Psychopathology Flashcards by Rai Christiana

Absence of psychopathology
• Alleviation of gross pathologic signs and symptoms of illness

Mental Health as Normal

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Models of mental health

Above normal
Maturity
+ Psychology
Socioemotinal intelligence
Subjective well-being
Resilience

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Reasonable, rather than an optimal, state of functioning

Mental Health as Above Normal

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Mental state that is objectively desirable

Mental Health as Above Normal

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Freud mental health as above normal

Capacity to work and to love

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progressive brain myelination and also evolution of emotional and social intelligence through experience

Healthy adult development

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sustained separation from social, residential, economic and ideological dependence on family of origin

Identity

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permits person to become reciprocally, not selfishly, involved with a partner

• Intimacy

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mastered together with or that follows the mastery of intimacy
• Find a career as valuable as play when they were kids
• Contentment, compensation, competence and commitment

Career consolidation

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clear capacity to care for and guide the next generation; good mentors

• Generativity -

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achieving some sense of peace and unity with respect both to one’s life and to the world
• Erikson: “An experience which conveys some world order and spiritual sense dearly paid for, it is the acceptance of one’s one and only life cycle as something that had to be and that, by necessity, permitted of no substitution.”

Integrity

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Mental Health as Socioemotional Intelligence

Accurate conscious perception and monitoring of one’s emotion
• Modification of emotions so that the expression is appropriate. Capacity to self soothe personal anxiety and to shake of hopelessness and gloom
• Accurate recognition of and response to emotions in others
• Skill in negotiating close relationship with others
• Capacity for focusing emotions towards a desired goal. Delayed gratification and adaptively displacing and channeling impulse

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Benefits of socioemotional intelligence

Better emotionally adjusted
• More popular
• More responsive to others
• Do better in school and work

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3 broad classes of coping mechanisms to overcome stress

Consciously seeking social support
Conscious cognitive strategies
Adaptive involuntary coping mechanisms = defense mechanisms
• Distort our perception of internal and external reality in order to reduce subjective distress, anxiety and depression

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Healthy and adaptive
• Socially adaptive and useful in integration of personal needs and motives, social demands and interpersonal relations
• Underlie seemingly admirable and virtuous patterns of behavior

Mature defense mechanisms:

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permits the discharge of emotion without individual discomfort and without unpleasant effects on others

Humor

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individual getting pleasure from giving to others what the individual would have liked to receive

Altruism

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gratification of an impulse whose goal is retained but whose aim or object is changed from a social objectionable one to a socially valued one; feelings are acknowledged, modified and directed toward a relatively significant person or goal so that modest instinctual satisfaction results

Sublimation

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defense that modulates emotional conflict or internal/external stressors through stoicism; minimizes and postpones but does not ignore gratification; “no”

Suppression

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capacity to keep affective response to an unbearable future event in mind in manageable doses

Anticipation

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classification of mental disorders with associated criteria designed to facilitate more reliable diagnosis

DSM-5

2013 American Psychiatric Association

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Intellectual disability
• Communication disorders
• Autism spectrum disorder
• Attention
deficit/hyperactivity disorder
• Specific learning disorder
• Tic disorder
• Elimination disorder

Neurodevelopmental
Disorders

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Group of conditions with onset in developmental period

Neurodevelopmental
Disorders

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Characterized by developmental deficits that impair personal, social, academic or occupational functioning

Neurodevelopmental
Disorders

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Manifest early in development, before child enters grade school

Neurodevelopmental Disorders

Frequently co-occur with each other

Neurodevelopmental Disorders

Intellectual developmental disorder Characterized by deficits in general

Mental abilities

Intellectual developmental disorder Results in impaired

adaptive functioning, such that he fails to meet standards of personal independence and social responsibility,

disorder with onset during the developmental period that includes both intellectual and adaptive functioning deficits in conceptual, social, and practical domains.

(Intellectual Developmental Disorder)

Deficits in intellectual functions,

(Intellectual Developmental Disorder)

Deficits in adaptive functioning

(Intellectual Developmental Disorder)

(Intellectual Developmental Disorder) Onset of intellectual and adaptive deficits during the

(developmental period.)

Prevalance of intellectual disability

Overall general population prevalence of approx. 1% • Severe intellectual disability is approx. 6/1,000

Course of developmental disability

• Onset: developmental period • Severe: first 2 years of life with delayed motor, language and social milestones • Mild: may not be identifiable until school age

Intellectual disability under age 5

global developmental delay

Causes of developmental delay

Genetic Acquired

This diagnosis is reserved for individuals under the age of 5 years when the clinical severity level cannot be reliably assessed during early childhood. This category is diagnosed when an individual fails to meet expected developmental milestones in several areas of intellectual functioning, and applies to individuals who are unable to undergo systematic assessments of intellectual functioning, including children who are too young to participate in standardized testing. This category requires reassessment after a period of time.

Global Developmental Delay

Deficits in development and use

Language disorder • Speech sound disorder • Social (pragmatic) communication disorder

• Disturbance of the normal fluency and motor production of speech, including repetitive sounds or syllables, prolongation of consonants or vowel sounds, broken words, blocking or words produced with excess physical tension

• Childhood-onset fluency disorder (stuttering)

Persistent deficits in social communication and social interaction across multiple con-texts,

Autism Spectrum Disorder

Restricted, repetitive patterns of behavior, interests, or activities,

Autism Spectrum Disorder

Autism Symptoms must be present in the

Early developmental period

Autism Symptoms cause

Clinically significant impairment

- odd, repetitive behaviors, absence of typical play

Age 2

Autism Symptoms typically recognized at

12-24 mo

Delayed language development with lack of social interest, odd play patterns, unusual communication pattern

Autism Spectrum Disorder Delayed and regression lang not degenerative

Prognostic factors for autism

- presence or absence of Assoc intellectual disability - more mental health prob - epilepsy

Autism risk factors

Environmental Genetic and physiological

Environmental risk factors Autism

Advanced parental age, low birth weight, fetal exposure to valproic acid

Autism Genetic and physiological disorder

Heritability - 37-90%

• Impairing levels of inattention, disorganization, and / or hyperactivity - impulsivity • Inability to stay on task, seeming to not listen, and losing materials, at levels that are inconsistent with age or development • Overactivity, fidgeting, inability to stay seated, intrusive to other people's activity, inability to way that are excessive for age or developmental level

Attention Deficit/Hyperactivity Disorder (ADHD)

Inattention: Six (or more) of the following symptoms have persisted for at least 6 months to a degree that is inconsistent with developmental level and that negatively impacts directly on social and academic/occupational activities:

Attention Deficit/Hyperactivity Disorder (ADHD)

Hyperactivity and impulsivity Six (or more) of the following symptoms have persisted for at least 6 months to a degree that is inconsistent with developmental level and that negatively impacts directly on social and academic/occupational activities:

Attention Deficit/Hyperactivity Disorder (ADHD)

Adhd Several inattentive or hyperactive-impulsive symptoms were present

Prior to age 12

Adhd Several inattentive or hyperactive-impulsive symptoms are present in

2 or more setting

Adhd prevalence

5% of children • 2.5% of adults

Adhd Development and course

Preschool - manifest as hyperactivity • Often identified in elementary years with inattention • Relatively stable through early adolescence • Some symptoms of motoric hyperactivity becomes less obvious but difficulties with restlessness, inattention, poor planning and impulsivity persist

Deficits in acquisition and execution of coordinated motor skills • Clumsiness and slowness or inaccuracy of performance of motor skills that cause interference with ADLs

Developmental coordination disorder

Repetitive, seemingly driven, and apparently purposeless motor behaviors such as hand flapping, body rocking, head banging, self biting or hitting • Interfere with social, academic and other activities

Stereotypic movement disorder

sudden, rapid, recurrent, nonrhythmic, stereotyped motor movements or vocalizations

Tics

• Tourette's disorder, persistent (chronic) motor or vocal tic disorder, provisional ic disorder, other specified tic disorder or unspecified tic disorder

Tic disorder

Both multiple motor and one or more vocal tics have been present at some time during the illness, although not necessarily concurrently.

Tourette

Tourette’s Disorder Frequency and onset

Persisted for > 1 yr since first tic onset Onset before 18 y/o

Single or multiple motor or vocal tics have been present during the illness, but not both motor and vocal.

Persistent (Chronic) Motor or Vocal Tic Disorder

Tic prevalence

Common in childhood but transient in most cases • Tourette's - 3-8/1,000 school-age children • M>F (2-4:1)

Developmental course of tic disorder

Onset - 4-6 yo • Peak severity - 10-12yo then decline during adolescence

Schizophrenia begins before

Usually begins before age 25, persists throughout life and affects persons of all social classes • Diagnosis based on psychiatric history and mental status examination • No laboratory tests

Schizophrenia

Demence precoce • Described deteriorated patients whose illness began in adolescence

Benedict Morel (1809-1873)

• Dementia precox -change in cognition and early onset (precox) of disorder • Long term deteriorating course and clinical symptoms of hallucinations and delusions

Emil Kraepelin

-change in cognition and early onset (precox) of disorder

Dementia precox

• Schizophrenia • Schism - "separation" • Presence of schism among thought, emotion and behavior • Identified 4 primary symptoms (4As) 1. Associations 2. Affect 3. Autism 4. Ambivalence • Secondary symptoms: hallucinations and delusions

Eugene bleuler

Schism

Separation

Shizophrenia • Identified 4 primary symptoms (4As)

(4As) 1. Associations 2. Affect 3. Autism 4. Ambivalence

Schizophrenia prevalence

0.3-0.7%; US 1% • M=F • Peak age of onset: 10-25yo in M; 25-35 yo and onset after 40 yo (bimodal) in F • Onset before age 10 and after 60 is extremely rare • Males - negative symptoms and longer duration of disease; poorer outcome

Schizophrenia course

• Emerge between late teens and mid-30s • May be abrupt or insidious • Earlier age of onset, worse prognosis

ego disintegration; return to a time when ego was not yet developed

Freud

distortion in infant-mother relationship • Infant unable to separate and progress beyond the closeness and complete dependence in mother-child development in oral phase = insecure identity

Margaret Mahler

defect in ego functions permits intense hostility and aggression to distort the mother-infant relationship which leads to eventual personality disorganization and vulnerability to stress

Paul Federn

disturbance in interpersonal relatedness; adaptive method to avoid panic, terror and disintegration of the sense of self

Harry Sullivan

children receive conflicting parental messages about their behavior, attitude and feelings; they withdraw into psychotic state to escape the unsolvable confusion

Double bind

one parent is overly close to child of opposite gender

Schisms

power struggle between parents resulting in dominance of one parent

Skewed

Suppress emotional expression and when child leaves home, cannot relate to others

• Pseudomutual and pseudohostile families

Schizophrenia signs

Delusions. 2. Hallucinations. 3. Disorganized speech (e.g., frequent derailment or incoherence). 4. Grossly disorganized or catatonic behavior. 5. Negative symptoms (i.e., diminished emotional expression or avolition).

Continuous signs of the disturbance persist for at least 6 months. This 6-month period must include at least 1 month of symptoms (or less if successfully treated) that meet Criterion A (i.e., active-phase symptoms) and may include periods of prodromal or residual symptoms. During these prodromal or residual periods, the signs of the disturbance may be manifested by only negative symptoms or by two or more symptoms listed in Criterion A present in an attenuated form (e.g., odd beliefs, unusual perceptual experiences),

Schizophrenia

Type 1 schizophrenia

Normal brain structures by CT scan • Relatively good response to treatment • Hallucinations, delusions, bizarre behavior and positive formal though disorder

Type 2 schizophrenia

Structural brain abnormalities by CT scan • Poor treatment response • Diminished emotional expression

decrease in motivated self-initiated purposeful activities

Avolition

diminished speech output

Alogia

apparent lack of interest in social interactions

Asociality

treatment, rehabilitation and support activities

Assertive community treatment

focuses on real life plans, problems and relationships; reduce social isolation; increase sense of cohesiveness and improve reality testing

Group therapy

Improve cognitive distortions Correct error in judgement Improve reality setting

Cognitive behavioral therapy

A. The presence of one (or more) delusions with a duration of 1 month or longer. B. Criterion A for schizophrenia has never been met. Note: Hallucinations, if present, are not prominent and are related to the delusional theme (e.g., the sensation of being infested with insects associated with delusions of infestation). C. Apart from the impact of the delusion(s) or its ramifications, functioning is not markedly impaired, and behavior is not obviously bizarre or odd.

Delusion disorder

This subtype applies when the central theme of the delusion is that another person is in love with the individual.

Erotomanic

This subtype applies when the central theme of the delusion is the conviction of having some great (but unrecognized) talent or insight or having made some important discovery.

Grandiose

This subtype applies when the central theme of the individual's delusion is that his or her spouse or lover is unfaithful.

Jealous

This subtype applies when the central theme of the delusion involves the individual's belief that he or she is being conspired against, cheated, spied on, followed, poisoned or drugged, maliciously maligned, harassed, or obstructed in the pursuit of long-term goals.

Persecutors

This subtype applies when the central theme of the delusion involves bodily functions or sensations.

Somatic

Two (or more) of the following, each present for a significant portion of time during a 1-month period (or less if successfully treated). At least one of these must be (1), (2) or (3): 1. Delusions. 2. Hallucinations. 3. Disorganized speech (e.g., frequent derailment or incoherence). 4. Grossly disorganized or catatonic behavior. 5. Negative symptoms (i.e., diminished emotional expression or avolition). B. An episode of the disorder lasts at least 1 month but less than 6 months. When the diagnosis must be made without waiting for recovery, it should be qualified as

SChizophreniform

Psychopathology Flashcards

(102 cards)