psych disorders Flashcards
(100 cards)
1
Q
Panic Disorder
A
- Recurrent unexpected panic attacks
- If you have only had one panic attack but meet the other criteria, you’ll probably be diagnosed
**At least one of the attacks has been followed by 1 month (or more) of one or both of the following
1) Persistent concern or worry about additional panic attacks or their consequences
2) A significant maladaptive change in behavior related to the attacks
Behaviors designed to avoid triggers to panic attacks → inhibit daily life - Disturbance is not attributable to the physiological effects of a substance or another medical condition
- Disturbance is not better explained by another mental disorder
2
Q
Agoraphobia
A
- Marked fear or avoidance about 2 (or more) of the following five situations
1) Using public transportation
2) Being in open spaces
3) Being in enclosed spaces
4) Standing in line or being in a crows
5) Being outside of the home - The individual fears or avoids these situations because of thoughts that escape might be difficult or help might not be available in the event of panic or other embarrassing symptoms
- Agoraphobic situations are almost ALWAYS AVOIDED
- Start to avoid so much of life because of this extreme fear
- Fear/anxiety is out of proportion to actual danger
- Fear/anxiety is persistent → 6 months+ (DSM benchmark)
3
Q
Generalized Anxiety Disorder
A
- Excessive anxiety and worry, occurring more days than not for 6+ months, about a number of events or activities (such as work or school performance)
- Individuals find it difficult to control the worry (cognitive/social)
- Try to manage it but nothing works → makes you miserable
- Anxiety and worry are associated with 3+ of the following symptoms
1) Restlessness or feeling keyed up or on edge
2) Being easily fatigued
3) Difficulty concentrating or mind going blank
4) Irritability (nervous system on edge)
5) Muscle tension (can’t relax)
6) Sleep disturbance
[does not have to have panic symptoms)
4
Q
Social Anxiety Disorder
A
- Always being inside your head about other people
- Fear of NEGATIVE EVALUATION (THE OTHER)
- Extreme or irrational concern about being negatively evaluated by other people, at least 6 months
- Sometimes (not always) manifests as shyness
- Leads to significant impairment and/or distress
- Avoidance of feared situations, or endurance with extreme distress (you are miserable)
- SUBTYPE: Performance ONLY
- Can manifest differently for people (think of Blushing)
5
Q
Taijin Kyofusho
A
- How SAD manifests in Japan
- the fear of offending others or making them uncomfortable (most common in males)
6
Q
Specific Phobias
A
- Feared object/situation is endured with great distress or avoided, at least 6 months
- Key distinction → phobias do not involve people’s evaluation of the individual or being perceived
- Daily life is disrupted
- Fear is excessive and unreasonable
- Involved EXPECTED panic attacks
- MAIN CATEGORIES
1) Blood/Injection/Injury
2) Natural Environment
3) Situational (enclosed spaces, public transport, etc.)
4) Animals
5) Other (ex: Trypophobia is the fear of small holes)
7
Q
Separation Anxiety Disorder
A
characterized by children’s unrealistic and persistent worry that something will happen to their parents or other important people in their life or that something will happen to the children themselves that will separate them from their parents (they’ll get lost, kidnapped, killed, etc.)
8
Q
Selective Mutism
A
- rare childhood disorder characterized by a lack of speech in one or more settings in which speaking is socially expected.
- As such, it seems clearly driven by social anxiety, since the behavior does not occur due to a lack of knowledge of speech or any physical difficulties, nor is it due to another disorder in which speaking is rare or can be impaired such as autism spectrum disorder
9
Q
Obsessive-Compulsive Disorder
A
- Characterized by obsessions and compulsions
- Can result from Thought-Action Fusion
- Exposure and Response Prevention is helpful for treatment
10
Q
Hoarding Disorder
A
- OC Related Disorder
- Was a type of compulsion that developed into its own disorder
- Compulsion: accumulate things and unable to let them go
Impairment and distress in terms of mobility (all the stuff everywhere), hazard to health and safety, hygiene (can’t use bed, bath, kitchen, etc.) - Treatment for this is a monumental task → lots of push back and rationalization of actions
11
Q
Body Dysmorphic Disorder
A
- OC Related Disorder
- Viewed as a distortion of the body
- Distortion is so high that you believe that people are looking at your because you are ugly
- Person may start to lose touch with objective reality based on their appearance
- Obsession: an over-focus on a perceived flaw in your appearance
Usually facial features (nose, skin, etc.) - It’s the PERCEPTION OF THE FLAW that matters here
- Different from social anxiety disorder because the fear of negative evaluation associated with SAD is not solely based on flaws/appearance
- Compulsion: spending all their time trying to fix that flaw
- Usually never resolved stress → Once you fix the flaw, it only provides temporary relief
your obsession may manifest elsewhere and you may fixate on a different flaw
12
Q
Trichotillomania
A
compulsive pulling of hair
13
Q
Excoriation
A
compulsive pulling of skin
14
Q
PANS (PANDAS)
A
- OCD brought on by a medical condition
- Pediatric onset of sudden OCD symptoms that stem from a certain infection
(For PANDAS, it’s strep) - Need biological treatment = antibiotics
- Germs and separation anxiety are the most common, but can be other OCD symptoms as well
15
Q
Koro
A
- Culturally-specified form of OCD
- the belief, accompanied by severe anxiety and sometimes panic, that the genitals are retracting into the abdomen
- most common in Chinese males
16
Q
Post-Traumatic Stress Disorder
A
- A specific event (that threatened your sense of safety) must happen as a part of the criteria → feeling helpless and horror
- Generally need ~ 1 month at least from the trauma and seeing symptoms
- Less than a month but severe symptoms → acute stress disorder
- Intrusion symptoms (intruding upon your daily life) such as physiological reactions, distress at exposure, memories and dreams
- Avoidance of stimuli, detachment, inability to recall traumatic memory
- Negative thoughts or mood associated with the event (LOTS OF DISTRESS)
- SUBTYPE: Delayed Onset
- TREATMENTS: Imaginal exposure and Eye Movement Desensitization and Re-Processing (EMDR)
17
Q
Reactive Attachment Disorder (RAD)
A
- Trauma-stressor-related disorder
- Have trouble developing emotional attachments because of experiencing severe abuse and neglect
18
Q
Disinhibited Social Engagement Disorder (DSED)
A
- Will engage/attach to anyone, even unfamiliar people/strangers
- experienced abandonment, neglect, or abuse
- Typically in children
19
Q
Acute Stress Disorder
A
- Less than a month since traumatic event happened but PTSD symptoms have emerged
20
Q
Somatic Symptom Disorder
A
- Somatic symptoms present, creating high anxiety (and this can cycle)
- Have actual significant bodily symptoms that can be overwhelming and lead you to be anxious
- ex os symptoms: Chronic headaches, rashes, leg pain
CRITERIA - Presence of one or more somatic symptoms (sustained)
- Symptom is often medically unexplained → sometimes will be dismissed by doctors, especially for women of color
1) Excessive thoughts, feelings, and behaviors related to the symptom
2) Excessive thoughts about the seriousness of the symptom
3) Frequent complaints and requests for help
4) **Health-related anxiety
5) Excessive research about symptoms - Substantial impairment in social or occupational functioning
MORE RARE than Illness Anxiety Disorder
21
Q
Illness Anxiety Disorder (Hypochondriasis)
A
- Preoccupation with having or acquiring a serious illness but somatic symptoms are NOT present (or very very mild)
- Ex: I had a mild headache → I think I have a brain tumor
- Convincing yourself that you have severe bodily symptoms when you literally don’t → distress over this (increased focus on physical sensations)
CLINICAL DESCRIPTION - Severe anxiety about the possibility of having/acquiring a severe disease
- Actual symptoms are either very mild or absent
- Strong disease conviction
- Medical reassurance is not helpful
22
Q
Dhat
A
- Culturally specific somatic disorder = India
- Symptoms (dizziness, fatigue) attributed to semen loss in Indian cultures
23
Q
Kyol goeu (Khyal)
A
- Culturally specific somatic disorder = Khmer people of Cambodia
- Fear that the wind cannot circulate effectively through the body
- Dizziness, weakness, fatigue, and trembling are seen as signs
24
Q
Conversion Disorder (Functional Neurological Symptom Disorder)
A
- Stress translates into PHYSICAL symptoms
- One or more altered voluntary motor or sensory function → NEUROLOGICAL in nature!!
- Symptoms don’t match established medical conditions
- Not better explained by another mental or medical disorder
- Significant impairment or distress caused
25
Factitious Disorders
- manufacturing/making up symptoms → concerning behavior with no clear external motivation → more about the feeling
- Play the sick role (sympathy)
- DIFFERENT from MALINGERING = faking illness due to EXTERNAL motivation
26
Munchausen Syndrome
- BY PROXY is the most common → person physically creates the symptoms themselves (ex: drink something to make symptoms come true, cause a stomach ache)
- Think Deedee and Gypsy-Rose Blanchard (parent-child proxy situation)
27
Dissociative Identity Disorder
- Dissociate into someone else in a given moment (another alter)
- Alters can develop as a coping mechanism, especially for those who have dealt with SEVERE trauma and abuse (an escape)
- TREATMENT aims to integrate the multiple personalities into one
28
False Memory Syndrome
- Misattribute the source to accurate information that you may have
- Source monitoring errors are cognitive errors
- NOT A DSM/MENTAL DISORDER
29
Depersonalization-Derealization Disorder
- Dissociative Disorder
- Sense of being outside yourself → upsetting/off putting
- High frequency and intensity that causes distress
30
Dissociative Amnesia: Dissociative Fugue
- a subtype of dissociative amnesia
- travel/go somewhere during a dissociative state/episode → don’t remember how you got there (diff alter?)
31
Schizophrenia
- Psychotic symptoms (hallucinations/delusions) lasting MORE than 6 months
- Positive symptoms include delusions (Persecution, Grandeur, Capgras, Cotard's) and hallucinations
- Negative symptoms include
1) Alogia = lack of speech
2) Apathy = absence of care/reaction to anything
3) Avolition = absence of energy/motivation to initiate/persist in any activities
4) Anhedonia = absence of pleasure/spark/joy
5) Affective flattening = everything is really dull/flat (absence of emotional expression)
- Also includes disorganized symptoms
- Often develops in early adulthood
- TREATMENT: Antipsychotic meds needed to treat psychotic symptoms, but best paired with therapy as well
- Increased risk of suicide and poorer self-care
- CLINICAL DESCRIPTORS = Paranoid, Catatonic, Residual, Disorganized, Undifferentiated
32
Schizophreniform Disorder
- Psychotic Disorder
- SHORTER DURATION: Psychotic symptoms lasting between 1-6 months at the time of diagnosis (>6 months = schizophrenia)
- Relatively good functioning
- Most patients resume normal lives
- Lifetime prevalence: 0.2% (pretty rare)
33
Brief Psychotic Disorder
- psychotic disorder
- characterized by the presence of one or more positive symptoms such as delusions, hallucinations, or disorganized speech or behavior lasting 1 MONTH OR LESS.
- often precipitated by extremely stressful situations.
34
Schizoaffective Disorder
- psychotic disorder
- symptoms of schizophrenia + a mood disorder (depressive or manic)
35
Attenuated Psychosis Syndrome
- psychotic disorder
- These people may have some of the symptoms of schizophrenia but are aware of the troubling and bizarre nature of these symptoms → will seek out mental health help
36
Delusional Disorder
- Psychotic Disorder
- This disorder is characterized by a persistent delusion that is not the result of an organic factor (such as brain seizures) or of any severe psychosis in the absence of other characteristics of schizophrenia
- The delusions are often long-standing, sometimes persisting over several years
- functioning is not markedly impaired, and behavior is not obviously bizarre or odd
- Relatively LATE onset
37
Shared psychotic disorder (folie a deux)
- psychotic disorder no longer recognized by DSM
- the condition in which an individual develops delusions simply as a result of a close relationship with a delusional individual (like contagious)
38
Depression
- Persistent sadness felt most of the day nearly every day for at least 2 weeks
- Cognitive symptoms (how depression affects how you think)
1) thoughts of hopelessness, helplessness
2) find it hard to make decisions
3) Risk of suicide when people feel worthless, like a burden, etc.
- Disturbed physical functioning
1) Fatigue
2) Changes in eating and sleep
- Emotional symptoms
1) Tearfulness, sadness
2) Anhedonia = lack of ability to find pleasure/joy/spark
- TREATMENT: Meds (antidepressants)
1) SSRIs
2) SNRIs (norepi and dopamine)
3) Tricyclics (risk of overdose)
4) MAO Inhibitors
5) Transcranial Magnetic Stimulation
- TREATMENT: THERAPY!!!
- Acceptance and Commitment Therapy (ACT) = mindfulness and accepting and moving on from thoughts rather than fighting them
- Gentle, nonjudgmental observer
- Identify thought as just a thought and create distance from it → separate yourself from it so you do not feel threatened by it, by merely observe → DISEMPOWER THOUGHTS = Cognitive Defusion
- CBT and Interpersonal Therapy
- SPECIFIERS
1) Seasonal Pattern
2) Peripartum Onset
3) Atypical features
4) Catatonic features
5) Melancholic features (more severe somatic symptoms)
6) Mixed Features (symptoms of mania)
7) Anxious Distress
8) Psychotic features
39
Premenstrual Dysphoric Disorder
- Significant depressive symptoms occurring prior to period during the majority of cycles, leading to distress and impairment
- Controversial diagnosis
1) Advantage = legitimizes the difficulties some people face when symptoms are severe
2) Disadvantage = pathologized an experience many consider to be normal (people who get their period stereotyped as moody and no clear-headed)
40
Seasonal Affective Disorder
- These depressive episodes (with the seasonal pattern specifier) must have occurred for at least 2 years with no evidence of nonseasonal major depressive episodes occurring during that period of time.
- SAD may be related to daily and seasonal changes in the production of melatonin, a hormone secreted by the pineal gland.
41
Bipolar I
- FULL Mania and FULL Depression
- Signs of mania are important
42
Bipolar II
- Hypomania (not full) and FULL Depression
43
Cyclothymia
- Chronic cycles of hypomania and mild depression (both not full)
- Takes 2 years to get this diagnosis
- Very few periods of euthymia = “normal” mood periods → equidistant from depression and mania
44
Dysthymia (Persistent Depressive Disorder)
- Chronic mild depression for 2 years or longer
- No cycling, no manic symptomatology
45
Double Depression
- Major depressive episode on top of a baseline of PDD
- Can be triggered by a major life event
- This treatment would need to be serious (risk of suicide)
46
Disruptive Mood Dysregulation Disorder (DMDD)
- Basically Bipolar for kids = Created so we’d stop shutting kids into bipolar box
- Explosive behavior → inability to regulate mood (no control) and this can be dangerous
47
Bulimia
- Eating Disorder
- Presence of “out-of-control” binges (building block of bulimia)
that occur for a discrete period of time (2 hours or less) and on average, once a week for at least 3 months
- Very distressing urges to binge where the person feels that they have no control, and this can be very distressing
- Compensatory Behaviors occur also on average, at least once a week for 3 months
1) Purging (throwing up)
2) Fasting
3) Excessive exercise
4) Laxatives
5) Diuretics (make you pee i.e. coffee)
- Binging and compensatory behaviors form a vicious cycle
- Not particularly underweight (can be at a normal weight or overweight)
- Most people with bulimia do want to seek treatment (don’t like this vicious cycle)
- LATER onset than anorexia
- MOOD INTOLERANCE = Cannot tolerate uncomfortable feelings (fear/anxiety/shame/sadness/fear) → resort to compensatory behavior
- TREATMENT:
1) Can try SSRIs
2) Postponing binges and Urge Surfing
3) CBT and IPT
- MEDICAL CONCERNS = Constant fluctuation between binge and compensatory behavior can cause the following (will depend on the compensatory behavior)
1) Salivary gland enlargement
2) Electrolyte imbalances
3) Cardiac problems
4) Kidney problems (dehydration)
5) Dental enamel erosion (from purging → stomach acid in mouth)
Intestinal problems
48
Anorexia Nervosa
- Eating Disorder
- Intense fear of gaining weight or being fat → restriction of food intake
- Significantly low body weight
- According to the DSM, you would have to be severely underweight to get this diagnosis (% for your height), but many do not follow this criteria to a T.
- Body image disturbance/distortion and negative self-evaluation
- Many people with anorexia do not flaunt their bodies because they hate the way their body looks (wear baggy clothing)
- Not very willing to seek treatment (think they’ll gain weight) -> IPT may he helpful
- TWO SUBTYPES
1) Binging/purging = some people with anorexia are convinced that they binged (just by eating anything) and will purge → warped concept of a binge (not actually a binge) and this is different from bulimia because they didn’t actually binge, they just throw up after eating
2) Restricting
- LESS common than Bulimia
- MEDICAL CONCERNS:
1) Loss of period and fertility (cannot sustain a baby → not always permanent)
2) Sensitivity to cold → low body fat = lack of proper insulation
3) Lanugo = body creates extra hair to try and insulate
4) Low blood pressure and HR, cardiac problems
5) Body shutting down or death by starvation (significant mortality rate)
48
Orthorexia
- NOT a DSM eating disorder
- Rigidity and obsession around healthy food to a point where it causes impairment and stress
Very strict eating patterns because they think they have to, not really for their overall health or safety
49
Binge-Eating Disorder
- Out of control binges WITHOUT the compensatory behavior
- About half of patients seeking bariatric (severely overweight) care surgery suffer from BED
- Tend to be older than those with other eating disorders
- Emotional differences from people who are obese without BED
1) Have much higher rates of depression and anxiety (comorbid with other psychological disorders)
2) Not just the shame of being overweight, but the psychological distress behind binging
- TREATMENT: similar to Bulimia treatment where we target the binging behavior; could also consider bariatric surgery
50
Muscle dysmorphia/ "Bigarexia"
- how eating disorders may manifest in men = muscles are not big enough
51
Dysomnias
- problems in the amount, timing, or quality of sleep
- ex: Insomnia and Narcolepsy
52
Parasomnias
- abnormal/disturbed activities during sleep
- ex: Disorder of Arousal and Nightmare disorder
53
Insomnia Disorder
- Difficulty falling asleep at bedtime, problems staying asleep throughout the night, or sleep that does not result in the person feeling rested even after normal amounts of sleep.
- Most prevalent sleep disorder and most comorbid with other psych disorders
- ETIOLOGY
1) Delayed temp and rhythm within someone's body
2) Physical pain
3) Respiratory problems
4) Hormonal issues (melatonin)
5) Other medical or psychological disorders
- TREATMENT:
1) Benzodiazapenes
2) Progressive Relaxation Treatments
3) Cognitive treatments
4) Stimulus Control
54
Gender Dysphoria
- originally known as Gender Identity Disorder
- your biological sex does NOT match your gender identity AND distress/impairment is caused because of this
- Controversial because what if the distress is caused by the culture you’re living in and not gender identity itself? Do you have the disorder due to the actions of others (culturally imposed)?
1) Lack of support
2) Bullying
55
Sexual Dysfunction
- Something going wrong during one of the stages of the sexual response (Desire, Arousal, Plateau, Orgasm, or Resolution)
- ex: Erectile dysfunction (arousal)
- TREATMENTS:
1) Sensate focus/non demand pleasure
2) Education about sex itself
3) CBT for performance anxiety
4) Self-pleasuring
5) Meds if hormonal problem
56
Fetishistic Disorder
- Paraphilic Disorder
- arousal/desire for some type of object or situation that is not inherently sexual in nature → becomes a sexual trigger
- Can cause sexual arousal and behaviors that are very inappropriate and that may happen frequently
- ex: feet (think flip flop story)
- Important to think about at what point are we stigmatizing a kink?
57
Voyeuristic Disorder
- Paraphilic Disorder
- observing someone without their consent in a sexual manner
- The violation itself is part of the arousal
- Ex: peeping Tom’s, installing cameras
58
Exhibitionist Disorder
- Paraphilic Disorder
- exposing yourself in a sexual way without the consent of others (you are aroused by this)
59
Transvestic Disorder
- Paraphilic Disorder
- Objectification of articles of clothing
- Ex: a person stealing women’s underwear
60
Sexual Sadism Disorder
- Paraphilic Disorder
- get off on inflicting pain on others
- When these become borderline noncon, pain becomes too much → disordered behavior
61
Sexual Masochism Disorder
- Paraphilic Disorder
- get off on being on the receiving end of pain
- When these become borderline noncon, pain becomes too much → disordered behavior
62
Frotteuristic Disorder
- Paraphilic Disorder
- Sexual arousal from rubbing up against someone without their consent
63
Sadistic rape
- Paraphilic Disorder
- desire/arousal from the violence itself (of raping someone)
64
Pedophilic Disorder
- desire/attraction to prepubescent children (< 13 years old)
- Purely about attraction → pedophilic disorder doesn’t automatically mean the person is a child abuser (some people actively try not to act on urges)
65
Incest
- Sexual desire for people we are related to
- Often due to sexual abuse
dependent/influenced by culture/family dynamics
66
Substance-Related Disorders
- Substance dependence/addiction
1) Physiological = tolerance and withdrawals
2) Psychological = drug-seeking behavior
- As major stressors (trauma, poverty, relationship issues) aggravate many disorders we have discussed, so do they increase the risk of excessive use and dependence on psychoactive substances
- SYMPTOMS: Amounts of substance are not specified (more about the effects); 11 symptoms that represent the range of severity (2-3 = MILD, 4-5 = MODERATE, 6 or more = SEVERE)
1) Substance taken in larger amounts or over a longer period than intended
- Setting intentions and going over them consistently (cannot limit)
2) Persistent desire to cut down/unsuccessful efforts
3) Lots of time on activities related to obtaining, using, or recovering
- Occupy a lot of your thoughts → can cause impairment and distress
4) Strong cravings/desires for substance
5) Disruption in fulfilling obligations, due to use
(work, school, social obligations, etc.)
6) Social or interpersonal problems due to use
- Relationship problems, friends always have to take care of you, more aggressive and starting fights
7) Activities given up or reduced because of use
- Not as interested in prior hobbies, don’t hang out with friends/family, narrowing of world
8) Use when physically hazardous
- Drunk driving, drinking at work, etc.
9) Use despite knowledge of having physical and psychological problems related to it
- Aware but you JUST CAN’T STOP → desperate
10) Tolerance
11) Withdrawal
- HIGHLY COMORBID with other psychological disorders
- Substances include depressants, stimulants, opiates, hallucinogens, and other (steroids, MDMA, etc.)
- TREATMENTS: Should always try a bunch of diff things to find the best fit!!!
1) Agonists: Mimic effects of substance and binds to receptors → prevents withdrawals but doesn’t make you high
- E.g. methadone and suboxone
2) Antagonists: Block the effects of the substance (prevents receptor binding)
- E.g. naltrexone
3) Aversive treatments: Will cause patient to feel horrible when engaging with substance → hopefully will stop taking substance; Need to be highly motivated to take aversive treatment
- E.g. Antabuse for alcohol abuse
4) Counseling and 12-step programs (ex: AA)
67
Gambling Disorder
- Acts on internal dopamine/reward systems and similar tolerance/withdrawal patterns when person gambles → included in substance-related disorders
68
Fetal Alcohol Syndrome
- Caused by drinking during pregnancy
- Unknown at what stage of pregnancy drinking causes the most damage
Irreversible damage caused → neuro-developmental delays, anatomical abnormalities
69
Impulse Control Disorders
- Really compelling and repetitive urges that almost act as a dopamine hit themselves
- Very likely to interact with the criminal justice system
- Etiology surrounding disruptions in brain function which translates into such abnormal impulsive behavior
- However, research on etiology is VERY LIMITED
70
Intermittent Explosive Disorder
- Major anger-management issues; unable to overcome impulse to act aggressively
- Cannot stop acting dysfunctionally on their rage
- Violent, fight all the time
Impairing behavior
- Research focuses on the brain regions involved as well as the influence of neurotransmitters such as serotonin and norepinephrine and testosterone levels, along with their interaction with psychosocial influences
- Potential disruption of the orbital frontal cortex's role ("the executive parts" of the brain) in inhibiting amygdala activation combined with changes in the serotonin system in those with this disorder
71
Kleptomania
- Steal because of the rush/desire
- Can’t overcome the strong urge to steal
- Brain-imaging research supports these observations of poor decision making, with one study finding damage in areas of the brain associated with poor decision making
72
Pyromania
- Urge to start fires
- Research on etiology and treatment is limited because so few people are diagnosed with this disorder
73
Chronic Fatigue Syndrome
- Marked by lack of energy, fatigue, a variety of aches and pains, and occasionally low-grade fever.
- People with CFS suffer considerably and often must give up their careers because the disorder runs a chronic course
- Originally linked to a virus, but no longer proven
- ETIOLOGY
1) extremely stressful environment
2) the changing roles of women
3) the rapid dissemination of new technology and information
4) Personality factors
- MICHAEL SHARPE'S THEORY = individuals with particularly achievement-oriented lifestyles (driven, perhaps, by a basic sense of inadequacy) undergo a period of extreme stress or acute illness.
1) misinterpret the lingering symptoms of fatigue, pain, and inability to function at their usual high levels as a continuing disease that is worsened by activity and improved by rest
2) results in behavioral avoidance, helplessness, depression, and frustration. They think they should be able to conquer the problem and cope with its symptoms
3) Chronic inactivity leads to lack of stamina, weakness, and increased feelings of depression and helplessness that in turn result in episodic bursts of long activity followed by further fatigue
- TREATMENT:
1) a cognitive-behavioral program that includes procedures to increase activity, regulate periods of rest, and direct cognitive therapy at the cognitions
- This treatment also includes relaxation, breathing exercises, and general stress-reduction procedures, interventions
2) CBT seems clearly indicated when patients have comorbid anxiety and depression
3) Medication has not been shown to be effective in treating it
74
Personality Disorders
- Personality disorders arise when the typical patterns that ALL of us have (personality part) become inflexible, maladaptive, and cause either significant impairment or subjective distress
- Pervade every aspect of someone’s life
- Originate in childhood and continue = Don’t diagnose a child with a personality disorder until they are above 18 years old and their personality has solidified a bit, but they usually START in childhood and run a chronic course
- Highly comorbid with other psychological disorders
- Little is known about causes or treatments
- 3 Clusters of Personality Disorders:
1) Odd or Eccentric
2) Dramatic, Emotional, Erratic
3) Anxious or Fearful
75
Paranoid Personality Disorder
- Cluster A: MISTRUST
- Does not trust anyone and believes that the world is a hostile place
- Suspicious, cynical, pervasive negative view of the world
- Could be caused by abuse/neglect in childhood
- Impairs life in that…
1) Strains and breaks relationships (family, friends, partners)
2) Can’t keep a job
- Often associated with depression but unlikely to seek treatment (probably won’t trust the therapist)
***NOTE: if a person has REALISTIC reason to be mistrustful, we would not give this diagnosis
- ex: Refugee, witness protection program, etc.
- DIFFERENT from psychotic symptoms associated with paranoia
76
Schizoid Personality Disorder
- Cluster A: DETACHMENT
- A high level of detachment from other people because they do not want to engage with people (more than just being a loner)
1) Let all of their relationships collapse
- Examples of impairment
1) Don’t have anywhere to go when their lease is up (can’t crash at a friend’s)
2) No one to pick them up after a surgery
3) Can’t hold a job because they don’t want to work with others
- A level of emotional detachment as well
- Can present as anhedonia
viewed by some to be one phenotype of a schizophrenia genotype
77
Schizotypal Personality Disorder
- Cluster A: ODD
- A weird/odd/eccentric behavior beyond just that of a kooky quirk
Illusions, superstitions, magical thinking
- Example causes of impairment and distress
1) One might keep getting sick because they don’t believe in the concept of a jacket
2) Family is exhausted with dealing with them
78
Antisocial Personality Disorder
- Cluster B: VIOLATION
- Antisocial = lack remorse, step on other people to achieve their goals, violate others (opposite of prosocial behavior) → “everyone else be damned”
- Manipulate, take advantage of, lie, cheat
- Many people with APD are slick charmers, very charismatic → can emulate how to act in social situations
- Often have very high IQs
**LACK EMPATHY AND REMORSE (Psychopathic behavior)
- Lack the wiring to form those connections
- Psychopathy = Personality trait in which you lack empathy and remorse (not a disorder itself) → people with APD act on this trait and violate others (manifest this characteristic into behavior)
- Substance abuse is heavily prevalent
- Predominantly male disorder
- Thought to have a GENETIC CAUSE
**Cortical Under-Arousal Hypothesis = Stress response/cortisol levels do not rise as much; Threat detection system in under-aroused (even at baseline)
- Ex: Richard Lee McNair
- PREVENTION IS KEY
1) Want to teach kids not to act on psychopathic traits (do not violate!)
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Conduct Disorder
- Precursor to Antisocial Personality Disorder
- Breaking rules, conducting antisocial behaviors (POOR CONDUCT)
- Can be common in kids
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Borderline Personality Disorder
- Cluster B: I Hate You, Don't Leave Me!
- Most common personality disorder diagnosed - 50% of personality disorders
- predominantly female patients
- Characterized by tumultuous, unstable relationships due to a fear of abandonment
- Push people away, then desperate to get them back, and this cycles
- On the border of psychosis and neurosis (nervousness/anxiety)
- From anger to deep depression VERY quickly
- Example: person at restaurant waiting for their boyfriend
- Highly comorbid with other disorders, specifically Depression (80%)
- CAUSES:
1) Strong genetic component; Also linked to depression genetically
2) High emotional reactivity may be inherited
3) May have impaired functioning of the limbic system
4) Early trauma/abuse increase risk
5) Many BPD patients have high levels of shame and low self-esteem
6) Feel very interpersonally ineffective = Don’t feel like they have any control in their relationships
- TREATMENT:
1) Antidepressant meds = short-term relief
2) Dialectical Behavior Therapy (DBT)
- Focus on dual reality of acceptance of difficulties, and need for change
- What is the path I can take to minimize destruction?
- Focus on interpersonal effectiveness and coping mechanisms
- Want to decrease arousal and self-sabotage
- Focus on distress tolerance to decrease reckless/self-harming behavior
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Histrionic Personality Disorder
- Cluster B: DRAMATIC
- Want to be the center of attention (positive and negative) at ALL COSTS (desperate for it)
- Provocative, superficial, exaggerate everything, only talk about themselves
- The drama causes impairment and distress to themselves or others
1) People get exhausted being in their presence
- Therapy goal = show how their behavior is not truly serving them → preventing them from being vulnerable
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Narcissistic Personality Disorder
- Cluster B: SELF-IMPORTANT
- Have this sense of superiority and entitlement where they truly think they are better than everyone else and deserve more
- Can lead them to be cold and callous to other people’s feelings
- Want ONLY POSITIVE attention because it signifies that they are the most important person in the room => Will dwell on negative attention
- Could be the result of a narcissistic wound = Insecurities that they are overcompensating for
- Increasing prevalence in most Western societies, primarily as a consequence of large-scale social changes, including greater emphasis on short-term hedonism, individualism, competitiveness, and success.
- Therapy goal = help them understand that this behavior is harming them and others
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Avoidant Personality Disorder
- Cluster C: AVOIDANCE
- So avoidant of relationships and people because they are scared → social anxiety on steroids
- Won’t even try to meet new people because of this fear
- Treatment is a lot more intense that those for anxiety disorders because they will be anxious about the idea of interacting with a therapist and the interpersonal dynamics involved
- These individuals may be born with a difficult temperament or personality characteristics.
- As a result, their parents may reject them or at least not provide them with enough early, uncritical love → may result in low self-esteem and social alienation, conditions that persist into adulthood.
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Dependent Personality Disorder
- Cluster C
- Someone has latched onto another person and is overly reliant on that person in an impairing and distressing way
- Therapy Goal = help them become their own person separate from the person they are dependent on (help them form and recognize their own thoughts, feelings, etc.)
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Obsessive-Compulsive Personality Disorder (OPCD)
- Cluster C
- No actual obsessions/compulsions!
**ANAL RIGIDITY! (this is their personality trait) → moderate genetic component
1) Things NEED to be their way or they cannot cope
2) Everything needs to be exact and perfect
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Neurodevelopmental Disorders
- Affect our neurological/intellectual development
- Can be diagnosed EARLY ON
1) In infancy, childhood, or adolescence
2) Some people are not diagnosed until later due to lack of access to care, masking symptoms, etc etc. but the symptoms should show up earlier on
- How do we qualify “normal development?”
1) Comprised of many factors
2) What about late bloomers? Kids that peak early?
3) We want to make sure we observe trajectories/patterns and not snapshots
- PREVENTION: (A lot of this is unknown or needs more research_
1) Early intervention can target and assist children who, because of inadequate environments, are at risk for developing cultural-familial IDD
- combines educational, medical, and social support for these children and their families
2) Researchers need to determine how best to identify children and families who will benefit from such programs, how early in the child's development programs should begin, and how long to continue these early intervention programs to produce desirable outcomes.
3) It may soon be possible to conduct prenatal gene therapy, where a developing fetus that has been screened for a genetic disorder may be the target of intervention before birth
4) Behavioral intervention for safety training, substance-use treatment and prevention, and behavioral medicine
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Attention-Deficit Hyperactivity Disorder (ADHD)
- Inattention (mental/cognitive)= Problems with details, not listening, mind wandering, disorganization, losing things, easily distracted, forgetful, lack of follow through
- Hyperactivity/Impulsivity (physical motor) = Problems with fidgeting, leaving your seat, running and climbing inappropriately, interrupting, difficulty waiting for one’s turn, hyperactive “motor” that is always on the go, unable to play quietly
- Can create problems in a social setting → exhaust/annoy friends or the people around you
- Can be:
1) Combined Presentation (ADHD)
2) Predominantly Inattentive (ADD)
3) Predominantly Hyperactive/Impulsive (AHD)
- Most commonly diagnosed in the US
- COURSE:
1) Symptoms usually appear around ages 3-4 (preschool to early elementary school years)
2) Half of children with ADHD continue to have difficulty as adults
- Can get labeled as a “bad kid” → self-fulfilling prophecy
- Divorce, lower education, substance abuse
3) Impulsivity decreases with age, but inattention usually remains
- Boys outnumber girls 3:1
- Sleep is a huge confound; children should get a sleep study first to see if that is causing the ADHD-like symptoms
- TREATMENT:
1) Stimulants (Ritalin, Adderall, Dexedrine, Cylert, Strattera) => Controversial tho
2) Behavioral treatments to create routine and structure
3) Combined treatments are best for social skills, parent-child-relationships, oppositional behavior, anxiety, and depression
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Autism Spectrum Disorder
- Includes Autistic Disorder, Asperger’s Disorder, Childhood degenerative Disorder, and Rett syndrome (lots of variability on this spectrum)
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Autistic Disorder (Autism)
- THREE MAIN AREAS:
1) Social
- always in their own little world
2) Communicative
- Slow to talk or talk in odd manners
- Delayed facials, pointing, gesturing
- Lack of eye contact
3) Restricted Behavior/Activities/Interest (atypicalities)
- E.g. stimming = repetitive movement to stimulate body (can be a grounding activity)
- Fixate on one topic or object
- Lack of diverse types of play
- THREE DIMENSIONS
1) Level 1 = needs support
2) Level 2 = needs substantial support
3) Level 3 = needs VERY substantial support
- More commonly diagnosed in males (gender ratio = 4-5:1)
- BIOLOGICAL COMPONENTS:
1) Significant genetic component; If you have one child with autism, the likelihood of having another child with autism is 20% (much greater risk than normal population)
2) Numerous genes on several chromosomes involved
3) Oxytocin receptor genes = Bonding and social memory; “love hormone”
4) Older parents associated with risk = Reduced quality of sperm and egg and difference in parenting styles with age
- TREATMENT:
1) Multidimensional comprehensive focus
- Children offered special education at school focusing on communication
- Judicious use of medication in some cases; No autism meds, but for certain symptoms such as anxiety, anger, etc.
- Families given support too
- When older, focus on integrating into community while maximizing independence
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Asperger's Syndrome
- Diagnosed as an adult!!!
- a condition on the autism spectrum, with generally higher functioning
- People with this condition may be socially awkward and have an all-absorbing interest in specific topics
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Specific Learning Disorder
- characterized by performance that is substantially below what would be expected given the person's age, intelligence quotient (IQ) score, and education
- A diagnosis of a specific learning disorder requires that the person's disability not be caused by a sensory difficulty, such as trouble with sight or hearing, and should not be the result of poor or absent instruction.
- Clinicians can use the specifiers for disorders to highlight specific problems for remediation
1) Reading
2) Written expression
3) Mathematics
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Intellectual Disability Disorder
- a disorder evident in childhood as significantly below-average intellectual and adaptive functioning
- a person must have significant atypical intellectual functioning, a determination made with one of several IQ tests with a cutoff score set by DSM-5 of approximately 70
- concurrent deficits or impairments in adaptive functioning = communication, self-care, home living, social and interpersonal skills, use of community resources, self-direction, functional academic skills, work, leisure, health, and safety
- The characteristic below-average intellectual and adaptive abilities must be evident before the person is 18
- Previously termed mental retardation
- DSM identifies difficulty in THREE DOMAINS
1) Conceptual = skill deficits in areas such as language, reasoning, knowledge, and memory
2) Social = problems with social judgment and the ability to make and retain friendships
3) Practical = difficulties managing personal care or job responsibilities
- ETIOLOGY
1) deprivation, physical or emotional abuse, and neglect
2) Cultural familial intellectual disability
3) Prenatal exposure to drugs, perinatal problems with labor and delivery, postnatal infections or head injury
4) Genetic influences with certain chromosome-linked genetic abnormalities
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Neurocognitive Disorders
- Affect learning, memory (episodic, semantic, procedural), and consciousness
- Most develop LATER in life
- Can affect behavior and personality
1) Depression
2) Paranoia
3) Agitation
4) Aggression and defensiveness
5) Relationship problems due to behavioral/personality changes
**note that UTIs can also cause such symptoms due to inflammation of brain
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Delirium
- Neurocognitive Disorder
- Temporary confusion and disorientation (during the course of several hours or days)
- People appear confused, disoriented, and out of touch with surroundings
- Subsides relatively quickly
- Prevalent amongst
1) Older adults
2) People undergoing medical procedures
3) Cancer patients
4) people with AIDS
- Many medical conditions that impair brain function have been linked to delirium
1) Intoxication by drugs and alcohol (substance-induced delirium)
2) Withdrawals from drugs
Infections
3) Head injury and other types of brain trauma
4) Improper use of medications
5) Experienced in children with high fever or who are taking certain medications
6) Dementia (50% of cases involve temporary delirium)
- Sleep deprivation, immobility, and excessive stress can contribute to delirium
- TREATMENT:
1) Need to address underlying causes and treat accordingly
- Is it due to withdrawals or substance use?
- Is it due to infection, brain injury, or a tumor?
2) The antipsychotic drugs haloperidol and olanzapine are also prescribed for individuals in acute delirium when the cause is unknown
3) The recommended first line of treatment for a person experiencing delirium is psychosocial intervention to reassure the individual to help them deal with the agitation, anxiety, and hallucinations of delirium
- The inclusion of a family member in the care for patients with delirium, such as overnight stays with the patient, may be a great comfort to the patient.
- A patient who is included in all treatment decisions retains a sense of control that can aid in the patient's ability to cope with anxiety and agitation due to the delirium.
- PREVENTION:
1) Proper medical care for illnesses and therapeutic drug use monitoring can play significant roles in preventing delirium
2) Structured multidisciplinary interventions that target the prevention of delirium during hospital stays in older patients are very effective (helping to re-orient them)
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Major Cognitive Disorder
- Neurocognitive Disorder
- new DSM-5 term for Dementia
- VERY prevalent in older adults (esp nowadays due to Baby boomer generation becoming of age)
- INITIAL STAGES:
1) Memory and visuospatial skills are impaired
- Episodic, procedural, semantic
- Depending on the level of impairment, may present as MILD CD
2) Facial agnosia = inability to recognize familiar faces (family, friends, etc.)
3) Delusions, apathy, depression, agitation, aggression
- LATER STAGES:
1) Cognitive functioning continues to deteriorate
2) Total support is needed to carry out day-to-day activities
3) Increased risk for early death due to inactivity and onset of other illnesses
- Not getting a lot of exercise or social contact → decreases immune system functioning
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Mild Neurocognitive Disorder
- Neurocognitive Disorder
- new DSM-5 term for early stages of cognitive decline
- Prevalence is greater than Major CD: 10% of adults 70+
- Individual is able to function independently with some accommodations (e.g. reminders/lists)
- Mild often transitions into major (progressive illness)
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Alzheimer's Disease
- Mild/Major Neurocognitive Disorder due to this (of the type)
- Most common; almost 50% of diagnoses = 5 million Americans, several million worldwide
- More common in less educated individuals
**More educated individuals decline more rapidly after onset; this suggests that education provides a buffer period fo better initial coping (THINK STILL ALICE) → may mask symptoms better
- Slightly more common IN WOMEN = Possibly because women lose estrogen as they age and estrogen may be protective
- Early and later stages = SLOW decline
- Middle stages = FAST decline
- Post-diagnosis survival = 8 years (variable)
- Onset = 60s and 70s (“early onset” = 40s and 50s)
- We can slow onset by exercising, eating well, socializing, and getting proper sleep
- ETIOLOGY:
1) Deterministic genes: if you have one of these genes, you have a nearly 100% chance of developing Alzheimer's disease (quite rare)
2) Susceptibility genes: These genes only slightly increase the risk of developing Alzheimer's disease (more common than deterministic)
- INFLUENCES ON ONSET AND COURSE:
- Education
- Culture (how natural it is perceived to be)
- Seeking out novelty and maintaining cognitive flexibility
- Having better coping skills
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Amnestic
- Refers to problems with memory that may occur in neurocognitive disorders
- Aphasia = difficulty with language
1) Expressive = difficulty expressing/saying language
2) Receptive = difficulty understanding language
- Apraxia = impaired motor functioning
- Agnosia = difficulty recognizing things/people
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Chronic Traumatic Encephalopathy (CTE)
- Repeated blows to the head (cumulative)
- Different from concussions
- Diagnosed after autopsies!
- Sports players are at high risk for this
1) Originally found in boxers, now in football and hockey players as well
2) Huge cultural mess!
- Americans love football but its dangerous for the players!
- EARLIER onset = Longer you play, the harder the hits, the more risky
- Behavior and personality changes such as aggression, depression, addiction
