Psychopathology (3)

Question 0

somatic symptom disorder

Answer 0

• excessively focusing on physical symptoms without regarding psychological workings, separate mind and body*
  symptoms:
• 1+ somatic symptoms that are distressing or results in significant disruption in daily life
• excessive thoughts, feelings, or behaviors related to somatic symptoms or associated health concerns (1+ signs)
  + disproportionate & persistent thoughts about the seriousness of one’s symptoms
  + persistently high level of anxiety about health or symptoms
  + excessive time & energy devoted to said concerns
• specify: with predominant pain, persistency, and severity

Question 1

somatic symptom and related disorders

Answer 1

• common feature: somatic symptoms are prominent, along with significant distress and functioning impairment
• patient are commonly encountered in primary care and medical settings but not psychiatric and mental health settings because diagnoses were reconceptualized
• emphasize diagnosis made on basis of positive symptoms and signs
• considerable medical comorbidity
• prominent focus on somatic concerns and initial presentation mainly in medical settings

Question 2

illness anxiety disorder (hypochondriasis)

Answer 2

symptoms:
- preoccupation with having or acquiring a serious illness
- somatic symptoms are not present or if present, only mild in intensity
+ if another medical condition is preent or there is a high risk for developing a medical condition, preoccupation is clearly excessive or disproportionate
- high level of anxiety about health & the individual is easily alarmed about personal health status
- individual performs excessive health-related behaviors or exhibits maladaptive avoidance (e.g. check for signs, avoid hospitals, etc.)
- preoccupation duration: 6+ months (feared specific illness can change)
- not better explained by another mental disorder
- specify: care-seeking or care-avoidant type

Question 3

conversion disorder (functional neurological symptom disorder)

Answer 3

• unconsciously convert psychological stress to neurological/physical symptoms even though there is no medical pinning behind them; psychogenic aka coming from one’s own thoughs*
• 1+ symptoms of altered voluntary motor or sensory funtion
• clinical findings provide evidence of incompatibility between symptom and recognized neurological/medical condition
• not better explained by another medical or mental disorder
• causes significant distress, impairs functioning, and warrants medical evaluation
• specify symptom type: w/ weakness or paralysis, abnormal movement, swallowing symptoms, speech symptoms, attacks or seizures, anesthesia or sensory loss, special sensory symptom, and mixed symptoms
• specify: acute episode, with or without psychological stressor

Question 4

psychological factors affecting other medical condition

Answer 4

patient has actual medical diagnosis & messes up their treatment by maladaptive cognitions or behaviors
- a medical symptom or condition is present (other than a mental one)
- psychological or behavioral factors adversely affect the medical condition in 1+ way:
+ factors influence course of medial condition as evident by a close temporal association between the psychological factors and development/exacerbation of or delayed recovery from condition
+ factors interfere with treatment
+ constitute additional well-established health risk for individual
+ influence underlie pathophysiology, precipitate/exacerbate symptoms or necessitate medical attention
- not better explained by another mental disorder
- specify severity (mild, moderate, severe, extreme)

Question 5

factitious disorder

Answer 5

patient fabricates disorder for some reasons, e.g. money or attention, may hurt themselves in the process knowingly or not; malingering = faking for an external gain or reward
- self-imposed
+ falsification of physical or psychological signs of symptoms, or induction of injury or disease, associated with identified deception
+ the individual presents to others as ill, injured, or impaired
+ deceptive behavior is evident even in absence of obvious external rewards
+ not better explained by another mental disorder
+ specify: single or recurrent episode(s)
- imposed on another (by proxy): same thing but on someone else/victim

Question 6

etiologies of somatic disorders

Answer 6

• historical & sociocultural:
  + past: disorder called hysteria, almost exclusively a woman’s problem, lumps basically any condition
  + religious aspect: seizures = being seized by the Devil
  + mass hysteria: psychogenic seizures serve as psychological relief
  + Charcot, Freud’s teacher, focuses on psychoneurological aspect of hypnosis
  + Freud proposes the concept of unconscious driving hysterical behaviors -> psychoanalysis
  + women were restricted under Victorian decorum ideals -> relief
  + American culture idealizes gentility -> Scarlett O’Hara Syndrome that results in faints, fits, spells, etc.
• cognitive-behavioral: reinforcement provided for continue the “sick” role

Question 7

differential diagnoses for somatic disorders

Answer 7

• epilepsy is neurological, proven by EGG scan of brain waves during muscle convulsions
• seizures are triggered by stress
• psychogenic symptoms show no brain abnormalities

Question 8

treatment for somatic disorders

Answer 8

• pain management: be careful with medication because they are only temporary and can become addictive
• body feedback machine: monitors physical movements so you can learn ho to cope with physical symptoms
• hypnosis: #1 thing = patient has to be susceptible
  + best guy: Martin Erikson
  + factors: suggestion, susceptibility, and trance
• there is a link between hypnosis and dissociation (think guy who walks on nails)
• ulcers and chronic fatigue can NOT be listed as psychogenic=
• there is no such thing as a nervous breakdown

Question 9

feeding and eating disorders

Answer 9

• characterized by persistent disturbance of eating or eating-related behavior -> altered consumption or absorption of food
• impair physical health or psychological functioning
• common theme: dangerous eating

Question 10

pica

Answer 10

• persistent eating of nonnutritive, non-food substance for 1+ month
• behavior is inappropriate to developmental level
• behavior is not part of a culturally supported or socially normative practice
• if behavior occurs in context of another mental disorder: sufficiently severe to warrant additional medical attention

Question 11

rumination

Answer 11

• repeated regurgitation of food for 1+ month, regurgitated food may be re-chewed, re-swallowed, or spit out
• not attributable to associated gastrointestinal or other medical condition
• disturbance does not occur exclusively during course of anorexia, bulimia, binge-eating disorder, or avoidant/restrictive food intake disorder
• if symptoms occur in context of another mental disorder: sufficiently sever to warrant additional clinical attention
• thought to b more prevalent in people with intellectual disability
• specify if in remission

Question 12

avoidant/restrictive food intake disorder

Answer 12

• eating/feeding disturbance (lack of interest n eating food and avoidance based on sensory characteristics of food OR concern about aversive consequences of eating) manifested by persistent failure to meet appropriate nutritional and/or energy needs and 1+ sign:
  + significant weight loss/failure to achieve expected weight gain/faltering growth (in children)
  + significant nutritional deficiency
  + dependence on enteral feeding/oral nutritional supplements
  + marked interference with psychosocial functioning
• not better explained by lack of available food or by an associated culturally sanctioned practice
• does not occur exclusively in context of anorexia or bulimia; no evidence of a disturbance in the way in which body weight or shape is experienced
• not attributable to concurrent medical condition & not better explained by another mental disorder
• if disturbance occurs in context of another condition: severe enough (exceed routine associated) to warrant additional clinical attention
• specify if in remission

Question 13

anorexia nervosa

Answer 13

• characterized by intense fear of gaining weight*
• restriction of energy intake relative to requirements -> significantly low body weight (less than minimally normal or expected in the case of <18 years old)
• intense fear of gaining weight or becoming fat; persistent behaviors that interfere with weigh gain despite significantly low weight
• disturbance in the way body weight or shape is experienced undue influence of body weight or shape on self-evaluation; persistent lack of recognition of seriousness of the current low weight
• specify: type (restricting or binge-eating/purging), if in partial or full remission, severity (mild, moderate, severe, extreme) based on BMI

Question 14

bulimia nervosa

Answer 14

characterized by drastic compensatory behaviors
- recurrent episodes of binge-eating:
+ eating in a discrete period of time (within any 2-hour period) an abnormally large amount of food
+ sense of lack of control over eating during episode (feeling like they can’t stop or control)
- recurrent inappropriate compensatory behavior in order to prevent weight gain (self-induced vomiting, excessive exercise, fasting, misuse of medication like diuretics and laxatives)
- duration: 3+ months
- self-evaluation is unduly influenced by body shape and weight
- does not occur exclusively during episodes of anorexia
- specify: if in partial or full remission and severity (based on frequency of compensatory behaviors/week)

Question 15

binge-eating disorder

Answer 15

characterized by binge-eating
- recurrent episodes of binge-eating
- episodes are associated with 3+ symptoms:
+ eating much more rapidly
+ eating until uncomfortably full
+ eating large amounts of food when not physically hungry
+ eating alone due to embarrassment of amount of food intake
+ feeling depressed, guilty, or disgusted after
- marked distress is present
- frequency: at least once/week, 3+ months
- not associated with recurrent use of inappropriate compensatory behavior; does not occur exclusively in context of anorexia and bulimia
- specify if in partial or full remission and severity (based on frequency of binge-eating episodes per week)

Question 16

other specified feeding or eating disorder

Answer 16

• atypical anorexia nervosa: all criteria met besides weight loss
• bulimia nervosa with low frequency and/or limited duration: all criteria met besides frequency and duration
• binge-eating with low frequency and/or limited duration: all criteria met besides frequency and duration
• purging disorder: recurrent purging behavior to influence weight or shape without binge-eating
• night-eating syndrome:
  + recurrent episodes of night-eating
  + patient is aware of and can recall eating
  + not due to external influences or local social norms
  + causes distress and/or impairs functioning
  + not attributable to another mental disorder, substance use, or another medical disorder or condition

Question 17

etiologies of feeding and eating disorders

Answer 17

• sociocultural & evolutionary:
  + most prevalent in middle-class, Caucasian females of Western countries
  + depends on culture (Africa: heaviness = wealth + fertility, Western countries: slenderness = sign of status)
  + women conform to societal beauty standards (socioeconomic: poor prefers plump, climate: people of warmer countries prefer plump, cultural: matriarchy-driven society prefers skinny to NOT please men)
• biological & behavioral:
  + we evolve to really enjoy and savor food -> dopamine released and pleasure pathways opened when we eat
  + very similar to addiction - based on operant conditioning
• cognitive & sociocultural:
  + unhealthy cognitions about beauty ideals, weight, and body type
  + suggestions from media (thin culture, relationship between appearance and sexuality, positive reinforcement)

Question 18

treatment for feeding and eating disorders

Answer 18

• NOT psychopharmacology!
• “rehab” center -> getting back on appropriate nutritional level and improve body image
• support groups
• good sleep! (prevent stress and stress eating)

Question 19

sleep-wake disorders

Answer 19

• complaints: dissatisfaction with quality, timing, and amount of sleep
• cause daytime distress and impairment in functioning
• often accompanied by depression, anxiety, and cognitive changes
• persistent sleep disturbance increases risk for developing mental illnesses and substance use disorders

Question 20

insomnia disorder

Answer 20

• predominant complaint of dissatisfaction of sleep quality or quantity with 1+ symptoms:
  + difficulty initiating sleep
  + difficulty maintaining sleep (frequent awakenings or problems returning to sleep after awakenings)
  + early morning awakening with inability to return to sleep
• causes distress or impairs functioning
• frequency: 3+ times/week; duration: 3+ months
• occurs despite adequate opportunity for sleep
• not better explained by an does not occur exclusively in the context of another sleep-wake disorder
• not attributable to substance use
• not adequately explained by comorbid mental illnesses or medical conditions
• specify: non-sleep disorder, medical comorbidity, frequency (episodic, persistent, recurrent)

Question 21

hypersomnolence disorder

Answer 21

excessive sleepiness, chronic tiredness, doesn’t get benefit of sleep
- self-reported excessive sleepiness (hypersomnolence) despite a main sleep period of 7+ hours with 1+ symptoms:
+ recurrent periods of seep or lapses into sleep within the same day
+ prolonged main sleep episode of 9+ hours that is non-restorative/unrefreshing
+ difficulty being fully awake after abrupt awakening
- frequency: 3+ times/week; duration: 3+ months
- causes significant distress or impairs functioning
- not better explained by and does not occur exclusively during course of another sleep disorder
- not attributable to symptoms of substance
- not adequately explained by coexisting mental and medical conditions
- specify: with mental disorder, with medical condition, with another sleep disorder; type (based on duration - acute, subacute, persistent), severity

Question 22

narcolepsy

Answer 22

characterized by neurological and medical criteria
- recurent periods of irrepressible need to sleep, lapsing into sleep, or napping within the same day (3+ times/week, 3+ months) with 1+ symptoms:
+ episodes of cataplexy a few times/month:
~ brief (secs to mins) episodes of sudden bilateral loss of muscle tone with maintained consciousness, precipitated by laughter/joking
~ spontaneous grimaces or jaw opening episode with tongue thrusting or a global hypotomia without any obvious emotional trigger
+ hypocretin deficiency (exclude brain injury, inflammation, and infection)
+ nocturnal sleep polysomnograph showing sleep latency
- specify: type and severity

Question 23

obstructive sleep apnea

Answer 23

characterized by physical obstruction for breathing - think overweight middle-aged man sleeping on his back
EITHER - evidence by polysomnographs of 5+ obstructive apneas or hypoapneas/hour of sleep along with one or both:
+ nocturnal breathing disturbances: snoring, snorting/gasping, or breathing pauses
+ daytime sleepiness, fatigue, or unrefreshing sleep despite sufficient opportunities for sleep (not better explained by another mental or medical condition)
OR - evidence by polysomnographs of 15+ obstructive apneas and/or hypoapneas/hour of sleep regardless of accompanying symptoms
- specify severity

Question 24

central sleep apnea

Answer 24

* heart-related* - evidence by polysomnographs of 5+ central apneas/hour of sleep - not better explained by another current sleep disorder - specify: idiopathic central sleep apnea, Cheyne-Stokes breathing, comorbid with opiod use

Question 25

sleep-related hypoventilation

Answer 25

- polysomnographs demonstrate episodes of decreased respiration associated with elevated carbon dioxide levels (measure with oxygen saturation) - not better explained by another sleep disorder - specify: idiopathic hypoventilation, congenital central alveolar hypoventilation, comorbid sleep-related hypoventilation; severity

Question 26

Circadian rhythm sleep-wake disorder

Answer 26

- persistent/recurrent pattern of sleep disruption that is primarily due to alteration of the Circadian system OR misalignment between endogenous Circadian and sleep-wake schedule due to environment of occupation (e.g. shift work, college) - leads to excessive sleepiness/insomnia/both - causes distress and/or impairs functioning - specify: type (delayed sleep phase, advanced sleep phase, irregular sleep-wake, non 24-hour sleep-wake, shift work)

Question 27

non-rapid eye movement (NREM) sleep arousal disorder

Answer 27

* not dreaming but still moving physically* - recurrent episodes of incomplete awakening from sleep accompanied by sleep walking or sleep terror - little to no dream recall - amnesia for episodes is present - not attributable to physiological effects of a substance - not adequately explained by coexisting mental or medical conditions - specify type (sleepwalking, w/ sleep-related eating, sexsomnia, or sleep terror)

Question 28

nightmare disorder

Answer 28

* vivid distressing dreaming, no movement* - repeated occurrences of extended, extremely dysphoric, and well-remembered dreams that usually involve efforts to avoid threats - individual rapidly becomes alert and oriented upon awakening - cause distress or impair functioning - not attributable to a substance - not adequately explained by coexisting mental or medical condition - specify: during sleep onset, w/ associated non-sleep/sleep/medical disorder, type (based on duration - acute, subacute, persistent), severity

Question 29

rapid eye movement (REM) sleep behavior disorder

Answer 29

*dreaming AND acting out/moving in sleep even though body should be paralyzed* - repeated episodes of arousal durring sleep associated with vocalization and/or complex motor behaviors - behaviors occur during REM sleep - upon awakening individual is completely awake, not confused or disoriented EITHER - REM sleep without atonia on polysomnograph OR - history suggestive of REM seep behavior disorder & an established synucleinopathy diagnosis (e.g. Parkinson's) - cause distress or impair functioning - not attributable to substance use or another medical condition - not adequately explained by coexisting mental or medical conditions

Question 30

restless legs syndrome

Answer 30

*can't sleep because of restlessness and urge to move legs8 - urge to move legs, usually accompanied by/in response to uncomfortable & unpleasant sensations in the legs + urge begins or worsens during rest/inactivity + urge is partially or completely relieved by movement + urge worsens or occurs only during the evening or night - frequency: 3+ times/week; duration: 3+ months - cause distress or impair functioning - not attributable to another mental disorder or medical condition; not better explained by a behavioral condition - not attributable to drugs or medication

Question 31

brain regions in sleep

Answer 31

- the brain is thinking and working during sleep! - increased activity in: + part of visual cortex + part of attention processing + hippocampus (memory consolidation!!) + emotions - decreased activity in: + prefrontal cortex + frontal cortex

Question 32

blended etiologies for sleep-wake disorders

Answer 32

- sociocultural & biological: Circadian rhythm is important but certain circumstances (college, shift work) make us go against our natural biological clock - biological & cognitive-behavioral: pattern of sleep deprivation (life problems -> sleep problems -> life problems and so on) - cognitive-behavioral & psychodynamic: + people get anxiety from nightmares -> avoid/prevent sleep -> bad cognition + memory consolidation happens in sleep!! + dream content study

Question 33

treatment for sleep-wake disorders

Answer 33

- cognitive-behavioral: + use CPAP aka breathing machine (roadblock: limit love life) + avoid sleeping on back + writing new ending to nightmare (roadblock: some may not be open to that type of exposure) + pharmacology (roadblock: addiction) + practice good sleep hygiene

Question 34

classes of drugs

Answer 34

- alcohol - caffeine - cannabis - hallucinogens - inhalants - tobacco - opioids - sedatives, hypnotics, and anxiolytics - stimulants - others/unknown

Question 35

how drugs work

Answer 35

- drugs taken in excess directly activate reward system, which takes part in reinforcing behaviors and producing memories - activation is so intense, the system neglects normal activities - pleasure pathways are activated directly through drugs, and not through adaptive behaviors - produce feelings of pleasure (high) and release dopamine; lower levels of self-control => addiction - two types of disorders: substance-use ad substance-induced

Question 36

substance use disorder

Answer 36

- problematic pattern of substance use leading to significant distress or impairment in functioning, 2+ symptoms over 12+ months: + substance taken in larger amounts/over a longer period than intended + persistent desire/unsuccessful efforts to cur down/control use + great deal of time spent in substance-related activities (obtain, use, recover) + craving/strong desire or urge to use substance + recurrent substance use results in failure to fulfill major obligations at work, home, etc. + continued use despite having persistent/recurrent social or interpersonal problems caused or exacerbated by substance use + important activities (social, occupational, recreational) given up or reduced due to substance use + recurrent use in hazardous situations + continued use despite knowledge of current problem (physical/psychological) likely caused by substance use - tolerance, defined by: EITHER + meed for markedly increase amount of alcohol to achieved desired effects OR + markedly diminished effect with continued use of same amount of alcohol - withdrawal, manifested by: EITHER + characteristic withdrawal syndrome OR + alcohol is taken to relieve/avoid withdrawal symptoms - specify: if in early or sustained remission, if in controlled environment, severity

Question 37

substance intoxicattion

Answer 37

- clinically significant problematic behavioral or psychological changes that developed during or after alcohol ingestion - 1+ sign during or shortly after use: + slurred speech + incoordination + unsteady gaid + nystagmus (rapid involuntary eye movement) + memory or attention impairment + stupor or coma - not attributable to another medical condition & not better explained by another mental disorder

Question 38

substance withdrawal

Answer 38

- cessation of/reduction in substance use that has been heavy or prolonged - 2+ symptoms developing within several hours to a few days after cessation/reduction: + autonomic hyperactivity (e.g. increased pulse rate) + increased hand tremor + insomnia + anxiety + nausea/vomiting + transient hallucinations/illusions (visual, tactile, auditory) + psychomotor agitation + generalized tonic-clonic seizures - cause significant distress or impair functioning - not attributable to another medical condition, not better explained by another mental disorder - specify if with perceptual disturbances

Question 39

gambling disorder

Answer 39

- persistent/recurrent problematic gambling behavior leading to significant distress or impairment, 4+ symptoms over 12 months: + need to gamble with increasing amount of money to achieve desired excitement + restless/irritable when attempting to cut down or stop gambling + often preoccupied with gambling + has made repeated unsuccessful efforts to control, cut down, or stop + often gambles when distressed + often returns to get even after losing + lies to conceal extent of involvement + has jeopardized or lost a significant relationship, job, educational or career opportunity due to gambling + relies on others to provide money to relieve desperate financial situations caused by gambling - not better explained by manic episode - specify: if in early or sustained remission, severity

Question 40

etiology for substance abuse

Answer 40

biological & cognitive-behavioral: - similar to food - limbic system & reward system with pleasure pathways - drugs mimic natural reward we have developed (e.g. cocaine is like sugar - both highly potent and signify energy source)

Question 41

withdrawal

Answer 41

- body tries to maintain homeostasis -> opponent process model + compensates for pleasure/high with low/withdrawal (wavy graph) + therefore self-reinforces drug-taking and repeats cycle - this is why it is pharmacological treatment is problematic -> fixing highs and lows can mess up homeostasis and induce addictive behaviors

Question 42

treatment for substance abuse

Answer 42

- pharmacology: either reduce withdrawal effects or reduce effects of drugs + some people are not willing to give up the high + drugs that reduce withdrawal effects are only temporary fixes + ethical reason (e.g. prescription medication Antabuse makes you physically unwell when you ingest alcohol -> re-conditioning)

Question 43

problems with addiction

Answer 43

- it's a disease of youth! + peak prevalence: 18- to 29-year-olds - habits are almost impossible to unlearn - treatment conflict: harm reduction (controlled use) or abstinence (just say no to alcohol and drugs) - can we categorize "behavioral addictions"?