized by:
  
  • Eating in a discrete period of time a huge amount of food.
  • A sense of lack of control over eating during the episode
• Recurrent inappropriate compensatory behaviours
• Binging and purging once a week for 3+ months
• Self-evaluation unduly influences by body shape
• The disturbance does not occur exclusively during episodes of anorexia nervosa

Question 123

Binge-Eating Disorder Diagnostic Criteria (DSM 5)

Answer 123

• Recurrent episodes of binge eating:
  
  • In a discrete time frame, eating huge amounts of food
  • A sense of lack of control over eating during the episode
• Binge eating episodes associated with 3+ of
  
  • Eating more rapisly than normal
  • Eating until uncomfortably full
  • Eating when not hungry
  • Eating along due to embarassment
  • Feeling disgusted with self, depressed, guilty
• Marked stress regarding binge eating
• No inappropraite compensatory behaviours

Question 124

Biological causes of eating disorders

Answer 124

• Heritability especially with specific symptoms
• Inherited tendencies: emotional instability, poor impulse control, anxiet and mood disorders
• Neurobiological:
  
  • hypothalmus involvement
  • serotonin: low activity associated with impulsivity and binge-eating.

Question 125

psychological causes of eating disorders

Answer 125

• Low sense of personal control
• low self-confidence
• perfectionistic attitudes
• perception of being overweight
• Distorted body image
• Preoccupation with food and appearance
• Mood intolerance
• Higher levels of anxiety

Question 126

Family influences on eating disorders

Answer 126

• Characteristics of families with eating disordered child:
  
  • Successful, driven, perfectionistic
  • Overly concerned with appearance
  • Harmony maintained at all costs
  • Enmeshed
• History of dieting, eating disorders (mothers)

Question 127

Causes of Eating Disorders: Integrative Model

Answer 127

• Inherited Biological vulnerability linked to impulsive eating behaiour
• Psycholigcal factors such as perfectionism and anxiety focused on appearance interact, resulting in distorted body image
• Social influences shape attitudes toward body shape
• Attempts to restrict eating meet social ideals and internalized standards of size
• Anorexia, bulimia and BED develop and lead to chronic cycles of disordered eating behaviours

Question 128

Medical Treatment for Eating Disorders

Answer 128

• Anorexia - atypical antipsychotics can be successful
• Bulimia - Antidepressants reduce binging and purging behaviour, but aren’t that helpful in longterm
• BED - prozac has no benefit, meridia possible benefit

Question 129

Psychological treatment for Eating disorders: Transdiagnostic Treatment

Answer 129

• Focus on treating causal factor and concerns of all eating disorders:
• Targets:
  
  • Importance of body shape
  • Disordered eating and related behaviours
  • Readiness to change

Question 130

Psychological treatment for Anorexia

Answer 130

• Weight restoration
• Education, behavioural and cognitive interventions; often involved family
• Imperitive to target dysfunctional attitudes about body shape

Question 131

Psychological Treatment for Bulimia

Answer 131

• Cognitive-behaviour therapy targets:
  
  • dysfunctional beliefs toward dieting, purging, healthy eating, body sizes
  • Coping strategies for resisting urge to binge/purge

Question 132

Psychological Treatment for Binge Eating Disorder

Answer 132

• Cognitive-behaviour therapy similar to bulimia
• Interpersonal psychotherapy is equally effective

Question 133

Purpose of Assessing Psychological Disorders

Answer 133

1. Understand the individual
   
   • Current distress/symptoms/impairment
   • Current functioning
   • Past history
2. Determine a diagnosis
3. Inform treatment
4. Predict behaviour - prognosis

Question 134

Clincal Assessment:

Reliability

tools to determine

Answer 134

Consistency of the measurement (psychological testing) or procedures (clinical interview)

Test-retest - do the test twice

Inter-rater - used during interview. 2 people observe and must rank the scene the same

Question 135

Clinical Assessment: Validity

types

Answer 135

degree to which a technique or test measures what it is designed to measure

Content - does it measure what it is supposed to measure?

Predictive - we want to the method to be predictive, not correlative

Criterion - does the test refelct a certain set of abilities

• Standard - do the questions being asked actually get at a conclusion
• Concurrent - two instruments that are supposed to measure the same thing. Do they?

Question 136

Clinical Assessment: Standardization

Answer 136

Procedures established to ensure consistency

Question 137

Semi-structured interviews

Answer 137

• Specific format of questions, but you can still veer off to gather more info
• SCID (structured clinical interview of DSM) is semi-structured. Takes at least 2 hours and covers everything

Question 138

Unstructured Interviews

Answer 138

• Counselor comes up with their own set of questions, covering most of DSM
• Have to ask about thought of harming self or others

Question 139

Domains that clinical interviews assess

Answer 139

• Current behaviour and presenting problem
• Attitudes
• Emotions
• Detailed history
• Individual, family, social and occupational/school functioning
• Level of impairment and severity of symptoms
• Strengths, coping

Question 140

Clinical interview. Assess current level of functioning (8)

Answer 140

1. Current/recent stresses, losses or trauma
2. Depressive symptoms
3. Suicidal ideation
4. Functional impairment
5. Physical health issues (Hypothyroidism shows depression)
6. Social, emotional, relationship problems
7. Substance use or abuse
8. Family violence

Question 141

Mental Status exam (BATMIS)

Answer 141

Provide clinical information about a client’s emotional and cognitive functioning by:

• Assessing functioning in several domains related to overall psychological functioning
• Appearance and behaviour
• Thought processes
• Mood and affect
• Intellectual functioning
• Sensorium

Used in more hospital settings. Quick to tell what is going on psychologically and whether or not further assessment is necessary

Question 142

Mental Status Exam: Appearance and behaviour

Answer 142

• Summary of physical appearance
• Overal attitude and behaviours, fidgets, psychomotor agitiation
• Acting like they are seeing and hearing things that aren’t there

Question 143

Mental Status exam

1. Thought processes
2. Sensorium

Answer 143

1. Coherence or incoherence of thoughts
2. Assess pastient’s awareness of circumstances/situation. Are they in touch with reality

Question 144

Behavioural Assessment and Observation

Answer 144

• Observational assessment focuses on
  
  • Antecedents - what came before the behaviour in question (eg trigger of a tantrum)
  • Behaviour - what did they do
  • Consequences - what happened as a result of the behaviour? Was in reinforced or punished?
    
    • Yelling at a child can be reinforcing

Question 145

Psychological Testing

• Objective tests
• Projective tests
• Depression inventory
• CPCL
• TAT

Answer 145

• Objective tests
  
  • Standardized, empirically based, consistent
  • Self-report measures
  • Paper and pencil type
• Projective tests (eg roarshack)
  
  • Unstructured, ambiguous stimulus to which the person responds
  • Find out the things that even the person in question is unaware of
• Depression inventory (for adults)
• CPCL (children’s behavioural checklist)
• TAT = thematic apperception test. Not very reliable. Tell a story about the image on the card.

Question 146

Cognitive testing

Answer 146

• Determine intellectual ability and functioning
• Neurophysiology assessment
  
  • Determine cognitive functioning and potential deficits (memory impairment, cognitive impairment)
• Main tests for learning disorders
• WISC-IV has good validity

Question 147

MMPI

Answer 147

Objective personality test

• Originally not diverse, but now it is good for a diverse crowd
• Validity scale.
• L scale = lying and trying to look good
• F scale = infrequency scale, infrequent ways of responding, exaggeration of symptoms
• K scale = Defensiveness and suppressor scale. How they view themselves, hiding their scales

Question 148

Imaging brain structure

Answer 148

CAT = computer axial tomography

MRI = magnetic resonance imaging

Question 149

Imaging Brain function

Answer 149

PET = positron emission tomography

SPECT = single photon emission computed tomography

The same process, different tracer

fMRI = brief view of changes in brain activity

Question 150

Psychopathological Assessment

Answer 150

• EEG (electroencephalogram) - brain wave activity
• Heart rate and respiration - cardiorespiratory activity
• Electrodermal response/levels - sweat gland activity
• EMG (electromyography) - muscle tension

Question 151

Classical categorical approach

Answer 151

assumes each disorder is unique with its own set of symptoms and causes - you have it or you don’t.

Question 152

Dimensional approach

Answer 152

places disorders on a continuum from non-existent to severe, based on empirical data.

Question 153

prototypical approach

Answer 153

combines classical and dimensional views

the one the DSM 5 uses. Though DSM 5 leans toward dimensional

Question 154

DSM

Answer 154

standardized system and criteria for diagnosis; aid in evaluating prognosis and treatment planning

DSM 3 brought multiaxial diagnostic system and detailed criteria for each disorder based on expert consensus

DSM 4 went to prototypical approach with empirical grounding

Question 155

DSM 5

Answer 155

• greater emphasis on dimensional approach
• COnsideration for neural underpinnings, family variable and genetic factors
• Disordes clustered on a general internalizing (behaviours) and externalizing (internal feelings) spectrum
• Emphasis on development and the impact or gender and culture

Question 156

Kayak - Angst

Answer 156

Episodes of intense fear, worries about drowning; rapid heart beat, trembling ; similar to panic disorder

Inuit

Question 157

Taijin kyofusho

Answer 157

Phobia regarding body (offensive appearance, odor) causes intense fears intense fears of humiliation; similar to social phobia.

Japanese

Question 158

Brain Fag

Answer 158

• Difficulties concentrating, thinking, remembering; somatic complaints; head, neck, blurred; similar to anxiety/depression
• West African Origins

Question 159

Ataques de Nervios

Answer 159

Headaches, tearfulness, irritability, sleep/eating disturbances, trembling, similar to panic attack

Question 160

Dissociative disorder overview

characterized by:

Answer 160

• Severe alterations or detachments in identity, memory or consciousness, depersonalization, derealization
• Depersonalization: detachment from self; feeling as if outside body
• Derealization: feeling unreality in the world

Question 161

Types od Dissociative Disorders

Answer 161

Depersonalization/derealization disorder

dissociative identitiy disorder

dissociative amnesia

Question 162

Depersonalization/Derealization Disorder

describe

prognosis

comorbidity

Answer 162

Severe/frightening feelings of depersonalization and derealization

• Can experience on or the other, but most people experience both
• Clinically significant stress
• Not out of touch with reality - know something is wrong
• chronic, lifelong
• Comorbidity: anxiety and mood disorders

Question 163

Causes of Depersonalization/derealization disorder

Answer 163

• Cognitive deficits
• Easily distracted, deficit in 3d vision

Question 164

Dissociative Amnesia

Descriptions

types

Answer 164

Inability to recall important personal information, usually of traumatic nature. Inconsistent with normal forgetting

Localized = can recall some, but not all of the events for a specific period of time - usually related to trauma

General - inability to recall anything (identity). Very rare.

Question 165

Causes of dissociative amnesia

Answer 165

Little is known; trauma and stress heavily involved

Question 166

Treatment for Dissociative Amnesia

Answer 166

Usually get better without treatment

Question 167

Dissociative Identity disorder

defining factors

Answer 167

Dissociation of certain aspects of personality

Alterations in affect, behaviou, consciousness, memory, perception, cognition and or sensory-motor functioning

Recurrent gaps in memory of everyday events/personal info/trauma

Adoption of new identities or “alters” - usually 15 (2-100)

Host: the identity that keeps the other identities together

Switch: transition from one perosnality to another

Question 168

Dissociative Identity disorder

Stats

Comorbidity

Prognosis

Answer 168

• 1.5% a year
• Female 9:1
• Comorbid with anxiety, substance abuse, depression, borderline personality disorder
• Onse it Childhood. Lifelone, chronic course. Switch frequency decreases with age.

Question 169

Dissociative identity disorder Causes

biological

history

autohypnotic model

Answer 169

Biological:

• Biological vulnerability (no genetic links found)
• Smaller hippocampal and anygdala volume

Trauma/abuse history

• May be extreme subtype of PTSD
• Natural tendency to dissociate from horrific experiences

Autohypnotic model - highly suggestible persons may be able to use dissociation as defence against extreme trauma

Question 170

Dissociative Identity disorder Treatment

Answer 170

• Goals:
  
  • Reintegration of identities
  • Identify/neutralize triggers that provoke memories of trauma and the dissociation that neutralizes them
  • Visualize and learn to cope with traumatic memories
• Medications - unknown efficacy

Question 171

Eating Disorders (3)

Answer 171

1. Anorexia nervosa
2. Bulimia Nervosa
3. Binge eating disorder

Question 172

Diagosing sexual disorders - what is considered normal?

Answer 172

Sexual disorders aren’t diagnosed unless thare cause subjective distress to the client; UNLESS the behaviour is against the law.

Question 173

Sexual dysfunctions all involve (3)

Answer 173

desire, arousal and/or phases of human sexual response cycle

Question 174

Are sexual dysfunctions lifelong or acquired?

Answer 174

They can be either.

Lifelong as in when you start becoming sexual.

Question 175

Life factors that can contribute to a sexual dysfunction (6)

Answer 175

1. Body image
2. Mood disorders, anxiety
3. Sexual abuse, trauma
4. Exhaustion
5. Cultural and religious factors - what is and isn’t acceptable
6. Anxiety (arousal desire performance).

Question 176

Male Hypoactive Sexual Desire Disorder

Answer 176

• Deficient or absent sexual thoughts and desire for sexual activity
• 6 months+
• Clinicaly significant distress to the individual
• Not better explained by a nonsexual mental disorder, relationship distress or other stressor or substance or medical condition
  
  • some have concerns about ejaculation or erection and avoid sexual realtions because of that.

Question 177

Male Erectile Disorder

Answer 177

• At least one of the following in 75-100% of partnered sexual activity:
  
  • Difficulty obtaining erection
  • Difficulty maintaining erection until completion of activity
  • Decrease in erectile rigidity
• 6 months+
• Distress to individual
• Not better explained by nonsexual mental disorder, relationship stress, other stressor, substance or medical condition

Increases with age

Myth that if you don’t have erectile dysfunction you never have problems - drinking, drugs all cause erectile issues

Question 178

Female Sexual Interest/Arousal Disorder

describe

things to rule out

Answer 178

• Lack of/reduced sexual interest/arousal. Shows 3 of:
  
  • Absent/reduced interest in sex activity
  • Absent/reduced sexual thoughts/fantasies
  • Absent/reduced sexual excitement/pleasure in almost all sexual encounters
  • Absent/reduced genital/non-genital sensations during sexual activity in almost all encounters
  • Reduced initiation of sexual activity + typically unreceptive to partner’s attempts to initiate
• 6 months+
• Distress to client
• Rule out medication, menopause, might be pain problem, sexual abuse

Question 179

Female Orgasmic Disorder

describe

myths about orgasm

things that may cause this

Answer 179

• 1 or both of the following 75-100% of partnered sexual activity:
  
  • Delay in/infrequency of/absence of orgasm
  • Reduced intensity of orgasmic sensations
• 6 months+
• Clinically significant distress to individual
• Not bettere explained by nonsexual mental disorder, relationship distress, other stressors, substance or medical condition

similar to erectile dysfunction. About 50% females report not always having an orgasm. Happens in spite of adequate stimulation

Other factors: lsexual inexperience, pelvic nerve damage, SSRis inhibit orgasm, vaginal dryness

Question 180

Delayed Ejaculation Disorder

Answer 180

• One of the following on 75-100% of partnered sexual activity and without individual desiring delay
  
  • Delay in ejaculation
  • Infrequency or absense of ejaculation
• 6 months+
• Distress to individual
• Not better explained by nonsexial mental disorder, relationship distress, other stressors, substance or medical condition

NOTE: Myth that men ejaculate all the time, after age 50 ejaculation is delayed after refractory period

Question 181

Treatment for Female ORgasmic Disorder

Answer 181

psychoeducation: many women don’t get as many orgasms as you think

Behavioural and medical treatment too

Question 182

Premature Ejaculation Disorder

Answer 182

• Recurrent pattern of ejaculation during partnered activity within 1 min following vaginal penetration and before individual wishes it
• 6 months +
• Distress to indivdual
• Not better explained by nonsexual mental disorder, relationshp stress, other stressors, substance or medical condition

Question 183

Premature ejaculation disorder treatments

Answer 183

psychoeducation

behavioural and medical treatment

Question 184

Realms of sexual disorders

Answer 184

Arousal disorders

Orgasmic Disorders

Sexual pain disorders

paraphilic disorders

gender dysphoria

Question 185

Genito-Pelvic Pain/Penetration Disorder

Answer 185

• REcurrent difficulties with 1+ of:
  
  • Vaginal penetration during intercourse
  • vulvovaginal or pelvic pain during vaginal intercourse
  • Fear or anxiety about vulvovaginal/pelvic pain before, during or after vaginal penetration
  • Tensing or tightening pelvic floor during attempted vaginal penetration - vaginal/pelvic floor muscle spasms - vaginismus (most usualy presentation)
• 6 months+
• Distress to individual
• Not better explained by nonsexual mental disorder, relationship distress, other stressors, substance or medical condition

Usually appears in early adultyhood or menopause

Correlated with vaginal infection and use of tampons

Question 186

Causes of Sexual Dysfunctions

Biological

Psychological

Social/cultural

Answer 186

Biological Contributions:

• Physical disease and medical illness (once treated, pain is gone)
• Substance use/abuse
• Endometriosis is a risk - can lead to built up scar tissue that causes pain. Women wh ohave had children are less at risk bc of shedding

Psychological Contributions:

• Performance anxiety
• Stress

Social and Cultural Contributions:

• Erotophobia - Learned negative attitudes about sexuality
• Lack of knowledge regarding sexuality (eg religious affiliations)
• Negative or traumatic sexual experiences
• Deterioration of intimate relationship/poor communication

Question 187

Assessing Sexual Behaviour and Sexual Dysfunction

Answer 187

Comprehensive Interview:

• History of sexual behaviour, lifestyle, associated factors
  
  • First sexual experiences, what changed
• Intimate relationship quality or distrese - determine degress of distress

Psychophysiological Evaluation:

• Exposure to erotic material
• Determine extent and pattern of physiological + subjective sexual arousal - might have low sex drive

Medical Examination:

• Rule out potential medical causes

Question 188

Treatment of Sexual Dysfunctions

psychosocial intervention (Sensate Focus)

Answer 188

Masters and Johnson;

Education and elimination of performance anxiety using sensate focus

Sensate focus = no sex agreement, over time, more sexual activity allowed. Idea is that if you tell someone they can’t have sex it takes off the pressure to perform; couples realize other ways of sexually satisfying each other

Question 189

Treatment of Sexual Dysfunctions

Additional Psychosocial procedures for:

1. Premature ejaculation
2. female orgasm disorder
3. vaginismus
4. Low sexual desire

Answer 189

1. Squeeze technique: for premature ejaculation
2. Masturbatory training: Female orgasm disorder. Learn about your body and what kind of stimulation you need to get an orgasm
3. Use of vaginal dilators: vaginismus
4. Exposure to erotic material: low sexual desire

Question 190

Medical treatment for sexual dysfunctions

Answer 190

• Primarily available for erectile dysfunction
• Medications
• Implants and surgery

Question 191

Gender Dysphoria

Answer 191

• Incongruence between one’s experiences and assigned gender
• 6 months+
• 2 of:
  
  • Incongruence between experienced gender and primary/secondary sex characteristics
  • Distress
  • Strong desire:
    
    • to be rid of one’s primary/secondary sex characteristics
    • for primary/secondar sex characteristics of other gender
    • to be treated as other gender
    • to be other gender
  • Strong conviction that one has the gender’s typical feelings
• Clinically significant distress or impairment in social, occupational or other areas of functioning

Question 192

Gender Dysphoria:

Prevalence

co-morbidity

getting surgery

development

Answer 192

• Rare - 0.002-0.014%
  
  • More males than females
  • Found across lifespan, cultures and countries
• Comorbid: anxiety, depression, suicide
• Surgery only approved after diagnosis (if you weren’t distressed you wouldn’t get the diagnosis)
• Develops early (as early as 4 years old)

Question 193

Gender Dysphoria causes

Answer 193

Evidence of genetic vulnerability

Question 194

Gender Dysphoria: Assessment and treatment

Answer 194

• Assessment: developmental, sexual and relationship history
• Psychosocial Treatment: realigning the person’s psychological gender with their natal sex (if desired)
• Medical Treatment: sex-reassignment surgery
  
  • Prerequisites for surgery:
    
    • 1-2 years in preferred sex role
    • Assessment by physician/psychiatrist
    • Hormone therapy
• healing work to deal with mistreatment

Question 195

Paraphilic disorders are…

Answer 195

Unusual sexual interests, attraction and arousal.

Socially defined as inappropriate

May cause distress/imairment to individual or has personal harm or risk of harm to others/illegal

Question 196

Fetishistic Disorder

explain

common fetishes

• comorbidity*
• onset*

gender split

Answer 196

• intense sexual arousal from
  
  • Use of nonliving objects OR
  • High specifc focus on non-genital body parts as manifested by fantasies, urges or behaviours
• Must cause distress to warrant diagnosis
• 6 months+
• Commonly: footwear, rubber articles, leather clothing, female undergarments | feet, toes, hair
• Comorbid with anxiety, modd and substance disorder
• Onset in teens, more males

Question 197

Transvestic disorder

explain

autodiphilia

onset

Answer 197

• Recurrent and intense sexual arousal from corssdressing as manifested by fantasies, urges or behaviours
• Diagnosis if:
  
  • 6 months+
  • Crossdressing is almost always accompanied by sexual excitement
  • Individual experiences distress or impairment
• Majority are male; many are married

Autodiphilia = arousal to themselves as the other gender

Onset in childhood/adolescence

Sexual excitement almost always tied to crossdressing

Question 198

Voyeuristic Disorder

Answer 198

• Recurrent, intense sexual arousal from observing unsuspecting person naked, undressing or engaging in sexual activity, manifested by fantasies, urges or behaviours
• Element of risk necessary for arousal
• 18 years old+
• Against the law so daignosed without distress
• comorbid with ADHD

Question 199

Exhibitionistic Disorder

Answer 199

• Recurrent, intense sexual arousal from exposure of one’s genitals to unsuspecting persons, manifested by fantasies, urges or behaviours
• Element of thrill and risk are necessary for sexual arousal
• Illegal
• Comorbid with ADHD

Question 200

Frotteuristic Disorder

Answer 200

• Recurrent, intense sexual arousal from touching or rubbing against a nonconsenting person, manifested by fantasies, urgest or behaviours
• Illegal
• Comorbid with anxiety and substance abuse

Question 201

Sexual masochism

• onset*
• risks*

Answer 201

• Recurrent and intense sexual arousal from the act of being humiliated, beaten, bound or otherwise made to suffer, manifested by urges, fantasies and behaviours
• Needs to cause distress for diagnosis
• 6 months+
• Onset in late teens or adulthood
• May include autoerotic practices leading to injury or death

Question 202

Sexual sadism

Answer 202

• Recurrent and intense sexual arousal from physical or psychological suffering of others, manifested by fantasies, urges or behaviours
• Sexual urges have been acted upon with a non-consenting person or must cause clinically significant distress or impairment to warrant a diagnosis
• 6 months+
• Onset in late teens/adulthood
• Many sexually related homicides due to sadism

Question 203

Pedophilic Disorder

• types*
• minimum age*
• comorbidity*

Answer 203

• Recurrent, intense, sexually arousing fantasies, sexual urges, or behaviours which involve sexual activity with a prepubescent child (<13)
  
  • Exclusive or nonexclusive type
• Must have acted on child-focused sexual urges or experience distress or impairment
• Minimum 16 years old; at leat 5 years older than victim
  
  • Not typically diagnosed for an older teen in an ongoing sexual relationship with a younger teen
• 6 months+
• 3-5% of male population; unknown for females
• Combordity: substance abuse, mood/anxiety disorders, other paraphilias, antisocial personality disorder

Question 204

Causes of paraphilic disorders (7)

Answer 204

1. Low arousal from appropriate stimuli
2. Seuxal problems
3. Social deficits
4. Early experiences
   
   1. Inappropriate arousal/fantasy
   2. Classical conditioning
5. High sex drive
6. Low suppression of urgest/drive
7. Reinforcement via orgasm

Question 205

Paraphilic DIsorders

Assessment

Treatment

Answer 205

Assessment:

• Extent of deviant patterns of sexual arousal, sexual history, social skills and the ability to form relationships

Psychosocial interventions:

• Behavioural, family/marital and group therapy
• Relapse prevention
• 12-step programs (SAA)
  
  • Covert sensitization = imagine aversive outcome to acting on the paraphilia
  • Orgasmic reconditioning = Masturbate at the same time and when they are about to orgasm, insert a more appropriate fantasy.

Medications: Chemical castration reduced testosterone - only for chronic offenders. Only works while being used.

Question 206

Do you have to have withdrawal or tolerance to be diagnosed with a substance-related or addictive disorder?

Answer 206

No. You can be psychologically impaired without being physically addicted.

Question 207

Substance-Related and Addictive Disorders:

Symptoms subtypes (4)

Answer 207

1. Impaired control
2. Social impairment
3. Risky use
4. Pharmacological

Question 208

psychoactive substances

Answer 208

substances that alter mood and/or behaviour

ingested to become intoxicated/high

Question 209

Substance related disorders are

Answer 209

Disorders based on problems related to use and abuse of psychoactive substances

Question 210

Substance related disoreders

DSM 5 criteria (11)

Answer 210

1. Substance often taken in larger amounts or over a longer period of than intended
2. Persistent desire or unsuccessful effors to cut down or control substance use
3. Great deal fo time speak in activities necessary to obtain, use and recover from the effects of the substance
4. Cravings or urges to use the substance
   
   • Physiological addiction or psychological learning
5. Failure to fulfill obligations at work/school/home due to substance use
6. Continues despite persistent/recurrent interpersonal problems caused by or exacerbated by substance use
7. Important social/occupational/recreational activities given up or reduced due to substance use
8. Recurrent substance use in situations in which it is physically hazardous
9. Continued use despite knowledge of physical or psychological problem that is likely to been caused or worsened by the substance
10. Tolerance
11. Withdrawal

Question 211

Substance related disorders

3 types of symptoms

Answer 211

cognitive, behavioural, physiological

Question 212

Substance related disorders

Limitations on diagnosis

Answer 212

• Applied to all classes of substances, but NOT caffeine
• Min 2 of of 11 symptoms over 12 months
• DIstress/impairment

Question 213

Substance related disorders risky use symptoms

Answer 213

1. Recurrent substance use in situations in which it is physically hazardous
2. Continued use despite knowledge of physical or psychological problem that is likely to be caused or worsened by the substance
   
   • Eg you have a DUI but you drive drunk anyways
   • You have lung cancer by the smoke anyways

Question 214

Substance related disorders

Pharmacological Symptoms

Answer 214

1. Tolerance as shown by 1 of:
   
   • Need for increased amounts to achieve original/desired effect
   • Diminished effect with continued use of same amount of substance
2. Withdrawal as manifested by either of:
   
   • Characteristic withdrawal syndrome for the substance
   • Same (or closely related) substance is taken to relieve or avoid withdrawal symptoms

you don’t need to have these to be diagnosed

Question 215

Psychoactive substances of Abuse

Substance Classifications

Answer 215

Depressants

Stmulants

Opiates/Opioids

Cannabis

Hallucinogens

Other drugs of abuse

Question 216

Depressants

Result in:

Examples:

Answer 216

Result in behavioural sedation

Ex: alcohol, sedatives, anxiolytic drugs

Question 217

Stimulants

What do they do?

Examples

Answer 217

increase alertness and elevate mood

Ex: methamphetamines, cocaine, nicotine, caffeine

Question 218

Opiates/Opioids

What do they do?

Examples

Answer 218

Produce analgesia and euphoria

Ex: oxycodone, heroin, morphine, codeine

Question 219

Cannabis

What does it do?

Answer 219

Alter sensory perception

Question 220

Hallucinogens

What do they do?

Answer 220

Alter sensory perception

Question 221

Other drugs of abuse

Answer 221

inhalants, anabolic steroids, medications

Question 222

Alcohol:

stats on population

Gender

At risk populations

Answer 222

23% of population exceeds low risk; 17% exceeds high risk; 10% have drinking related problems; 3% alcohol dependent

Men more likely to drink heavily than women

On university campus: Binge Drinking and Drunkorexia

Question 223

What is drunkorexia

Answer 223

Undereating in order to ‘save’ calories for drinking

found on university campuses

Question 224

Alcohol: effects on central nervous system and feeling/behavioural/experience outcomes

• depresses what?*
• sensorimotor effects*
• memory loss*

Answer 224

• Initially depresses inhibitory centres of brain
• Influences several NT systems, such as GABA, glutamate and serotonin
  
  • Depresses tendency to worry about what other think of you
• Impaired motor coordination, sow reaction time, confusion, slurred speech, hearing and judgement impairment
• Anti-anxiety effects with GABA system
• Glutamate system responsible for memory loss/black outs
• Interacts with every organ in body

Question 225

Effects of chronic alcohol use

Answer 225

• Alchohol withdrawal: delerium tremors, hallucinations, body tremors, flu like symptoms, nausea, vomiting, periods of high anxiety
• Associated brain conditions
  
  • Dementia and Wernicke’s disease (confusion, loss of coordination, unintelligible speech due to thymin deficiency)
• Fetal alcohol syndrome
• Liver disease: Cirrhosis

Question 226

Effects of amphetamines

• action in brain
• Overdose symptoms
• addiction due to
• tolerance
• withdrawal

Answer 226

• Produce elation, vigor, reduce fatigue
• Stimulate CNS by enhancing release of domapine, norepiniphrine while also blocking reuptake
  
  • Followed by a ‘crash’ of tiredness and depression
• Overdose: hallucinations, panic, agitation, paranoid delusions, repressed respiratory ability and more
• Highly addictive bc of NT activity
• Tolerance and dependence are typical
• Withdrawal similar to depression

Question 227

Meth in america

Answer 227

Huge issue, started because there was a meth weight loss pill

Question 228

Negative reinforcement and addiction

Answer 228

Taking something away that is hurtful. Eg alcohol takes away anxiety

Question 229

What are opioids

Answer 229

The class of natural and synthetic substances with narcotic effects

Includes: heroin, codein, morphine and oxycodone

Question 230

Effects of Opioids

• activate:*
• low doeses cause*
• high doses cause*
• withdrawal*

Answer 230

• Activate body’s enkephalins and endorphins
• Low doses: euphoria, dowsiness, slowed breathing
• High doses: can result in death
• Withdrawal: nausea, vomiting, muscle aches, diarrhea, insomnia, bad flue symptoms
  
  • Can be lasting and severe

Question 231

Opioids mortality rates

Answer 231

High mortality of 30% - suicide, homicide, accidents, HIV due to intravenous injection

Not as bad in Canada

Question 232

What durg used to be sued to treat addictions to another drug?

Answer 232

heroine used to be used to treat cocaine addictions

Question 233

What are hallucinogens?

Their effects

examples

Answer 233

• Substances that change perception
• Produce delusions, paranoia, hallucinations, dissociative experiences and altered sensory perception. Flashbacks of these experiences after substance has worn off
• Built up tolerance wuickly, withdrawal isn’t bad, tolerance fades without use
• Ex: LSD, psilocybin (mushrooms), PCP

Question 234

psychoactive substances mimic NTs

Answer 234

Each mimics a different NT and they’re all agonists

Question 235

Cannabis

Effects

Frequent users

Withdrawal

Answer 235

• Effects: Mood swings, heightened sensory experiences, dream-like states
  
  • Larger doses: paranoia and hallucinations
• Frequent users experience impairments in memory, concentration, reduced self-esteem, relationship impairment, impaired motivation
• Cannabis withdrawal syndrome
  
  • Irritability, anger, anxiety, depressed mood, restlessness, sleep problems, decreased appetite, weight loss
• Amotivational syndrome in long term pot users

Question 236

Causes of addiction:

Family and genetic influences

Answer 236

• Strong genetic component to substance abuse
• Genes influence alcoholism and alcohol consumption levels
• Genetic differences in alcohol metabolism
• Multiple genes impilcated in substance abuse

Question 237

Neurobiological influences in addiction

• brain regions that involve*
• pleasure pathway*
• inhibition*

Answer 237

• Addiction involves several brain regions and neurocircuitry related to reward, motivation, memory and impulse control
• Most drugs activate pleasure pathway in brain
  
  • Dopaminergic system in midbrain, frontal cortex
  • Effects on pleasure pathway can be direct or indirect. Directly by alcohol, amphetamines, cocaine and nicotine
• NTs responsible for anxiety/negative affect may be inhibited by psychoactive substances

Question 238

Psychological dimentions in addiction:

Answer 238

Role of positive and negative reinforcement:

• Pleasurable effects of substance
• Self-medication and tension reduction
• Substances used to cope with negative affect

Opponent Procces Theory

• Integrates positive and negative reinforcement model to explain continued use and abuse -
• Use to feel good - use to excess - hangover (aversive) - do it again because it felt good - repeat
• Eventually you may do it to feel normal

Role of Expectancy

• Expectancies regarding effects and use seem to have an indirect influence on drug use and relapse

Question 239

2 levels or pleasure: 2 levels of reinforcement

Answer 239

• We are aware of feelings good on a psycholoigcal level when we use the substance; body is also experiencing physiological level of pleasure when we use
• In opponent process theory, when we use again we experience 2 levels of reinforcement. Physological because hangover is taken away and psychological because we feel good again.

Question 240

Causes of substance abuse:

Social and Cultural dimension

Answer 240

• Modeling and exposure has been shown to be a prerequisite for use
  
  • Media, family, peers - modeling by parents is CRITICAL (high percentage of adults drink at least moderately in N. America)
  • Normality of substance abuse
• Societal views on abuse/dependence
  
  • Drug abuse seen as a failure of self-control, moral weakness
  • OR drug abuse is seen as a disease that is caused by some underlying process (medical view)
• Cultural factors influence how substance use is manifested
  
  • Cultural expectations regarding use and definitions of abuse

Question 241

Substance dependence treatment: Biological

Answer 241

• Agonist substitution: Safer drug with similar chemical composition
• Antagonistic treatment: drugs that block or conteract pleasurable effects
• Aversive treatment: make ingestion of substance extremely unpleasant
• Cope with withdrawal and reduce cravings
• Efficacy is limited when biological measures are used alone
• Better with psychological treatment

Question 242

Substance Dependence treatment:

Angonist substitution

Answer 242

Safer drug with similar chemical composition

Eg: methadone, nicotine gum/patch -> harm reduction

Question 243

Substance dependence treatment:

Antagonistic treatment

Answer 243

drugs that block or conteract pleasurable effects -> immediate withdrawal symptoms (Hospital detox only)

Eg: naltrexone for opiate and alcohol dependence

Question 244

Substance dependence treatment:

aversive treatment

Answer 244

make ingestion of substance extremely unpleasant - not used often, high relapse rate when discontinued. Administered by doctors.

Ex: Antabuse for alcoholism, silver nitrate for nicotine

Mild electric shock in some cases

Question 245

Substance dependence treatment: Psychological treatments

Answer 245

Comprehensive Treatment and Preventional Programs

• Highly individualized therapy plan; unique vulnerabilities and environments
• Individual and group therapy
• Aversion therapy and covert sensitizatin
• Contingenxy management
• Relapse prevention
• Preventative effors via education
• community support programs

Question 246

Substance addiction treatment: Covert Sensitization

Answer 246

pairing the addictive behavoiur with an unpleasant experience like imagining getting caught while driving/exhibiting

Question 247

Substance addiction Treatment: Contingency management

Answer 247

A reward system that is individually powerful

Question 248

Substance addiction treatment: Community reinforcement

Answer 248

Getting family and friends to be supportive is really important.

Question 249

Substance addiction treatment: Relapse prevention

Answer 249

Figure out what there is in their life that could put them on the path to relapse. Anticipate and prepare.

Question 250

Gambling disorder

Description

Onset - early onset associated with?

Subtypes

Answer 250

• Persistent and recurrent problematic gambling behaviour that disrupts one’s life across several areas
• Onset: more common in young adults and middle aged adults (especially since internet gambling)
  
  • Earlier onset associated with pattern of impulsivity and substance abuse
• Subtypes: based on motivation. Action motivated do it for a rush, Escape Type gamble to escape their ordinary life.

Question 251

Gambling disorder clinical symptoms

Answer 251

4 or more of:

1. Needs to gamble with increasing amounts of money in order to achieve the desired excitement.
2. Is restless or irritable when attempting to cut down or stop gambling.
3. Has made repeated unsuccessful efforts to control, cut back, or stop gambling.
4. Is often preoccupied with gambling (e.g., having persistent thoughts of reliving past gambling experiences, handicapping or planning the next venture, thinking of ways to get money with which to gamble).
5. Often gambles when feeling distressed (e.g., helpless, guilty, anxious, depressed).
6. After losing money gambling, often returns another day to get even (“chasing” one’s losses).
7. Lies to conceal the extent of involvement with gambling.
8. Has jeopardized or lost a significant relationship, job, or educational or career opportunity because of gambling.
9. Relies on others to provide money to relieve desperate financial situations caused by gambling.

Question 252

Gambling disorder treatment

Answer 252

• Less than 10% seek treatment and of that there is a huge number of drop outs
• CBT that targets gambling motivation has shown promising results

Question 253

Personality disorders general comorbidity

Answer 253

Often comborbid with mood disorders and that makes the disorders both more difficult to treat.

Question 254

Personality disorders

General description

Course

Diagnosis

Onset

Answer 254

• Enduring and relatively stable psychological disturbance
• Evidence that it may improve over life course, even without treatment
• No need for clinical distress for diagnosis. Impairment is enough
• Onset usually inchildhood and adolescence but not diagnosed until 18 years+

Question 255

Five factor model

Answer 255

Neuroticism = emotional instability, anxiety

Extroversion: sociability, warmth, assertiveness

Openness: open to experience and others’ viewpoints, curious

Agreeableness: straighforwardness, trust, altruism

Conscientiousness: Competence, persistence and prudence

Question 256

General Personality disorder diagnoistic criteria

Answer 256

• Inner experience and behaviour that deviates from expectations of one’s culture in 2 or more of: cognition, affect, interpesonal functioning or impulse control
• Enduring pattern:
  
  • Pervasive across a range of situations
  • Leads to clinically sig distress or impairment
  • Stable, long duration, onset can be traced to childhood/early adulthood
  • Cannot be better explained by another mental disorder, medical condition or substance use

Question 257

Prevalence of Personality Disorders

Prevalence

Comorbidity

Diagnostic controversy

Answer 257

• .5-2.5% of general population
  
  • Higher number of inpatient and outpatient settings
• comorbidity: high rates
• Diagnostic controversy: Clinican Bias
  
  • Diagnoses of personality disorders suggest bias to gender, specific behaviours or experiences (crime, abuse, trauma)
  • Bias is reason to do a structured interview.

Question 258

Cluster A disorders

Answer 258

social skill deficits and odd, eccentric, unusual behavoiurs

Paranoid personality disorder: .5-27.5%

Schizoid personality disorder: 0.8-11%

Schizotypal personality disorder: 0-22%

high risk of suicide

Question 259

Cluster A disorders on 5 Factor Model

Answer 259

Parnoid PD:

• Low extraversion: introverted, shy, socially awkward
• Low openness: closed off, rigid, inflexible
• Low agreeability: antagonistic, argumentative, hostile

Schizoid PD:

• Low extraversion

Schizotypal PD:

• High neuroticism: proneness to psychological distress and/or impulsivity
• low extraverson
• high openness: receptivity to experience, imaginative, curious

Question 260

Paranoid Personality Disorder DSM criteria

Answer 260

Pervasive distrust such that others’ motives are interpreted as malevolent by 4+ of:

• Suspects, without proof, that other are exploiting/harming them
• Preoccupied with unjustified doubts about loyalty/trustworthiness of friends/associates
• Reluctant to confide in others due to unwarranted fear that info will be used against them
• Sees hidden meanings in benign remarks
• Persistently bears grudges, not apparent to others
• Perceives attacks on their character and quick to react angrily
• Recurrent suspicions, without proof, regarding partner’s fidelity

Not as extreme as schizophrenic delusions.

Question 261

Paranoid personality disorder: rejection sensitivity and empathy

Answer 261

High rejection sensitivity

low empathy

Question 262

Paranoi Personality Disorder prevalence

Answer 262

Inpatients: 10-30%

Outpatients: 2-10%

Common in deaf, because they can’t hear everything that is going on.

Question 263

Paranoid Personality Disorder: Causes

Answer 263

• Genetic contribution
• Biological and psychological contributions are unclear
• Possible result of early learning that people and the world are dangerous

Question 264

Paranoid Personality Disorder: Treatment options

Answer 264

• Few seek professional help on their own
• Treatment focuses on development of trust
• Cognitive therapy to counter negative thinking
• Lack good outcome studies showing that treatment is efficatious

Question 265

Schizoid Personality Disorder: Criteria

Answer 265

• Pervasive pattern of detachment from social relationships, restricted range of expresion of emotions in interpersonal settings, indicated by 5 or more of
  
  • Doesn’t want or like close relationships with others, including family
  • Almost always chooses solitary activities
  • Little interest in sexual experiences with another person
  • Takes pleasure in few activities - restricted emotion range
  • Lacks close friends other than 1st-degress relatives
  • Appears indifferent to the praise or criticism from others
  • Emotional coldness, detachment, flattened affect.

Question 266

Schizoid Personality disorder

prevalence

Causes

Treatment options

Answer 266

• ~3-4% of population
• Uncommon in clinical settings
• Possible family link to schizophrenia and schizotypal PD
• Few seek professional help on own
• Focus on value of interpersonal relationships, empathy, social skills
• Poor prognosis

Question 267

Schizotypal Personality disorder DSM criteria

Answer 267

• Pervasive pattern of social deficits shown by rediced capacity for close relationships, cognitive/perceptual distortions and eccentricities of behaviour, shown by 5+ of:
  
  • ideas of reference
  • odd beliefs or magical thinking that influence behav
  • unusual perceptual experiences, including bodily illusions
  • odd thinking speech
  • suspicious or paranoid ideation
  • inappropriate or constricted affect
  • odd/eccentric/peculiar behaviour or appearance
  • lack close friends other than 1st degree relatives
  • social anxiety associated with paranoid fears

Strong links with schizophrenia

truly cannot relate to others socially/deficit not anxiety. Links drawn to autism

• *

Question 268

Schizotypal personality disorder

prevalence

cause

Answer 268

Prevalence

• 0-0.2% of general population
• High risk for developing schizophrenia
• 30-50% reach criteria for major depression

Causes

• Possible phenotype of schizophrenia genotype
  
  • Much higher rates in relatives of schizophrenia
• Brain deficits, reduced activity in left hemisphere, prefrontal cortex and temporal lobe

Question 269

Schizotypal Personality disorder: treatment options

Answer 269

• Often brought to treatment by concerned family or employers
  
  • Odd behaviour makes them noticeable
• High suicide completion rate ~10% (stress, PD, depression)
• Main focus on developing social skills, addressing depression
• Antipsychotics show mild to moderate symptom improvement

Question 270

Cluster B disorders

characterized by

different disprders (4)

Answer 270

Characterized by dramatic, emotional or erratic behaviours

1. Narcissistic PD
2. Histronic PD
3. Borderline PD
4. Antisocial PD

Question 271

5 Factor Model for CLuster B PDs

Answer 271

Borderline: high N, high E, Low A, low C

Narcissestic: high N, high A, low A, high C

Histronic: high N, high E, low C

Antisocial: low A, low C

Question 272

Narcissistic PD DSM Criteria

Answer 272

• Pervasive pattern of grandiosity (fantasy or behaviour), need for admiration, lack of empathy as indicated by 5+ of:
  
  • Grandiose sense of self-importance
  • Preoccupied with fantasties of unlimited success, power, brilliance, beauty or ideal love
  • Believes they they are special and can only be understood by/associate with other special people
  • Requires excessive admiration
  • Sense of entitlement
  • Interpersonally exploitative
  • Lacks empathy
  • Envious of others or believes that others of envious of them
  • Arrogant, haughty behaviours

Question 273

Narcissistic PD:

Prevalence

Causes

treatment

Answer 273

Prevalence: 2-16% of clinical population

• reports of increasing frequency
• equal in men and women

Causes:

• Genetic links and psychological links
• Linked with early failure to learn empathy as a child
  
  • Egocentrism stage at age 2-3

Treatment:

• Focus on grandiosity, lack of empathy and unrealistic thinking and co-occuring depression
• little evidence that treatment is effective.

Question 275

Histronic PD: DSM5Criteria

Answer 275

Pervasive pattern of excessive emotionality and attention-seeking as indicated by 5+ of

• Uncomfortable in situation when not centre of attention
• Inappropriate sexually provocative behaviour.
• Rapid shifting or shallow expression of emotions
• Uses physical appearance to draw attention to self
• Impressionistic style of speech, lacking detail
• Self-dramatization, theatricality, exaggerated expression of emotion
• Suggestible
• Considers relationships to be be more intimate than they are

Question 276

Histronic misdiagnoses and differences from narcissism

Answer 276

Many misdiagnosises of females because the characteristics are seen as sterotypically female

Different from narcissism in that Histronic craves attention, not because they think they’re better than anyone but because it makes them feel good. Narcissists think they deserve attention because of who they are

Question 277

Histronic Personality Disorder

Gender differences

Causes

Treatment

Answer 277

• Higher ration of females than males diagnosed

Causes: genetic contribution

• Also associated with early childhood separations, absense of meaningful relationships, deprivation/neglect or trauma

Treatment:

• Focus on attention seeking and problematic interpersonal behaviours and underlying sense of inadequacy
• little evidence that treatment is effective.

Question 278

Borderline Personality Disorder DSM 5 criteria

Answer 278

Instability in interpersonal relationships, self-image, affect, marked impulsivity. 5+ of

• frantic efforts to avoid real or imagined abandonment
• pattern bt instable and intense interpersonal relationships alternating between extremes of idealization and devaluation
• identity disturbance: unstable self-image or sense of self
• impulsivity in 2+ areas that are potentially self-damaging
• suicidal behaviour, gestures, threats, self-mutilation
• Affective instability, reactivity in mood - react to whatever internal feelings they are experiencing in the moment
• Chronic feeling of emptiness
• Inappropriate, intense anger or difficulty controlling ager
• Transient, stress-related paranoid ideation or dissociative symptoms

Rejection sensitivity

Question 279

Borderline personality disorder:

prevalence

comorbidity

risks

Answer 279

One of the most common PDs seen in psychiatric settings

combordity with: depression, bipolar disorder, substance abuse, bulimia

high risk of: suicide

Question 280

borderline personality disorder

causes

Answer 280

Causes:

• Genetic, neurological, environmental and psychological links
• High concordance rates
• Deficits in prefrontal cortex and limbic system
• Early trauma and abuse (correlated)
• High rates of rejection sensitivity

Question 281

borderline personality disorder:

treatment options

Answer 281

Antidepressants provide short-term relief

Dialectical Behavioural Therapy is most promising approach

• Learn coping skills and healthier ways of interpreting situations they’re in
• emotional reactivity

Question 282

Antisocial Personality Disorder DSM 5 criteria

Answer 282

Disregard for and violation of others since age 15, shown by 3+ of:

1. failure to conform to social norms - lawful behaviours. Repeatedly performing acts that are grounds for arrest
2. deception - lying, use of aliases, conning others for personal profit or pelasure
3. impulsive, failure to plan ahead
4. irritability and aggressiveness - physical fights or assaults
5. irresponsibility - failure to sustain consistent work behaviour or honour financial obligations
6. lack of remorse - indifferent or rationalizing having hurt, mistreated or stolen from another

Question 283

antisocial personality disorder in children

Answer 283

often diagnosed as conduct disorder

Question 284

antisocial PD

prevalence

associated clinical features

Answer 284

Prevalent: in prisons. ASPD 75%; psychopathy 40%

• Higher in young adults, people with a family history, urban areas, low socioeconomic status

Associated with tendency to be irresponsible, impulsive, deceitful, lack empathy

• Substance abuse in 83%
• Many have history of ADHD, learning difficulties or behavioural problems (conudct disorder or oppositional defiant disorder)
• Many from families of inconsistent parental discipline/support and histories of criminal and violent behaviour.

Question 285

what is psychopathy:

Answer 285

Subgroup of ASPD, characterized by callousness toward others, deceptivenessm lacks remorse, manipulative, lacks empathy, eggocentric.

Relationship with criminality and ASPD

Question 286

Causes of antisocial personality disorder:

genetic and neurobiological theories

Answer 286

• Genetic influence suggested by twin/family studies: 38% genetic; 55% concordance rates.
• Neuroimaging shows deficits in prefrontal cortex and related provlems with executive functioning and inability to inhibit impulses.
• Cortical immaturity hypothesis: cerebral cortex isn’t fully developed yet.
• Underarousal hypothesis: low cortical arounsal.
• Fearlessness hpothesis: psychopaths vail fair to repsond with feat to danger cues

Question 287

treatment of antisocial personality disorder

Answer 287

• Few seek help on their own
• High relapse
• Prevention and rehabilitation
  
  • Early - parent training
  • Prevention:
    
    • rewards for pro-social behaviour
    • skills training
    • improve social competence
• engagement in antisocial behaviours is predictive of poor prognosis, even as children

Question 288

Cluster C Disorders

disorders included

Answer 288

Includes:

1. Dependent Personality Disorder
2. Avoidant Personality Disorder
3. Obsessive Compulsive Personality Disorder

Question 289

Dependent Personality Disorder DSM 5 Criteria

Answer 289

Need to be taken care of, leading to submissive, clinging behaviour, fear of separation shown by 5+ of:

1. difficulty making everyday decisions without excessive advice and reassurance
2. needs other sto assume responsibility for most major areas of life
3. difficulty initiating projects or doing things on their own
4. goes to excessive lengths to obtain support from others
5. feels uncomfortable or helpless when alone
6. urgently seeks another relationship when a close relationship ends
7. unrealistically preoccupied with fears of being left to take care of oneself

Question 290

Dependent Personality Disorder

prevalence

causes

treatment

Answer 290

Prevalence: more commonly diagnosed in women

Causes: In addition to genetic contribution; linked to early disruptions in learning independence

Treatment:

• CBT and social skills training helpful
• Target skills that foster independence

Question 291

Avoidant PD DSM 5 criteria

Answer 291

Social inhibition, feelings of inadequacy, hypersensitivity to negative evaluation as shown by 4+ of:

1. avoiding occupational activities that involve significant interpersonal contact, because of fear of criticism/rejection
2. unwilling to get involved with people unless certain of being liked
3. restraint within intimate relationships because of fear of being shamed or ridiculed
4. preoccupied with being criticized or rejected in social situations
5. inhibited in new interpersonal situations because of feelinds of inadequacy
6. views self as socially inept, personally unappearling or inferior to others
7. relcutant to take personal risks or engage in any new activities because they may prove embarassing

Question 292

Avoidant personality disorder

prevalence

causes

treatment

Answer 292

Equal distribution in men and women

Causes: shared genetic vulnerability with Social Anxiety Disorder

• linked to early development - difficult temperment may lead to early rejection; higher rates of parental rejection, absense, abusiveness, inconsistency

Treatment: similar to treatment for Social Anxiety Disorder

• Target social skills and anxiety
• many good outcomes.

Question 293

Obsessive-Compulsive Personality Disorder DSM 5 Criteria

Answer 293

Preoccupation with orderliness, perfectionism, mental/interpersonal control, at expense of flexibility, openness, efficiency by 4+ of:

1. detais, rules, lists, organization, schedules to the extent where the major point of the activity is lost:
2. Perfectionism that interferes with task completion
3. excessively devotes to work to the exclusion of leisure activites and friendships
4. overly conscientious, inflexible about values
5. unable to discard worn out, or worthless objects
6. reluctant to delegate tasks or to work with others
7. spends little on self or others
8. rigidity and stubbornness

Question 294

obsessive-compulsive PD

prevalence

treatment

Answer 294

One of the most prevalent PDs in general population

Treatment: address fears related to the need for orderliness, rumination, procrastination and feelings of inadequacy