Psychopathology (1) Flashcards
(63 cards)
0
Q
history of insanity
A
- prehistoric: people attempt to fix different behavior by drilling the brain or exorcising
- Greek & Roman: Hippocrates suggested that different behavior is a brain malfunction
- Middle Ages: main ideology was that evil spirit was the cause of different behavior; evidence on cases caused by fungi and bacteria
- Renaissance: establish bedlams which was practically dungeon-like asylums; hypnosis with magnets was popular
- Reform: Benjamin Rush treated behaviors as medical conditions and tried to seek cures, experimented with tranquilizer chair; Dorthea Dix was pro-medicine and -treatment; Thomas Kirkbride designed new bedlams out in the country that allowed air and light, treatments started to pop up
- Modern: Sigmund Freud invented psychoanalysis and started asking patients what they were thinking and feeling instead of disregarding their rights; Walter Freeman popularized lobotomy and went around in a van to perform ice-pick lobotomies
1
Q
culture-specific psychological phenomena
A
- ataques de nervios: fit-like intense emotional upset (acute anxiety, anger, grief, etc.) from stressful family events, suicidal ideation, or disability that leads to sense of being out of control
- dhat syndrome: young men attribute various symptoms (fatigue, anxiety, weight loss, impotence, depression) to semen loss
- khyal cap: panic attacks (shortness of breath, dizziness, palpitations, etc.) out-of-the-blue or triggered by worrisome thoughts, standing up suddenly, negative associations (i.e. odor), or agoraphobic cues (i.e. crowds)
- kufungisisa: anxiety, depression, and somatic problems that come from “thinking too much”
- nervios: general state of vulnerability to stressful or difficult experiences wiith symptoms like headaches, neck tension, irritability, irregular sleep, etc.
- shenjing shuairuo: irregularity in a combination of physicality, emotions, excitement, nervous pain, and sleep caused by work- or family-stressors, failure, or embarrassment
- maladi moun: interpersonal envy and malice cause people to harm enemies by sending bad vibes and illnesses to successful people
- susto: unhappiness and illnesses (irregular sleep, troubled dream, sadness, etc.) caused by the soul leaving the body because of a frightening event, can be lethal in extreme cases
- taijin kyofusho: anxiety about and avoidance of interpersonal interaction due to extreme social sensitivity or fear of offending others
2
Q
etiology
A
study of the cause(s) of an illness
3
Q
possible etiologies for psychological dysfunctions
A
- evolutionary: evolutionary motives become harmful in the modern era
- biological: aging, cancer, nerves, pregnancy, hormones, gene, or combination?
- psychodynamic: subconscious drive leads to behavior, resolve with defend mechanisms
- humanistic: humans have needs and when they are not met, that is the source of mental conditions
- cognitive-behavioral: the negative things you think and actions you do lead to illnesses
- socio-cultural: the culture is causing the problematic behavior
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Q
epigenetics
A
study whether we can switch a genetic behavior on or off
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Q
multifinality vs. equifinality
A
- multifinality: one cause leads to multiple diseases
- equifinality: multiple causes lead to one disease
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Q
epidemiology
A
study of patterns of illness in the general population
father of epidemiology: John Snow, who studied cholera and found out the source was water
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Q
Hispanic paradox
A
Hispanics seem to have lower socioeconomic status but are happier in general -> patterns can depend on population
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Q
nosology
A
classification of disorders based on taxology in biology
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Q
comorbidity
A
when disorders overlap/when a person has more than one condition
10
Q
differential diagnosis
A
the process of ruling out similar conditions to make sure diagnosis is correct by doing multiple tests
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Q
psychometrics
A
study of psychological measurements
12
Q
reliability vs. validity
A
- reliability: consistency in testing
+ test-retest: multiple testings of the same test yield same results
+ interrater: consistency of result amongst different raters
+ internal consistency: all the questions measure the same thing - validity: test does what it’s supposed to
+ face: test measures what it says it does
+ content: questionnaire captures various aspects of disorder
+ predictive: test predict future behavior
+ concurrent: test correlates with other tests of the same disorder
+ construct: scale relates to other measures in a theoretically consistent way
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Q
assessment
A
measurements over a period of time (from half day to a day) doing multiple tests to assess multiple aspects
- interviews: unstructured, semi-structured, structured
- neuropsychiatric mental status tests: judging appearance, orientation (person, time, place) and test mental capabilities (serial 7, clock draw, trailmaking, RBANS, memory test, etc.)
- neurocognitive tests: Wechsler IQ test (test spatial intelligence, arithmetics skills, etc.)
- self-reports: on symptoms, suicide (ideation, intent, plan, past attemmpts) <- be careful with language!
- personality tests: trait measure, five factor (OCEAN), and Minnesota Multiphasic Personality Inventory (MMPI) to find criterion key
- projective tests: Rorschach inkblot, Thematic Apperception Test (TAT), family/tree draw, etc. to test unconscious
- observational and informant reports: when patients are underaged or incapable of self-reporting
- Functional Behavior Analysis: set scenario, analyze function/behavior, create hypothesis, come up with healthy solution
- biological tests: health and medical check-ups
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Q
pharmacogenomics
A
researching medicine and genetic behaviors to treat psychological conditions
- study genotype (gene), phenotype (behavior), and endophenotype (informative middleman)
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Q
psychotherapy
A
- also called “talk therapy”
- person speaks with a trained therapist in a safe and confidential environment to explore feelings and behaviors to gain an understanding of them and coping skills
- conversations led by therapist who then provides insight
- topics can be anything from past/current problems, experiences, thoughts, relationships, etc.
- can be applied to individuals, couples, groups, or families
- most effective when combined with medication
- present improvement after 6 months
- general format:
+ therapeutic alliance and rapport building
+ psycho-education and explanation of the theory behind treatment
+ progression of treatment (therapist and patient decide on method together)
+ planning of treatment - normalization: show people that there is acceptance and that it’s not totally uncommon to have the disorders/habits/tics
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Q
Cognitive-Behavioral Therapy (CBT)
A
- focus: relationships among thoughts, feelings, and behaviors
- therapists work to uncover unhealthy patterns of thought thay may create destructive self-fulfilling behavior
- therapists and patients work together to develop new and constructive ways of thinking that produce healthier behaviors and beliefs
- effective for depression, anxiety, bipolar, eating disorders, and schizophrenia
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Q
Dialectical Behavior Therapy (DBT)
A
- heavily based on CBT
- focus: validation and acceptance of uncomfortable thoughts, behaviors, and beliefs
- therapists help find balance between acceptance and change, develop new skills, and improve coping strategies
- helps decree frequency and severity of dangerous behaviors, encourage change through reinforcement, and empower patients
- usuallyy for patients with a primary diagnosis of borderline personality disorder
18
Q
Eye-Movement Desensitization And Reprocessing Therapy (EMDR)
A
- used to treat PTSD
- helps reduce emotional distress
- patients perform a series of back and forth, repetitive eye movement for 20 - 30 seconds to replace negative emotional reactions with less-charged or positive reactions (dual simulation of eye and memory)
- questionable validity
19
Q
exposure therapy
A
- type: cognitive-behavioral
- used to treat OCD, PTSD, and phobias
- patients work with therapists to identify triggers of anxiety and learn techniques to cope
- allows patients to confront triggers in a safe & controlled environment to reduce anxiety and practice strategies to avoid performing rituals
+ flooding: large amount of stimulus at one time (with consent)
+ desensitization: small amount, gradually increased over time
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Q
interpersonal therapy
A
- used to treat depression
- focus: patients’ relationships with others
- goal: improve interpersonal skills
- therapists helps evaluate skills and interactions, pinpoint negative patterns, and suggest positive strategies for understanding and interacting
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Q
Mentalization-Based Therapy (MBT)
A
- engages and exercises “mentalizing” (consciously perceive and understand one’s own inner thoughts and feelings) to connect with the self and with others
- used to treat people with borderline personality disorder (lack sense of self, feel “empty”)
- patients learn to empathize
- does not require a lot of structure, can be applied to individual or group
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Q
psychodynamic psychotherapy
A
- goal: recognize negative patterns of behaviors and feelings rooted in past experiences and resolve them
- uses free association and open-ended questions so patients can discuss whatever is on their minds
- therapists sift through those thoughts, point out unconscious pattern, bring negative associations from the past to patient’s attention, and help them overcome unhelpful behaviors
- useful for depression, anxiety, and borderline personality disorder
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Q
therapy pets
A
- provide comfort
- engage patients in structured animal-assisted therapy instructed by handlers
- used for patients with cancer, heart disease, and mental health conditions like PTSD and panic disorder
- help reduce anxiety and motivate via non-judgmental interaction
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medication
- more effective when combine with psycho therapy
- effects vary on individuals -> requires persistence in finding what works and consistence with usage
- psychiatric medication influences the brain chemicals that regulate emotions and thought patterns
- comes in different form: pill, liquid, injection, etc.
- increae dosage gradually and be careful about going off
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antipsychotics
- impact dopamine
- used to treat schizophrenia and schizoaffective disorders (newer ones can treat acute mania, bipolar, and treatment-resistant depression)
- 1st generation and 2nd generation medicines affect different areas of the brains and have different side effects (tardive dyskinesia for 1st and weight gain for 2nd)
- medicine in shot form (Long-Acting Injectable antipsychotic medication aka LAI) is recommended for forgetful patients
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antidepressants
- impact serotonin, nonepinephrine, and dopamine
- mot common & newest medicine with fewer side effects: SSRIs and SNRIs
- MAOIs are last resort medicine, of an older generation with dangeerous side effects and strict upkeeping diet
- mostly treat depression mixed with anxiety; higher doses may treat PTSD, general anxiety disorder, and OCD
- may worsen risk of mania for depression mixed with bipolar -> DON'T use them
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anti-anxiety
- certain medicines reduce emotional and physical symptoms
- some can treat social phobia, generalized anxiety disorder and panic disorder
- beta-blockers help with trembling and sweating
- benzodiazepines work quickly and especially effective short-term but beware of dependence
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mood stabilizers
- treat mood swings of bipolar disorder
- oldest and most effect: lithium (requires blood test and has potential serious side effects to kidneys and thyroid)
- prevent highs (manic/hypomanic episodes) and lows (depressive episodes)
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psychopharmacology
study of drugs and how they work
+ pharmacokinetics: how the drugs get into the body and how the body processes the drugs
+ route of administration: medications (psychoactive drugs) need dto get through the brain blood barrier
+ pharmacodynamics: mechanism of action, how drug affects the body and a person's behavior
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brain activity
- neurons communicate via a chemical-electrical process
- circuits are built at different regions of the brain
- neurotransmitters are chemical messengers
- communication between neurons are facilitated by receptors at the synaptic cleft
+ ionotropic receptors: molecules are keys to open gate and let ions in -> charge fires
+ metaotropic receptors
+ agonist: drug that mimics neurotransmitters and allows things to happen
+ antagonist: drug that blocks neurotransmitter activity
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neurocognitive disorders (NCDs)
- begin with delirium, followed by symptoms and etiological subtypes
- encompass group of diseases that mainly affects cognitive function
- acquired, not developmental
- signature; represent a decline from a previous level of functioning
- etiology and pathology can potentially be determined
-
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domains for diagnosis
```
- complex attention:
+ sustained attention (maintain focus over time)
+ divided attention (handle two tasks at once)
+ selective attention (maintain attention in presence of distraction)
+ processing speed (timing exercises)
- executive function:
+ planning
+ decision making
+ working memory
+ respond to feedback or error correction
+ override habits or inhibitions
+ mental flexibility
- learning and memory:
+ immediate memory
+ recent memory (free recall, cued recall, recognition memory)
+ very-long-term memory (semantic and autobiographical)
+ implicit learning
- language:
+ expressive language (naming, word finding, fluency, grammar, syntax)
+ receptive language (comprehension)
- perceptual - motor:
+ visual perception
+ visuoconstructional (like hand-eye)
+ perceptual - motor
+ praxis (like imitate gestures)
+ gnoxis (awareness and recognition)
- social cognition:
+ recognition of emotion
+ theory of mind
```
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delirium
- duration: about a week to several months
- symptoms:
+ disturbance in attention and/or awareness (reduced ability to focus, reduced orientation for environment, etc.)
+ disturbance developed over short period of time of hours or a few days (signify change, may fluctuate)
+ disturbance in recognition (like memory or language deficit)
+ disturbance can't be better explained with another condition
- specify in cases involving substance and drug use
- nature: episodic, in and out
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major neurocognitive disorder
| used to be dementia or Alzheimer's
- common for 60+ year-old patient
- symptoms:
+ evidence of significant cognitive decline in one or more domains based on concern of person, informant, or clinician or neuropsychosocial testing
+ cognitive deficits interfere with independence in everyday activities
+ deficits do not occur exclusively in context of delirium
+ deficits are not better explained by another mental disorder
- specify severity and whether or not behavioral disturbance is involved
- nature: constant, long-standing, gradual
- can only be confirmed postmortem
- involvement of amyloid plaques
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mild neurocognitive disorder
- symptoms:
+ evidence of modest decline in more cognitive domains
+ cognitive deficits don't interfere with independent functioning but activities require greater efforts
+ cognitive deficits don't occur exclusively in context or delirium
+ deficits are not better explained by another mental disorder
- specify etiology types (Alzheimer's, Lewy body, vascular, traumatic brain injury, etc.)
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order of nosology
abnormal behavior -> medical disease -> psychiatric disease -> thought pathology
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cognitive domains
- complex attention: having difficulty with competing events in the environment
- executive function: difficulty with making deciiions in daily life
- learning and memory: repeating self, needing reminders
- language: difficulty finding words, echolalia
- perceptual motor: difficulty with previously familiar activities
- social cognition: insensitivity to social standards, immodesty
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etiologies for mild neurocognitive disorder
- frontotemporal lobe degeneration
+ early onset (before 65)
+ can be seen promptly in brain scans
+ attack siide of brain that is less used
+ noticeable change in personality
- Lewy body disease:
+ appearance of plaques made of alpha-synuclein proteins
+ symptom: well-formed visual hallucinations
- vascular disease: a stroke
- traumatic brain injury: a concussion
- substance or medication use
- HIV infection: up to 50% of patients with HIV may have neurocognitive disturbance
- Prion disease: mad cow
- Parkinson's disease:
+ onset age: ~40 years old
+ genetic movement neurological disorder
- factitious disease: they are not faking the disorder but they TRULY believe in a false assumption
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delusions
- fixed beliefs that are not amenable to change in light of conflicting evident
- themes:
persecutory (getting harmed)
referential (certain gestures or comments are directed at oneself)
grandiose (patient thinking he/she is the best)
erotomanic (falsely believing that another is in love with him/her)
nihilistic (major catastrophy will occur)
somatic (focused on health and organ functions obsessively)
- bizzare (completely implausible) vs. nonbizarre (false but plausible)
thought withdrawal (thoughts are gone)
thought insertion (thoughts put in by stranger)
delusion of control (I'm controlled by outside forces)
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hallucinations
- perception-like experiences that occur without an external stimulus
- vivid, clear, full force and impact of normal perceptions but are not voluntary
- can be any sense, most common is hearing
- can occur before sleep (hypnagogic) or right after waking up (hypnapompic)
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disorganied thinking/speech
| also called "formal thought disorder"
- loose association/derailment: switch topic to topic
- tangentiality: completely irrelevant answers
- incoherence/"word salad": severely disorganized speech to the point of almost incomprehensibility
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grossly disorganized/abnormal motor behavior
- varies from "silliness" to unpredictable agitation
- beware of goal-directed actions (can be aggressive, offensive, or inappropriate)
- catatonic: marked decrease in reactivity to environment
+ ranges from negativism (resistance to instructions) to rigidity/inappropriate posture to mutism (complete lack of verbal response) or stupor (complete lack of physical response)
+ includes catatonic excitement (purposeless and excessive motor activity without cause)
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negative symptoms
- diminished emotional expression: reduction in facial expression, speech intonation, or physical movement
- avolition: decreasee in motivated self-initiated purposeful activities
- alogia: diminished speech output
- anhedonia: decreased ability to experience pleasure OR degradation in recollection off past pleasant experiences
- asociality: lack of interest in social interaction
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time range for schizophrenia spectrum disorders
- delusional disorder: at least 1 month of delusions, no other psychotic symptoms
- brief psychotic disorder: between 1 day and 1 month
- schizophreniform: less than 6 months, no decline in functioning necessary for diagnosis
- schizophrenia: 6 months or more, includes at least 1 month of active-phase symptoms, preceded or followed by at least 2 weeks of delusions or hallucinations without prominent mood symptom
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delusional disorder
- symptoms:
+ presence of one or more delusion with duration of at least one moth
+ functioning not markedly impaired; behavior is not obviously bizarre or odd
+ if present, manic or depressive episodes have brief relation during duration of delusions
+ disturbance not due to a different disorder
- specify type of delusions (erotomanic, grandiose, jealous, persecutory, somatic, mixed or unspecified) and whether content is bizarre or not
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brief psychotic disorder
- symptoms:
+ presence of one or more symptoms: delusions, hallucinations, disorganized speech, and grossly disorganized or catatonic behavior
+ disturbance lasts anywhere from a day to a month, with eventual return to premorbid functioning
+ disturbance is not better explained by any other disorder
- specify whether it is with or without: stressors, postpartum onset, or catatonia
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schizophreniform
- symptoms:
+ two or more symptoms for a decent chunk of time during a 1-month period: delusions, hallucinations, disorganized speech, grossly disorganized or catatonic behavior, or negative symptoms (one must be one of the first three)
+ episode duration is anywhere between 1 to 6 months
+ disturbance cannot be attributed to any substance, medication, major depressive disorder, schizoaffective, or bipolar disorder
+ specify if it is with or without good prognostic features or catatonia
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schizophrenia
- symptoms:
+ two or more symptoms for a decent chunk of time during a 1-month period: delusions, hallucinations, disorganized speech, grossly disorganized or catatonic behavior, and negative symptoms
+ significant decline in functioning from premorbid to onset of disturbance
+ continuous signs of disturbance persist at least 6 months
+ disturbance cannot be attributed to any substance, medication, bipolar disorder, schizoaffective disorder, or major depression disorder
+ for cases with autism or communication disorder: prominent delusions or hallucinations in addition to other symptoms for at least 1 month
- specify episode frequency and whether or not it is with catatonia
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schizoaffective disorder
- symptoms:
+ uninterrupted period of illness with concurrent major mood episode (depressive or manic)
+ delusions and hallucinations for at least 2 weeks
+ major mood episode symptoms
+ disturbance cannot be attributed to any substance or medication
- specify type (depressive or manic), frequency of episodes, and whether it is with or without catatonia
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substance/medication-induced psychotic disorder
- symptoms:
+ presence of delusions and/or hallucinations
+ evidence from history, physical exam, or lab findings that:
symptoms appear after exposure to medication/withdrawal/intoxication
substance or medication is capable of producing delusions or hallucinations
+ disturbance does not occur exclusively in context of delirium
+ disturbance causes distress and impairs functioning
- specify whether onset is with intoxication or withdrawal
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catatonia
- marked by presence of three or more psychomotor features
- disturbance involves decrease in motor activity, physical or verbal engagement, or excessive or peculiar motor activity
- various levels or severity (stupor, catalepsy, waxy flexibility, etc.)
- various levels of disengagement: severe (mutism) or moderate (negativism)
- excessive or peculiar behavior: complex behavior (stereotypy) vs. simple behavior (agitation)
- requires supervision to avoid harming others or self-harming
- may be rooted in malnutrition, exhaustion, hyperpyrexia, etc. -> be careful with diagnosis
52
catatonia associated with another mental disorder
three or more symptoms:
- stupor (no psychomotor activity)
- catalepsy (passive induction of posture held against gravity)
- waxy flexibility (slight resistance to positioning by examiner)
- mutism (no or very little verbal response)
- negativism (opposition to indifference)
- posturing (spontaneous and active maintenance of poe against gravity)
- mannerism (caricature act)
- stereotypy (repetitive, abnormally frequent non-goal-directed actions)
- agitation
- grimacing
- echolalia (mimic speech)
- echopraxia (mimic statement)
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etiology of schizophrenia spectrum disorders
- dopamine hypothesis: dopamine overstimulation cause positive symptoms
- paradox hypothesis: opamine plays a role in both positive and negative symptom
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differentiations
- paranoid vs. persecutory delusion: paranoia includes element of hostility
- psychotic vs. psychopathic: having psychosis symptoms vs. having antisocial personality disorder
- schizotypy = character trait (odd, whimsical, magical) but no full on psychosis/delusions/halllucinatios
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causes of schizophrenia spectrum disorders
- nature: fetal injury, personality, genetics, chemical imbalance, brain abnormality, mutations
- nurture: injury, traumatic stress, age, gender, education, comorbidities
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neurodevelopmental disorders
- onset with the developmental period (usually manifest early, before grade school)
- characterized by developmental deficits that impair personal, social, academic, or occupational functioning
- deficits vary from very specific learning limitations to global impairment of intelligence
- disorders often co-occur
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autism spectrum disorder
- symptoms:
+ persistent deficits in social communication and interaction across various contexts, currently or by history:
in social-emotional reciprocity (failure to hold back-and-forth conversation)
in nonverbal communicative behaviors used for social interaction (lack of facial expressions)
in developing, maintaining and understanding relationship
+ restricted, repetitive patterns of behavior, interests, or activities (at least 2 symptoms)
stereotyped or repetitive motor movements, use of objects, or speech
insistence on sameness, inflexible adherence to routines or ritualized pattern of verbal or nonverbal behavior
highly restricted, fixated interests that are abnormal in intensity or focus
hyper- or hyporeactivity to sensory input or unusual interest in sensory aspects of the environment
+ symptoms must be prsent in earaly developmental period
+ symptoms causes significant impairment in social, occupational, or important areas of current functioning
+ condition not better explained by intellectual disability or global developmental delay
- specify whether it is with or without catatonia, intellectual or language impairment, association with a known medical or genetic condition or environmental factor or with another disorder (neurodevelopmental, mental or behavioral)
58
attention-deficit/hyperactivity disorder (ADHD)
- symptoms:
+ persistent pattern of inattention and/or hyperactivity-impulsivity (6+ symptoms for 6+ months) that are inconsistent with developmental level and interferes with functioning or development
inattention: easily distracted, forgetful, fails to pay close attention to details, has difficulty sustaining attention, doesn't listen when spoken to, tends to lose things, fails to follow instructions and complete tasks, can't organize well, and avoids or dislikes tasks which require sustained mental effort
hyperactivity and impulsivity: fidgets/taps hands and feet/squirms in seat, leaves set when remaining seated is expected, runs around or climbs in inappropriate situations, difficulty waiting for turn, unable to play leisurely in a quiet manner, always restless or on-the-go, talks excessively, and blurts out answers to incomplete questions
+ several inattentive or hyperactive/impulsive symptoms are present prior to 12 years old
+ symptoms are present in at least two settings
+ clear evidence that symptoms interfere with or reduce quality of social, academic, or occupational functioning
+ symptoms don't occur exclusively during course of schizophrenia or psychotic disorder and are not better explained by another condition
- specify if there is combined presentation (inattention AND hyperactivity) or if it is predominantly inattentive or hyperactive-impulsive
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excess and deficit
- ADHD: deficit in attention, excess in activity
| - autism: deficit in social functioning, excess in focus of limited interest
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etiologies
- autism: chromosomal mutation (Rett syndrome) and underconnectivity in sensory processing (more activity in Wernicke's area and less in Broca's' area)
- ADHD: fragile X syndrome and low arousal levels
- exposure to TV and technology?
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differential diagnosis
- cluster A: odd/eccentric
+ schizotypal: strange personality
+ schizoid: lack of interest
+ paranoid: hostility and heightened skepticism
- cluster B: dramatic
+ antisocial: numbness, lack of empathy, disregard rules
+ narcissistic: egocentric, grandiose
+ borderline: dramatic mood swings
+ histrionic: hypersexualized
- cluster C: anxious/fearful
+ obsessive-compulsive: rigid, rule-abiding
+ avoidant: similar to social anxiety, feels inferior
+ dependent: complete dependence on others
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treatment for neurodevelopmental disorders
- pharmacology:
+ autism: stimulants (boost dopamine) or atypical psychotic (boot serotonin and lower dopamine)
+ ADHD: stimulants, nonepinephrine, or antihypertensive (blood pressure medication that boost nonepinephrine)
- diet: lessen gluten, food dye, etc. but still not scientifically proven
- skills training (basic life skills, adult patients may resist)
- environmental enrichment (sensory-stimulating exercises)
