507 - DEENA'S VERSION Gen Psychopathology Flashcards
anxiety disorders:
WHERE: General Psychopathology
WHAT:
- 29% prev in adults
- women more likely to have
- most common mental disorder
Types of Anxiety Disorders =
- GAD
- social anxiety disorder
- panic disorder
- specific phobia
- agoraphobia
Symptoms =
- physical arousal
- feelings of tension
- apprehension
- worry
Becomes abnormal when =
- it’s irrational
- uncontrollable
- disruptive
Treatments =
- CBT
- mindfulness
- relaxation
- exposure
- meds
WHY: Anxiety disorders are the most common mental disorders, so it’s important for counselors to be familiar with their presentation, how it may affect the patient’s life, and viable treatment options.
EXAMPLE: Sarah, a therapy client, told her therapist she avoids social settings due to her fear of being judged or not liked by others. She describes feeling tense and sweaty when she is in social situations. Her therapist says Sarah may be suffering from social anxiety.
anxiety sensitivity
WHAT: Misinterpretation of physical signs of anxiety. Leads individuals to fear these sensations bc they thing it will leave to negative consequences (i.e. panic attacks)
WHY: This is important because it can be a maintaining factor in a clients anxiety disorder. Using psychoeducation to teach that a racing heart does not always mean a panic attack is approaching allows the client to habituate to these sensations + decrease psychological distress.
EXAMPLE: Demi has high anxiety sensitivity. Sometimes, when her heart is racing and she gets sweaty (from walking, etc.), she thinks she’s going to have a panic attack and goes to the ER.
bipolar I vs bipolar II
WHAT:
Bipolar I =
- at least one manic episode in life time, lasting at least 1 week
- can be diagnosed without depressive episodes
Bipolar II =
- major depressive episode, at least 2 weeks
- hypomanic episode, 3-4 days
- no history of manic episodes
Treatment =.
- antipsychotics
- mood stabilizers
- therapy (social skills, med adherence)
Stats =
- age of onset 15-30
- equally common in men and women
- highly heritable
WHY: It is important to understand the differences between bipolar I and II and other disorders, as misdiagnosis can be harmful to the patient, and possibly worsen their condition.
EXAMPLE: Chris has been admitted to psychological care by his wife. His wife reports that for the past two weeks he has not been sleeping, has been talking extremely quickly, and has impulsively bought lots of things they cannot afford. The clinician suspects he may have bipolar I disorder.
borderline personality disorder
WHAT: Cluster B personality disorder
Long standing pattern of instability in…
- mood
- personal relationships
- self-image
that result in…
- extreme distress
- interference in social and occupational function
Symptoms =
- strong fear of abandonment
- emotional volatility
- manipulation
- black/white thinking
- feelings of emptiness
- poor sense of self
may also experience…
- inability to self-sooth
- self harm
- dissociative experiences
WHY: It is important to understand and be aware of personality disorders and how they vary, as they are highly comorbid
EXAMPLE: Stuart has come to therapy after a recent breakup. He says his ex-gf broke up with him due to his frequent, volatile emotional out bursts. He says he doesn’t understand why she gets upset, because he forgets all about it in a few days. The therapist suspects Stuart may have borderline personality disorder.
case study
WHAT: an in depth, detailed investigation of a rare event/condition in it’s natural context
Purpose =
- to answer a how or why question
- document success of OR describe a tx
- show new application of old tx
- assess a person’s tx journey
findings cannot be generalized or determine causality
WHY: Case studies are important as they are good tools to share rare phenomena, document a treatment’s effect on one patient, and possibly lead to future studies with larger sample sizes.
EXAMPLE: A client comes to therapy presenting with a rare psychological disorder. The therapist may look at case studies done on other people with this disorder to learn more about prognosis and treatments, since there may not be many manualizaed txs or larger studies done on it.
categorical vs dimensional diagnosis
WHAT:
Categorical =
- assume that. each disorder has a specific etiology, pathology, and treatment
- all disorders are distinctly diff from each other
Dimensional =
- more individualize
- symptoms reflect deviations from baseline
- take comorbidities into account
WHY: Important to know that the DSM leans much more towards categorical diagnoses. It is important to know the strengths and limitations of using categorical diagnoses versus dimensional ones in order to effectively evaluate and design a treatment plan.
EXAMPLE: A client comes to therapy presenting symptoms of hopelessness, suicidal ideation, anhedonia, and loss of interest. Without considering possible comorbid disorders, the client could be categorically diagnosed with depression.
comorbidity
WHAT: The co-occurence of disorders that may be interacting with each other
- common in mood + sub. use disorders
WHY: Important in determining which disorder to target in treatment first, as well as tells if a client may be more susceptible to developing another disorder. Knowing which disorders are commonly comorbid with others helps in better assessing a client, conceptualizing their symptoms, and developing a treatment plan.
EXAMPLE: Anxiety and depression have a high rate of comorbidity. A clinician should keep that in mind when assessing and diagnosing. Since it’s common for both disorders to present together, when dealing with a client that is presenting one of those disorders, they should assess for the other one.
competency to stand trial
WHAT: Cognitive assessment before trial (if concern is raised/at request) to determine if individuals are able to…
- understand the charges against them
- consult with an attorney with a reasonable degree of understanding
- assist in their own defense
**Burden placed on defense. to prove incompetence
WHY: Important to understand the large impact a mental disorder can have on someone; it can cause harm to themselves and others. People deemed incompetent will likely be sent to a psych hospital to receive treatment.
EXAMPLE: Barry has been diagnosed with schizophrenia after being arrested for murder. Due to his delusions and auditory hallucinations, he has been deemed incompetent to stand trial. He will be sent to a treatment facility, and later reevaluated to see if he can stand trial.
diagnosis
WHAT: A determination that a person’s symptoms meet the criteria of a particular disorder within the DSM.
✓ easily communicated between clinicians
X may carry negative connotation, may not be a perfect fit
WHY: Diagnoses are important in psychoeducation, understanding a client’s symptoms, guiding tx plans, and monitoring progress.
EXAMPLE: After an assessment interview, Caroline’s symptoms of a weight below a healthy BMI, starvation behavior, and fixation on food and weight meet all criteria to diagnose her with anorexia.
Diagnostic and Statistical Manual of Mental Disorders (DSM)
WHO: Published by the American Psychiatric Association
WHAT: A categorical classification systems used as a diagnostic tool of mental health disorders.
- provides criteria for diagnoses based on symptoms
- used when diagnosing + developing treatment plan
WHY: The DSM is used by all mental health professionals, regardless of what setting they work in. It is a standardized tool used for research and training. Ensures consistency throughout mental health professionals
EXAMPLE: After an assessment interview, Caroline’s symptoms of a weight below a healthy BMI, starvation behavior, and fixation on food and weight meet all criteria to diagnose her with anorexia.
diathesis-stress
WHAT:
Biological/genetic predisposition for certain disorder + environmental factors = Reason for disorders developing
WHY: The DS model is important to understand as it helps to explain etiology of a client’s disorder. It may aid in treatment, guiding the therapist to target a stressful environment and examine biological factors.
EXAMPLE: Demi had this first experience with psychosis after losing his job and boyfriend. After being diagnosed with schizophrenia, he got brain scans done that showed increased ventricles, which is common in people with schizophrenia. Demi had no mental health issues, until a period of intense stress.
differential diagnosis
WHAT: Determining which disorder a patient may have, when two or more disorders have overlapping symptoms
Goal = find which disorder best explains patient’s symptoms
WHY: It’s important to be able to differentiate between disorders, as several disorders have overlapping symptoms. Correctly diagnosing a patient allows for them to receive the appropriate treatment.
EXAMPLE: A client comes to therapy presenting with symptoms of depression, but also with an extensive history of trauma. The therapist may look in the DSM to see if the patient’s symptoms best meet criteria for depression or PTSD.
dissociative disorders:
WHAT:
Symptoms =
- disturbance in memory
- depersonalization
- derealization
- blurred sense of identity
- increased risk of suicide
often develops in response to trauma, abuse, or extreme stress
Includes dissociative amnesia, dissociative fugue, and dissociative identity disorder.
WHY: These disorders are important to understand because people who develop this diagnosis are at an increased risk for suicide and self harm. Understanding a patient’s background of trauma or abuse can aid in treatment.
EXAMPLE: Jane was sexually abused as a child. She tells her therapist she has little to no memory of her childhood. Her therapist suspects she is suffering from dissociative amnesia as a response to her trauma.
dopamine
WHAT: Neurotransmitter responsible for learning, reward, and motivation.
- low dopamine = depression, schizophrenia (neg sxs), high = Parkinson’s, schizophria (pos sxs)
Almost all substances affect dopamine system, causing use/abuse/dependence of substances.
- natural dopamine production declines when it’s regularly artifically introduced
WHY: Understanding how neurotransmitters can affect a person’s psychological state can aid in treatment planning and determining etiology. It also helps in psychoeducation to explain a disorder to patients.
EXAMPLE: Jenny was just diagnosed with depression and was prescribed medication. Her therapist explains that the medication helps to resolve the imbalance of dopamine and how that all produces Jenny’s symptoms
eating disorders:
WHAT: Include Anorexia Nervosa, Bulimia Nervosa, Binge Eating Disorder, Pica, Rumination Disorder
Characterized by/Symptoms:
- persistent distirbance of eating behaviors
- altered consumption of food (too much, too little, only eating certain foods, not eating certain foods)
- impairs physical health and functioning
*dysregulation of the SHT (Serotonin) system may contribute to symptoms
Stats:
- wommen > men
- onset = adolescence (15-19) (BN later than AN)
WHY: Important to know that EDs are much more common in women. Also they they often present differently with women more likely to desire a thin physique + purging bx, and men morre likely to desire a muscular physique + excessively excercise. Sociocultural influences (ideal body standards) impact ED development. EDs are often resistant to treatment.
GABA
WHAT: Neurotransmitter that regulates anxiety and produces a calming effect.
- it is inhibitory – causes neurons to stop firing
- GABA deficiency results in high anxiety
- increases dopamine in pleasure pathway
WHY: Important for therapists to understand the biochemical mechanisms GABA as it influences psychological well-being. Understanding the effect of an imbalance of GABA can enhance treatment plans.
EXAMPLE: Avery has a GABA deficiency. Because of this, she is frequently anxious. Her doctor has prescribed her benzos to regulate her symptoms.
heritability
WHAT: The capacity for a trait or mental disorder to be passed down genetically.
A statistical estimate of how much genetics contributes to traits and disorders, as compared to other factors (i.e. environment, lifestyle)
WHY: Important to understand how genetics and highly heritable disorders. It aids in psychoeducation, and helps to explain etiology, and helps to design effective treatment plans.
EXAMPLE: Demi is a new therapy client. Her therapist takes a family history from her. The therapist learns his dad and his grandmother have both been diagnosed with bipolar I. The therapist knows that bipolar I is extremely heritable, and will be looking for signs of it moving forward.
HPA pathway
WHAT: Hypothalamic-pituitary-adrenal pathway
Autonomic nerv system and endocrine system produce arousal and fear reactions.
Pathway =
sympathetic nervous system activated –> epinephrine and norepinephrine release –> ACTH (major stress hormone) and cortisol levels increased (starts fear responses of organs and muscles)
- hyperactive HPA pathways contributes to stress disorder, BPD, PTSD
WHY: This is important to understand, as an overactive HPA pathway can explain PTSD ‘attacks’ or symptoms, and the unpredictable emotional changes in BPD. Knowledge of the pathway can aid in developing effective treatments.
EXAMPLE: Sarah was just diagnosed with PTSD. Her therapist explains the HPA pathway, and how it maintains her anxiety symptoms.
idiographic vs nomothetic assessment/understanding
WHAT: Involved in case conceptualization + diagnosis
Idiographic Approach =
- individualized outlook
- considers contextual factors
- considers subjective experiences
- ex: Narrative, PCT
Nomothetic Approach =
- broad understanding of general patterns
- trends of larger population
can lead to generalization/stereotyping of certain populations
- ex: CBT
WHY: Good practice involves aspects from both approached. Considering unique patient factors as well as knowing about overall trends aids in developing effective treatment plans.
EXAMPLE: A therapist utilizes more of an idiographic approach during her assessments. She focuses on their individual assets, experiences, and family histories. She may use Person Centered or Narrative Therapy in practice.
mania
WHAT: Occurs in bipolar I
Symptoms =
- increased speech
- irritability
- not sleeping
- distractibility
- psychomotor agitation
- inflated self esteem
- increased goal directed activity
- involvement in potentially dangerous activities
*must be present for 1+ week (3-4 days = hypomania)
WHY: Important to know mania comes with increased risk of suicide. Recognizing a manic vs hypomanic episode helps in diagnosing bipolar I vs II. It also helps with psychoeducating the client about the cycle of their disorder.
EXAMPLE: Chris has been admitted to psychological care by his wife. His wife reports that for the past two weeks he has not been sleeping, has been talking extremely quickly, and has impulsively bought lots of things they cannot afford. The clinician suspects he may have bipolar I disorder.
mood disorders:
WHAT:
Characterized by severe disturbance in emotion and mood
- MDD, PDD, bipolar, cyclothymic
Causes/Etiology =
- dopamine and serotonin imbalance/dysfunction
- learning & modeling (learned helplessness, neg reinforcing bx)
- genetic factors
- high heritability
Symptoms =
- Feelings of sadness, emptiness, or hopelessness
- Difficultly concentrating
- Neg thots about self, world, future
- Social withdrawal
- Anhedonia
- Fatigue/lack of motivation
*inc risk of self harm + suicide
Treatment =
- meds
- CBT
- behavioral activation
- mindfulness based tx
WHY: Understanding mood disorders is important in learning how it can affect a person’s day-today life and aid in developing an effective treatment plan. Being aware of the high level of comorbidity can help with further diagnosis.
EXAMPLE: Patricia tells her therapist that for the last month she has trouble getting out of bed, no longer engages in hobbies she once enjoyed, and has generally been sad. Her therapist suggests she may be suffering from depression.
obsessive-compulsive and related disorders:
WHAT: Characterized by…
Obsessions =
- recurrent and persistence thoughts, urges, or images
- intrusive, unwanted
- distressing
Compulsions =
- repetitive behaviors or mental acts
- done in response to an obsessive thought to reduce anxiety
- common types: checking, counting, symmetry, handwashing
Treatment = ERP + CBT
WHY: Important to know that life prevalence is more common than acute prevalence. Important to understand how obsessions and compulsions are maintained through negative reinforcement in order to effectively intervene.
EXAMPLE: Carl has been diagnosed with OCD. He has obsessive, intrusive thoughts about his family dying in a car accident. He believes that if he doesn’t flip the light switch 7 times they will die. This is a compulsions maintained by the reduction of anxiety from the belief his family will die.
panic attack
What: A panic attack is a sudden episode of anxiety where an individual may experience a rapid or pounding heartrate, sweating, chocking sensations, dizziness, and thoughts such as they are “going to die” or “going crazy”. Panic attacks escalate rapidly and are intense. They can be unexpected or triggered.
personality disorders:
WHAT:
Disorders characterized by enduring patterns of perceiving, relating to, and thinking about the environment and oneself.
Symptoms/Traits =
person is
- inflexible
- maladaptive
- causes significant functional impairment
- causes distress
WHY: This is important as personality disorders have high comorbidity and are often resistant to treatment. Also, understanding that these behaviors may have been previously adaptive but are not maladaptive aids in psychoeducation, case conceptualization, and gaining an overall understanding of the client.
EXAMPLE: Stuart has come to therapy after a recent breakup. He says his ex-gf broke up with him due to his frequent, volatile emotional out bursts. He says he doesn’t understand why she gets upset, because he forgets all about it in a few days. The therapist suspects Stuart may have borderline personality disorder
positive vs negative symptoms
WHAT: Symptoms of schizophrenia
Positive symptoms =
- excess of bxs
- fluctuate in presence/severity
- ex: hallucinations, pressured speech
Negative symptoms =
- tend to be more stable
- less responsive to meds
- ex: blunted affect, anhedonia
*must last for 6 months in schizophrenia
WHY: Important to understand the prognosis and developmental course of schizophrenia. Helps with psychoeducation to explain the cycle of this disorder to a patient. Where a patient is in the cycle/course changes which treatment that should be used.
EXAMPLE: John was brought into treatment by his wife. She claims for the past five weeks he has been hearing things that aren’t there, speaking so quickly that no one can understand him, and a flattened affect. After assessment, John is diagnosed with schizophrenia.
psychosis
WHAT: A fundamental break with reality.
Include =
- hallucinations
- delusions
- disorganized thought, speech, or behavior
(depending on severity….)
- difficultly with social interaction
- impairment of daily function
WHY: Important to know that those with schizophrenia or severe bipolar may be at risk for psychosis. Understand what psychosis is like helps to understand and empathize with patients. The diathesis-stress model can also be applied to psychosis.
EXAMPLE: Demi had her first experience with psychosis after losing her job and boyfriend. She was experiencing auditory hallucinations, a fear that a government agency was watching her, and almost got fired from her job because of her strange behavior.
primary vs secondary gain
WHAT: Describes the motivation + benefits a person may get from symptoms/behaviors of a physical or mental illness
Primary Gain =
- psychological relief one gets from maintaining/developing symptom
- involves reducing or avoiding emotional conflict, anxiety, or stress
- provides psychological escape/reduced anxiety
Secondary Gain =
- external/tangible benefits one gets from a symptom or disorder
- typically to receive attention, avoid responsibilities, or gain sympathy
- provides external or observable advantages (missing work, getting disability payments, having others take care of them)
WHY: Important to know that primary and secondary gains are relevant to somatic disorders, and may explain the subconscious mechanisms that create and perpetuate symptoms and behaviors.
EXAMPLE: Jane doesn’t like school, and sometimes she gets stomachaches in the morning before school.
Each time this happens, her mother lets her stay home and makes her all her favorite foods. Not having to go to school is a primary gain, and receiving extra care and food from her mother is a secondary one.
PTSD
WHAT: A condition following the (in)direct exposure to or history of a traumatic event (actual or threatened death, serious injustice, sexual violation)
Criteria for diagnosis =
- intrusive symptoms
- avoidance symptoms
- negative alterations in cognition and mood
- alterations in/heightening of arousal and reactivity
- significant distress and impairment
**sx must be present for 1 month
WHY: This is important to understand how trauma affects each person differently. Presentation of symptoms vary, and not everyone develops PTSD after a traumatic event. Also important to know the importance of social support in treatment.
EXAMPLE: Jenny has come to treatment following a sexual assault in the parking garage she uses for work. She says that she has been late to work because she has tot find parking outside of the garage, she has been having flashbacks, and has overall been depressed since the assault. After assessment, Jenny is diagnosed with PTSD.
remission
WHAT: A period when symptoms of a disorder/disease are reduced (partial remission) or completely disappear (complete remission)
- client no longer experiences clinical levels of symptoms
WHY: Important to remember that remission of symptoms does not mean the client is cured of their disorder. 2/3 of clients with mental disorders with have periods of spontaneous remission. Also relevant to the residual phase (post episode) of schizophrenia.
EXAMPLE: Jane was diagnosed with depression and began medication and psychotherapy. After 3 months, Jane retakes the Beck Depression Inventory and finds she no longer meets the diagnostic criteria for depression– her symptoms have abated and she is considered to be in partial remission.
schizophrenia
WHAT: Chronic and severe mental disorder that causes a lost touch with reality
Affects how one thinks, feels, and behaves
2 types of symptoms =
1. positive (excess of bxs: hallucinations, pressured speech, disorganized bx*, delusions)
2. negative (absence of bxs: flattened affect, anhedonia, dec in goal directed bx, alogia)
*key symptoms; must have one for diagnosis
3 Phases =
1. Prodromal (up to 24m before episode)
- withdrawal and disinterest
- may include strange behavior, social withdrawal, problems functioning
- other watered down/attenuated symptoms (i.e. slightly disorganized speech, unusual but not delusions speech)
- Active (psychotic episode)
- pos + neg symptoms
- full symptoms present gradually or suddenly
- disturbances in functioning
- duration depends on when intervention happens - Residual (partial remmission)
- decrease in pos symp., neg symp. remain
Treatment =
- antipsychotic meds
- family based treatment
- skills training to prevent relapse
WHY: Schizophrenia is a disorder in which one’s environment plays a key role in the development. Applying the diathesis-stress model to this disorder allows the clinician to better understand the client’s etiology. It’s also important to understand the importance of family involvement in treatment.
EXAMPLE: John was brought into treatment by his wife. She claims for the past five weeks he has been hearing things that aren’t there, believing the government is out to get him, and speaking so quickly that no one can understand him. After assessment, John is diagnosed with schizophrenia.
serotonin
WHAT: Neurotransmitter responsible for regulating several cognitive functions such as mood, sleep, appetite, and memory.
Low levels = depression, suicidality, bipolar, anorexia, antisocial personality disorder
High levels = serotonin syndrome, mania in bipolar people
WHY: Understanding how neurotransmitters can affect a person’s psychological state can aid in treatment planning and determining etiology. It also helps in psychoeducation to explain a disorder to patients.
EXAMPLE: Jenny was just diagnosed with depression and was prescribed a SSRI. Her therapist explains that the medication helps to resolve the imbalance of serotonin and how that all produces Jenny’s symptoms
state vs trait anxiety
WHAT: Two ways which anxiety manifest
State =
- anxiety response to a stimulus in the moment
Trait =
- a temperament
- is carried thru one’s entire life
- anxious worldview
WHY: It is important to understand whether or not a client’s anxiety is pathological or not. It also helps to explain the role that anxiety can play in motivating one’s behavior.
EXAMPLE:
substance-related disorders:
WHAT: Maladaptive pattern of behaviors related to substance use.
Include =
- impaired control
- social impairment
- risky/unsafe use
- pharmacological criteria (tolerance, withdrawal)
*dopamine plays big role!
*maintained by learning (pos/neg rein, cues, modeling)
WHY: Important to know that SUD is highly heritable. A clinician should take a full family history incase there is a history of SUD. Since SUDs are very often comorbid, if a client has a SUD, they should be assessed for additional disorders. Important to remember the role learning plays in addiction, as it can help inn developing an intervention.
EXAMPLE: Dami has come into treatment at the request of her father. He says Demi’s drinking has gotten out of hand. She has been missing work, arriving home drunk everyday, gets agitated if she can’t have a drink. After further assessment, Dami is diagnosed with alcohol use disorder.
tolerance vs withdrawal symptoms
WHAT:
Tolerance =
- person needs to keep using larger doses of substance to feel desired effect
Withdrawal =
- physical and/or psychological response after discontinued use of a substance
- occurs after extended + consistent use
- indicates physical dependence upon substance
WHY: Important to remember that a client may have a psychological and physical reaction to discontinuing using a substance, and this altered state of mind and being may affect the client’s response to therapy.
EXAMPLE: Demi has bee heavily drinking for a few weeks now after breaking up with her boyfriend. She used to be able to get drunk ‘enough’ after 4-5 drinks, but over the last week she’s noticed she needs 5-6 drinks to get the desired effect. Demi’s tolerance has increased.
trauma and stress or related disorders:
WHAT: Disorders that describe maladaptive responses following stressful life events.
Adjustment disorder =
- least impairing
Acute stress disorder =
- given within first month after trauma
PTSD =
- given when symptoms are present 1+ month after trauma
ASD+PTSD symptoms =
- intrusive thoughts
- avoidance
- neg cognitions
- inc emotional response & arousal
- causes impairment and distress
Why: Following trauma, only some will develop ASD and even fewer will develop PTSD, thus, understanding risk and protective factors, such as social support and biological vulnerability, may help identify those at risk.
Cluster A personality disorders
WHAT:
Traits = odd, eccentric
Include =
- schizotypical
- schizoid
- paranoid
WHY:
EXAMPLE:
Cluster B personality disorders
WHAT:
Traits = dramatic, emotional, erratic, unstable, self-centered
Include =
- antisocial
- borderline
- histrionic
- narcissistic
WHY:
EXAMPLE:
Cluster C personality disorders
WHAT:
Traits = anxious, fearful, relationships dominated by anxiety
Include =
- avoidant attachment disorder
- dependent
- obsessive compulsive personality disorder
