Psychopathology (2)

Question 0

separation anxiety disorder

Answer 0

symptoms:
- developmentally inappropriate and excessive dear or anxiety concerning separation from those whom the individual is attached to, evident by 3+ persistent and excessive symptoms:
+ distress when anticipating or experiencing separation from home or from major attachment figures
+ worry about losing major attachment figures and possible harm to them
+ worry about experiencing an untoward event (i.e. kidnap) that will cause separation
+ reluctance/refusal to go out, away from home to elsewhere due to fear of separation
+ fear/reluctance of being alone or w/o major attachment figures
+ refusal/reluctance to sleep away from home or go to sleep w/o major attachment figures near
+ repeated nightmares about separation
+ repeated complaints of physical symptom when separation occurs or is anticipated
- fear, anxiety, or avoidance is persistent (4+ weeks for children/teenagers and 6+ months for adults)
- disturbance causes significant disstress or impairment in social, academic or occupational functioning
- not better explained by another mental disorder

Question 1

anxiety disorders

Answer 1

• share feature of excessive fear, anxiety, and related behavioral disturbances
• fear: response to real or perceived imminent threat; anxiety: respone to anticipation of future threat
• disorders tend to be highly co-morbid but can be differentiated by close examination of situation type and content of associated thoughts or belief
• fear or anxiety is excessive, persisting beyond developmentally appropriate periods and typically last 6+ months
• disorders may develop in childhood and will persist w/o treatment
• females are twice as likely to be diagnosed

Question 2

selective mutism

Answer 2

symptoms:
- consistent failure to speak in specific social situations in which there is an expectation for speaking despite speaking in other situations
- disturbance interferes with education/occupational achievement or social communication
- duration: 1+ months
- not attributable to lack of knowledge or comfort with language
- not better explained by a communication disorder

Question 3

specific phobia

Answer 3

symptoms:

• marked er or anxiety about a specific object or situation
• phobic object/situation almost always provokes immediate fear or anxiety
• phobic object/situation is actively avoided or endured with intense fear or anxiety
• fear or anxiety is out of proportion to actual danger posed and to social context
• duration: 6+ months
• causes impairment in social, occupational or other functioning
• not better explained by another mental disorder
• specify stimulus: animal, natural environment, blood/injection/injury, situational or others

Question 4

social anxiety disorder

formerly known as social phobia

Answer 4

symptoms:
- marked fear or anxiety about one or more social situations in which individual is exposed to possible scrutiny by others
- individual fears that he/she will act in a way or show anxiety symptoms that will be negatively evaluated
- social situations almost always provoke fear or anxiety
- social situations are avoided or endured with intense fear or anxiety
- fear or anxiety is out of proportion to the actual threat posed by situation and to the sociocultural context
- duration: 6+ months
- causes significant distress or impairment in social, occupational or other functioning
- not attributable to psychological effects of a substance or another medical condition
- not better explained by symptoms of another mental disorder
- if another medical condition is present, fear/anxiety/avoidance is clearly unrelated or excessive
- specify if it’s performance only (restricted to talking/performing in public)

Question 5

panic disorder

Answer 5

symptoms:
- recurrent unexpected panic attacks (abrupt surge of intense fear/discomfort that reaches a peak within minutes with 4+ symptoms below)
+ palpitations, pounding, increased heart rate
+ sweating, trembling, shaking, feelings of choking, shortness of breath
+ chest pain, dizziness, numbness/tingling sensation
+ nausea, abdominal stress
+ chill/heat sensation
+ feelings or unreality or self-detachment
+ fear or losing control or dying
- at least one attack has been followed by:
+ persistent concern/worry about additional attacks or their consequences
+ significant maladaptive change in behavior related to the attacks
- not attributable to physiological effects of a substance or another medical condition
- not better explained by another mental disorder

Question 6

agoraphobia

fear of open spaces and/or people

Answer 6

symptoms:
- marked fear/anxiety about 2+ out of 5 situations below:
+ using public transportation
+ being in open spaces
+ being in enclosed spaces
+ standing in line/being in a crowd
+ being outside of home alone
- fear and avoidance come from thoughts that escape might be difficult or help might be unavailable in the event of panic-like symptoms or embarrassing behaviors
- agoraphobic situations almost always provoke fear or anxiety
- situations are actively avoided, endured with intense fear/anxiety, or require companion
- fear/anxiety is out of proportion to the actual danger posed by situations and to the sociocultural context
- duration: 6+ months
- causes significant distress and impairment of functioning
- if another medical condition is present, fear/anxiety is clearly excessive
- not better explained by another mental disorder

Question 7

generalized anxiety disorder

Answer 7

symptoms:
- excessive anxiety and worry, occurring more days than not or 6+ months, about a number of events or activities
- individuals find it difficult to control anxiety
- 3+ associated symptoms:
+ restlessness/feeling on edge
+ easily fatigued
+ difficulty concentrating
+ irritability
+ muscle tension
+ sleep disturbance
- causes significant distress or impairment in functioning
- not attributable to physiological effects of a substance or medical condition
- not better explained by another mental disorder
- women are twice as likely to be diagnosed

Question 8

substance/medication-induced anxiety disorder

Answer 8

symptoms:
- panic attacks or anxiety is predominant
- evidence from history/physical examination/lab finding that:
+ symptoms developed during or soon after substance intoxication/withdrawal or after exposure to medication
+ involved substance/medication is capable of inducing panic attack or anxiety symptoms
- not better explained by an anxiety disorder that is not substance/medication-induced
- symptoms do not occur exclusively in context or delirium
- causes significant distres or impairment in functioning
- specify with onset during intoxication or withdrawal OR after medication use

Question 9

nosology for anxiety disorders

Answer 9

abnormal behavior -> medical disease -> psychiatric disease -> anxiety pathology

Question 10

differentiate: fear, worry, anxiety

Answer 10

• fear: emotional response to real or perceived imminent threat
• worry: apprehensive expectation (“what if”)
• anxiety: anticipation of future threats and unpleasant feelings of fear/concern

Question 11

differentiate: social anxiety vs. introversion

Answer 11

• social anxiety: concern of judgment

- introversion: slow-paced, contemplative, inward lifestyle

Question 12

tripartite model or anxiety and depression

Answer 12

• anxiety symptoms: negative affect + anxious arousal
• depressive symptoms: negative affect + low positive affect
  example: depressed patients will not find a funny joke funny, whereas anxious patients are still able to laugh, albeit nervously

Question 13

etiologies for anxiety disorders

Answer 13

• evolutionary: phobias are very common and could be linked with evolutionary advantage; #1 stressor: intrapersonal stress
• biology
  fight-or-flight response
  + brain detects danger -> activates Hypothalamic-Pituitary-Adrenal (HPA) axis
  + adrenal glands release cortisol
  neurotransmiters: serotonin, dopamine, nonepinephrine, and GABA
• cognitive behavioral: learning/training

Question 14

treatment for anxiety disorders

Answer 14

• medication: SSRIs, SNRIs, blood pressure medication

- psychotherapy: CBT, exposure therapy

Question 15

obsessive-compulsive and related disorders

Answer 15

• differ from developmentally normative preoccupations and rituals in the sense that symptoms are:
  + excessive
  + persisting past developmentally appropriate period
• distinction between clinical and subclinical require assessment of different factors like level of stress and effects on functioning

Question 16

obsessive-compulsive disorder (OCD)

Answer 16

symptoms:
- presence of obsessions, compulsions or both:
+ obsessions: recurrent, persistent, intrusive, and unwanted thoughts, urges, or images that cause significant distress or anxiety which individual attempts to ignore or suppress with some other thought or action
+ compulsions: unrealistic, excessive and repetitive behaviors or mental acts meant to prevent or reduce anxiety/stress or prevent some dreaded situations that individual fels driven to perform in response to obsessions or according to rigid rules
- obsessions or compulsions are time-consuming (1+ hr/day) or cause marked anxiety/distress and impair functioning
- not attributable to physiologgical effectts of a substance or another medical condition
- not better explained by symptoms of another mental disorder
- specify level of insight (fair/good, poor, absent with delusional beliefs) and if it’s tic-related

Question 17

body dysmorphic disorder

Answer 17

symptoms:
- preoccupation with one or more perceived defects or flaws in physical appearance that are not observable or appear slight to others
- at some point during cause of disturbance, individual has performed repetitive behaviors or mental acts in response to appearance concern
- preoccupation causes significant distress or impair functioning
- not better explained by concern with body weight in someone whose symptom meet criteria for an eating disorder
- specify whether with muscle dysmorphia and level of insight (good/fair, poor, absent with delusional beliefs)

Question 18

hoarding disorder

Answer 18

symptoms:
- persistent difficulty discarding or parting with possessions regardless of actual value
- difficulty is due to a perceived need to save items and distress associated with discarding them
- results in accumulation of possessions that congest and clutters active living areas and compromises their intended use (if not, it’s due to the interference of a third cleaning party)
- hoarding causes significant distress or impairs functioning
- not attributable to another medical condition
- not better explained by symptoms of another mental disorder
- specify level of insight and whether with excessive acquisition

Question 19

trichotillomania

hair-pulling disorder

Answer 19

symptoms:
- recurrent pulling out of one’s hair that results in hair loss
- repeated attempts to decrease or stop
- causes signifiant distress or impairment in functioning
- not attributable to another medical condition
- not better explained by symptoms of another mental disorder

Question 20

excoriation disorder

skin-picking disorder

Answer 20

symptoms:
- recurrent skin picking that leads to skin lesions
- repeated attempts to decrease/stop
- causes significant distress or impairment in functioning
- not attributable to physiological effects of a substance or another medical condition
- not better explained by symptoms of another mental disorder

Question 21

substance/medication-induced obsessive-compulsive and related disorder

Answer 21

symptoms:
- symptoms characteristic of obsessive-compulsive and related disorders predominate the clinical picture
- evidence from history, physical examination, or lab finding that:
+ symptoms developed during or soon after substance intoxication/withdrawal or exposure to a medication
+ involved substance/medication is capable of producing symptoms present
- not better explained by another OC and related disorder that is not substance/medication-induced (precede onset of use, symptoms lst 1+ months after, etc.)
- symptoms do not occur exclusively during course of delirium
- causes significant distress or impairment in functioning
- specify with onset during intoxication or withdrawal OR after medication use

Question 22

trauma- and stressor-related disorders

Answer 22

• disorders in which exposure to a traumatic/stressful event is a diagnosis criterion
• distress is present in a spectrum: anxiety, fear, anhedonia, to dysphoria
• reactive attachment vs. disinhibited social engagement: internalizing vs. externalizing

Question 23

reactive attachment diisorder

Answer 23

symptoms:
- consistent pattern of inhibited, emotionally withdrawn behavior towards adult caregivers, manifested by:
+ child rarely/minimally seeks comfort when distressed
+ child rarely/minimally responds to comfort when distressed
- persistent social/emotional disturbance characterized by 2+ symptoms:
+ minimal social and emotional responsiveness to others
+ limited positive affect
+ episodes of unexplained sadness, irritability, or fearfulness even during nonthreatening interactions with caregivers
- child experienced a pattern of extremes of insufficient care:
+ social neglect/deprivation
+ repeated changes of caregivers -> inability to form stable attachment
+ rearing in unusual setting (i.e. orphanage) which limits selective attachment
- care is presumed to be responsible for disturbance
- criteria are not met for autism
- onset: before 5 years old
- developmental age of 9+ months
- specify persistence and severity

Question 24

disinhibited social engagement disorder

Answer 24

symptoms: - pattern of behavior in which child actively approaches and interacts with unfamiliar adults and exhibits 2+ behaviors: + reduced/absent reticence in approaching and interacting with unfamiliar people + overly familiar verbal/physical behavior (not consistent with culturally sanctioned or age appropriate boundaries) + diminished/absent checking back with adult caregivers even in unfamiliar settings + willingness to go off with unfamiliar adults without or with minimal hesitation - behaviors are not limited to impulsivity but include social diinhibition - child experienced extremes oor insufficient childcare: + social neglect/deprivation + repeated change of caregivers -> inability to form stable attachment + unusual rearing settings that severely limit selective attachment - care is presumed to be responsible for disturbance - developmental age of 9+ months - specify persistency and severity

Question 25

post-traumatic stress disorder (PTSD)

Answer 25

symptoms: - exposure to actual or threatened death, serious injury, or sexual violence through: + directly experiencing + witnessing in person as it occurs to others + learning that it happened to close family or friend (for death, it has to be violent or accidental) + experiencing repeated or extreme exposure to aversive details - presence of 2+ intrusion symptoms associated with trauma: + recurrent, involuntary, and intruive distressing memories + recurrent distressing dreams with content or affec related tto trauma + dissociative reactions (i.e. flashback) which individual feels or ats as if trauma was recurring + intense/prolong psychological distress at exposure to internal/external cues that symbolize or resemble trauma + marked physiological reactions - persistent avoidance of stimuli associated with trauma after it occurred such as: + distressing memories/thoughts/feelings associated with trauma + external reminders - negative alterations in cognitions and mood associated trauma after it occurred by 2+ signs: + inability to remember an important aspect of trauma due to dissociative amnesia + persistent and exaggerated negative beliefs or expectations about oneself or the world + persistent and distorted cognitions about cause or consequences of trauma that lead to self-blaming + persistent negative emotional state + marked diminished interest or participation in significant activities + feelings of detachment/estrangement from other + persistent inability to experience positive emotions - marked alterations in arousal an reactivity associated with trauma, beginning or worsening after it occurred (2+ symptoms): + irritable behavior and angry outbursts expressed by verbal or physical aggression + reckless/self-destructive behavior + hypervigilance + exaggerated startle response + problems with concentration + sleep disturbance - duration: 1+ months - causes significant distress or impairs functioning - not attributable to physiological effects of a substance or another medical condition - specify with dissociative symptoms (depersonalization or derealization) and with delayed expression (6+ months after)

Question 26

acute stress disorder

Answer 26

the same as PTSD BUT occurs within 1 month of and resolves within that 1 month period

Question 27

adjustment disorder

Answer 27

symptoms: - development of emotional or behavioral symptom in response to an identifiable stressor occurring within 3 months of onset of stressor - symptoms are significant as: + marked distress, out of proportion to severity/intensity of stressor, is evident considering external context or cultural factors + significant impairment in functioning - does not meet criteria for another mental disorder and is not merely an exacerbation of a preexisting condition - symptoms do not represent normal bereavement - symptoms do not persist 6+ months once stressor/consequences are terminated - specify whether with depressive mood, mixed depressive + anxiety, disturbance of conduct, mixed disturbance of conduct + mood, or unspecified

Question 28

commonalities between obsessive-compulsive and trauma-related disorder families

Answer 28

- etiologies: + stressful event(s) + learning: behaviors are reinforced with operant conditioning (i.e. relief from feeling gross by washing hands repeatedly OR relief from trauma-related stress by avoiding) + inhibitory control problem: underactiity for OCD and overactivity for PTSD + related behaviors: tic for OCD and substance abuse for PTSD - issue: increased risk in suicide - first-line treatment: psychotherapy + safe exposure + trauma-focused CBT for PTSD: discuss and challenge Just World belief (good things happen to good people, bad things happen to bad people), write a trauma narrative and desensitize in a safe setting

Question 29

PTSD symptoms

Answer 29

intrusion avoidance cognition/mood symptoms alterations in arousal

Question 30

generalized anxiety disorder (GAD)

Answer 30

- NOT a catch-all diagnosis - definition: a lot of worry about a lot of things for a long time (6+ months) - symptoms: difficulty concentrating, muscle tension, sleep disturbance, irritability, fatigue, and restlessness - etiologies: + biology: amyglada problems (because communication between amyglada and HPA axis is done with serotonin) -> treat with SSRIs + cognitive: catastrophizing negative thought patterns OR high level of intolerance of uncertainty (measured with questionnaire) - to worry is normal!

Question 31

five big worry domains

Answer 31

``` - relationship/family: + with partner(s) + with friends + with family members - financial: + money/bills + housing - work (or lack thereof) - health: + mental health + physical health - miscellaneous: + legal issues + political issues/news + others ```

Question 32

etiologies for anxiety pathology

Answer 32

``` - nature: + evolution + familial predispositions (genetics) + sex + neurotransmitters + personality + HPA axis - nurture: + classical or operant conditioning + traumas + age + sex/gender + substance use + medical co-morbidities ```

Question 33

possible sources of depression

Answer 33

- chemical imbalance - irregularities in brain structure and function + depressed people have diminished activity in prefrontal cortex and increased activity in other areas + also abnormal levels of activity in subcallousal cingulate gyrus + reduced hippocampus volume? - disturbances in neural circuitry - psychological contributions (i.e. stressors) + brain releases cortisol to help cope with stress -> mobilize energy stored for fight-or-flight + excess might be harmful => depression can come from a complex combination of sources

Question 34

common features of depressive disorders

Answer 34

- sad, empty, or irritable mood | - somatic and cognitive changes that affect functioning

Question 35

disruptive mood dysregulation disorder | basically bipolar disorder in children 12+

Answer 35

symptoms: - severe recurrent verbal or behavioral temper outbursts that are grossly out of proportioin in intensity and duration given the situation/provocation - outbursts are inconsistent with developmental level - frequency: ~3 times/week - mood in between outbursts is persistently irritable for most of the day and nearly every day - symptoms are present 12+ months (no more than 3+ months w/o) - behavior present in 2+ settings and severe in at least 1 - first diagnosis age: between 6 and 18 - age of onset: before 10 - no full symptom for hypomanic or manic episode in a distinct period longer than a day - behaviors do not occur exclusively during an episode of major depressive disorder - not better explained by another mental disorder - not attributable to substance use or another medical or neurological condition

Question 36

major depressive disorder

Answer 36

symptoms: - 5+ symptoms present for 2+ weeks, signify a change in previous functioning (at least 1 symptom is either depressive mood or loss or interest/pleasure) + depressive mood most of the day, nearly every day + marked diminished interest or pleasure in almost all activities + irregularity in appetite or weight (more than 5% body weight in a month) + insomnia or hypersomnia + psychomotor agitation or retardation + fatigue or loss of energy + feelings of worthlessness or excessive/inappropriate guilt + diminished ability to concentrate + recurrent thought of death/suicidal ideation w/o plan - symptoms cause significant distress or impair functioning - ot better explained by psychotic disorders - no manic or hypomanic episode - specify background (may not be depression if circumstances are reasonable, like loss or bereavement)

Question 37

premenstrual dysphoric disorder

Answer 37

symptoms: - 5+ symptoms are present in the final week before onset of menses, improve within a few days of the onset of menses, and become minimal or absent in the week post-menses + at least one of these: + marked affective liability (mood swings, sad/tearful/sensitive) + marked irritability/angeer + marked depressed mood, feelings or hopelessness or insecurity + marked anxiety/tension + combinned with these to make at least 5: + subjective difficulty in concentration + marked lack of energy + change in appetite and/or sleep + sense of being overwhelmed or out of control + breast tenderness, swelling, joint/muscle pain, bloating or weight gain - cause significant distress or interfere with work/school/relationship/activities - not merely an exacerbation of another disorder - must observe symptoms for at least 2 cycles with daily ratings - not attributable to drug or substance

Question 38

substance/medication-indued depressive disorder

Answer 38

symptoms: - prominent and persistent disturbance in mood that predominates in the clinical picture, characterized by marked depressive mood and loss of interest - evidence from history, physical examination or lab finding that: + symptoms developed during or soon after substance intoxication/withdrawal or exposure to medication + involved substance i capable of producing symptoms mentioned - not better explained by another depressive disorder - symptoms do not occur only during delirium - cause significant distress or impair functioning - specify onset: during intoxication, during withdrawal or with exposure

Question 39

specifiers for depressive disorders

Answer 39

- with anxious distress - with mixed features (manic or hypomanic symptoms) - with melancholic features - with atypical features (i.e. mood reactivity) - with psychotic features - with catatonia - with peripartum onset - with seasonal pattern - in partial or full remission - severity (mild, moderate, severe)

Question 40

manic episode

Answer 40

- distinct period of abnormally and persistently elevated expansive/irritable mood and goal-directed activity/energy, lasting 1+ week for most of the day, every day - 3+ symptoms: + inflated self-esteem/grandiosity + decreased need for sleep + more talkative/pressured to keep talking + flight of ideas/racing thoughts + easily distracted + goal-directed activity and/or increased psychomotor agitation + excessive involvement in high-risk behaviors - marked impairment in functioning, may necessitatee hospitalization to prevent harm to self or to others - not attributable to any substance or medical condition - may be preceded or followed by hypomanic or depressive episodes

Question 41

hypomanic episode

Answer 41

- similar to manic, but disturbance is not severe enough to necessitate hospitalization or impair functioning - no psychotic features - not required, albeit common, in diagnosing bipolar disorder

Question 42

major depressive episode

Answer 42

- 5+ symptoms for 2+ weeks, represent a change from previous functioning, at least 1 is depressive mood or loss of interest/pleasure + depressive mood most of the day, nearly every day + diminished interest or pleasure + significant weight (more/less than 5% body weight) or appetite change + hypersomnia or insomnia + psychomotor agitation or retardation + fatigue/loss of energy + worthlessness or extreme/inappropriate guilt + diminished ability to think or concentrate + recurrent thought of death - cause significant distress or impairment in functioning - not attributable to any substance or medical condition

Question 43

bipolar I diagnosis

Answer 43

- at least 1 manic episode | - depressive episodes cannot be explained by schizophrenic spectrum disorders

Question 44

bipolar II disorder

Answer 44

- at least 1 hypomanic episode - at least 1 major depressive episode - episodes are not better explained by schizophrenic spectrum disorders - alternation between periods of depression and hypomania - cause significant distress or impair functioning

Question 45

cyclothymic disorder

Answer 45

symptoms: - 2+ years (1+ for children and teenagers) of numerous periods of hypomanic symptoms and periods of depressive symptoms that do not meet the episode criteria - during those years, the hypomanic and depressive periods have been present for at least 50% of the time (never 2+ months w/o symptoms) - never met criteria for any type of episode - not better explained by schizophrenia spectrum disorders - not attributable to any substance or medical condition - cause distress and impair functioning

Question 46

specifiers for bipolar disorders

Answer 46

- with anxious distress - with mixed features - with rapid cycling (4+ episodes/12 months) - with melancholic features - with atypical features (leaden paralysis, mood reactivity, etc.) - with psychotic features (mood congruent or mood incongruent) - with catatonia - with peripartum onset - with seasonal pattern - in partial or full remission - severity (mild, moderate, severe)

Question 47

nosology for depressive and bipolar disorders

Answer 47

abnormal behavior -> medical disease -> psychiatric disease -> mood pathology

Question 48

etiologies for mood pathology

Answer 48

- genetics: + 1st degree family members of major depressive disorder patients are twice to four times as likely to have the disorder + family members of bipolar I patients have ten times the chance of sharing the disorder - sex: M/F + females are twice as likely to have depression right at the start of puberty + males are more likely to have bipolar disorders (male:female = 11:1) and to complete their suicides - culture: + many countries don't recognize mental health, especially depression + bipolar disorders are most common in the US, which is amongst the happiest nations and nations with high suicidal rate) - chemicals: nonepinephrine, serotonin, dopamine - thought & self-esteem: + major depressive disorder: maladaptive cognitions and low self-esteem + bipolar I: cognitive impairment and grandiosity

Question 49

treatment for depressive and bipolar disorders

Answer 49

- psychotherapy: + depression: interpersonal therapy (increase social exposure and study attachment) + bipolar: interpersonal social rhythm therapy (inspired by Circadian rhythm) + cognitive behavioral therapy (CBT) for both - pharmacology: + bipolar: lithium + depression: SSRIs

Question 50

etiologies for mood pathology

Answer 50

``` - nature (diathesis) + evolution + familial predispositions (genetics) + brain abnormality + neurotransmitters + personality/identity - nurture (stress) + trauma stress/kindling (specific to bipolar) + interpersonal instability + age + sex + educational achievement + medical co-morbidities + substance use ```