507- General Psychopathology

Question 1

ADHD

Answer 1

From psychopathology, part of diagnosis. Attention-deficit/hyperactivity disorder: a neurodevelopmental brain based disorder marked by inattention, hyperactivity and impulsivity, or both. ADHD is commonly diagnosed in children, but symptoms must be age inappropriate for diagnosis. - Occurs in males4x more than females.- Commonly co-morbid with learning disorders and ODD/CD; also greater risk for substance abuse. - Strong genetic component; 30% chance if 1st degree family member carries it- ADHD is treated with stimulants like Ritalin and/or CBT (operant conditioning and token economies). Why: important to conceptualize and because it is so prevalent. A1 inattention, A2 impulsivity, or both. Clinical example: 7-yr-old Sophie disrupts her classroom instruction often by getting up and walking over to the window when she is distracted by something she sees outside, or blurting out thoughts and questions. When she is stuck at her desk, she fidgets constantly and is unable to sit still. Sophie’s pediatrician suspects that she may have ADHD.

Question 2

Anxiety disorders

Answer 2

Part of: psychopathology what: Anxiety disorders occur when feelings of anxiety interfere with everyday life, includes multiple physical characteristics, and is irrational, uncontrollable, and disruptive. The 3 components are cognitive, behavioral, and physical. Anxiety is distinct from fear in that it is the central nervous system’s physiological and emotional response to a vague sense of threat or danger rather than a response to an immediate threat. Worry, physical arousal, panic attacks, feelings of tension and apprehension are common in anxiety disorders. - more frequent in females (2:1) - most common of mental disorders (29% of adults in a lifetime). - Include Social Anxiety Disorder, Generalized Anxiety Disorder, Panic Disorder, Phobias, and Agoraphobia They are often maintained through avoidance. Treatments include cognitive-behavioral therapy, mindfulness and relaxation techniques, along with exposure (if applicable) and anti anxiety medications. Clinical example: Mark is afraid he will be judged or rejected in social settings. Even imagining a meal out with coworkers can elicit a physiological anxiety response in him. He avoids such situations as a way to manage his anxiety.

Question 3

Anxiety sensitivity

Answer 3

Part of: psychopathology What: A tendency to focus on one’s bodily sensations, assess them illogically, and interpret them as harmful. “Fear of fear.” Bodily sensations such as increased heart rate or nausea are mistaken as harmful and intensify anxiety. Who: term Anxiety Sensitivity originally coined by Reiss who created Anxiety Sensitivity Index (ASI) which has spurred additional research. This can habituate the disorder in a client and teaching a client to accept these sensations can improve overall wellbeing and decrease psychological distress. Clinical example: Brenda notices her heart rate increases as she climbs the stairs in her apartment building. She interprets her increased heart rate as a sign of physical danger and presents at the ER a short time later saying she thinks she is having a heart attack.

Question 4

Bipolar I vs. bipolar II

Answer 4

Part of: psychopathology What: Both are mood disorders in which patients experience major depressive episodes, manic episodes, hypomanic episodes, and/or mixed episodes. - Bipolar I is marked by full manic and major depressive episodes while bipolar II is marked by mildly manic episodes (hypomanic) and major depressive episodes. Bipolar II has later onset (around 20s). Bipolar II can be harder to detect as people do not notice the hypomanic episodes and rarely come into treatment. When they do it is for depression. Bipolar II is capable of turning into Bipolar I. - Bipolar 2 is harder to diagnose because symptoms often mimic euthymia and if they present to therapy its often for depression. Manic episodes typically last a week (hypomanic 3-4 days) & depressive episodes much longer- Bipolar I and II can include psychotic features either mood congruent (i.e. thinking you are god during manic episode) or mood incongruent Who: -Equally common in men and women. Onset between 15-30 yrs old. - Etiology ~ 50% heritability - strong genetic component- Treatment usually includes medication to prevent mania and reduce kindling effect (Antipsychotics, mood stabilizers, lithium) and psychotherapy (focus on medication management and social skills; used in conjunction to meds). Therapy shown to help reduce hospitalization. Clinical example: Drake has been unable to get out of bed most days for the past week. He finds pleasure in nothing, and had neglected his personal hygiene. A short time after this depressive episode, he finds himself staying up all night absorbed in a new project. He charges expensive items to his credit card and impulsively decides to go out with friends and get intoxicated. This episode continues for a week. Drake is suffering from Bipolar I.

Question 5

Borderline personality disorder

Answer 5

Part of: Clinical Psychopathology, cluster B personality disorders and the most prevalent in clinical settings. What: Borderline Personality Disorder is characterized by problems with interpersonal relationships, impulsivity, problems managing emotions, self-harm, and suicidality. Individuals with BPD often have a tremendous fear of abandonment and a poor sense of self. Etiology: genetic component, abuse or trauma in childhood, hyper-responsive HPA axis Who: more common in women Treatment: Most effective treatment is dialectical behavior therapy - developed by Marsha Linehan. Clinical Example: A client presents after her third suicide attempt. Her father reports she has trouble maintaining relationships, wild emotional outbursts, and uses alcohol almost daily. She has been cutting her mother left the family when she was eleven. Based on her history and symptomology, her therapist screens her for Borderline Personality Disorder.

Question 6

Case study

Answer 6

A type of research that includes a detailed description of a specific individual and treatment of that individual. Useful to document success of a specific treatment, to describe a new treatment, or to demonstrate novel application of existing treatment and can show the feasibility of implanting treatment with a specific population. Cannot generalize its results or determine causality. Its important for conceptualizing an individual’s case and can yield useful info regarding normal psychological phenomenon. Clinical example: A therapist working with a child with autism has a novel behavioral intervention. She decides to write a detailed case study of her treatment implementation to document the results of this new treatment.

Question 7

Categorical vs. dimensional analysis

Answer 7

Discussed in psychopathology as a way to diagnose and treat an individual. A categorical approach (used by the DSM) assumes that traits are either present or absent in people, like a light switch that is on or off. Many theorists argue for a dimensional approach, which would see these traits along a continuum. Clinical example: A clinician with a categorical approach may diagnose a woman who has volatile relationships, intense moods, self-harm practices and manipulative tendencies with borderline personality disorder. A clinician with a more dimensional approach might assess these behaviors according to severity and the degree to which they impact the person’s life.

This is a term discussed in General Psychopathology as a part of ways to diagnose. Categorical diagnosis assumes that disorders have specific etiologies, pathologies and treatment and that disorders are qualitatively distinct from normal functioning and from one another. Categorical diagnosis assigns people to defined groups on the basis of shared attributes, cardinal symptoms help shape the categories. Dimensional diagnosis allows for the symptoms reflecting quantitative deviations from normal functioning along dimensions to create a profile of emotional functioning. This allows for a distinction between being “very sad” and have MDD. The DSM-5 is currently categorical but shifting to a dimensional outlook. Categorical diagnosis does not account for comorbidity and the overlap of criterion between different disorders. It can also be difficult to distinguish between normal expression of negative emotion and having a mental disorder.

Question 8

Comorbidity

Answer 8

Part of psychopathology and diagnosis. A clinical term used to describe the coexistence of two or more clinical diagnoses in the same person at the same time. There are certain disorders that frequently present together, and it’s important to be aware of these as a therapist. Also one of the limits of categorical analysis. This may affect the type of therapeutic and pharmachological interventions available to the client. Clinical example: Substance abuse disorders are often comorbid with other mental disorders, so clinicians should assess for other disorders when treating substance abuse, and vice versa.

Question 9

Competency to stand trial

Answer 9

Part of the criminal committment in mental health law. A person is mentally competent to stand trial if the person charged with crime has capacity to understand the charges against them and ability to assist their lawyers in preparing a defense.- Has nothing to do with the insanity plea–competency to stand trial is about the person’s mental state at the time of the trial, not at the time of the crime.- Requires a cognitive assessment. - The burden is to prove incompetence (on defense)- If found incompetent, they will be held in a mental health hospital until competent, time dependent on the charges. After the time elapses, they will either be set free or put under civil commitment. Clinical example: Boris has been diagnosed with schizophrenia. He is arrested on murder charges. Because of his delusions and other mental instabilities, he is held in custody but declared incompetent to stand trial.

A persons competency to stand trial is their capacity to be tried in court as determined by their ability at the time of the trial to understand and appreciate the criminal proceedings against them, to consult with an attorney with a reasonable degree of understanding and to make and express choices among available options. A cognitive assessment is required to determine an clients competency and the burden is placed on the defense to prove incompetence

Question 10

Diagnosis

Answer 10

Part of assessment. From the Greek word “a discrimination” - a determination that a person’s problems reflect a particular disorder or syndrome in a particular classification system (typically DSM-5). Diagnostic labels make it possible for clinicians to communicate easily with each other and is important for insurance purposes, but they also carry a negative connotation and a social stigma. Diagnoses also may not be accurate or perfectly fit an individual’s symptoms. Clinical example: After an assessment interview, Claire’s symptoms of a weight below a healthy BMI for her age, starvation behavior, and fixation on thoughts of food and weight qualify her for an anorexia diagnosis.

Question 11

Diagnostic and Statistical Manual of Mental Disorders (DSM)

Answer 11

Part of assessment and psychopathology. The DSM-5 is a classification system, developed by the American Psychiatric Association and updated in 2013, which lists disorders, descriptions of symptoms, and guidelines for making appropriate diagnoses. It also includes dimensional information, rating how severe a client’s symptoms are and how dysfunctional the client is across various dimensions of personality and behavior and cultural norms. s a guideline for standards in diagnosis across clinical boundaries. Advantages of the DSM include that it allows for easy communication between clinicians and helps to stimulate research. Disadvantages include that diagnoses are stigmatizing and there can be significant overlap between disorders. Clinical example: Shelley, a therapist, uses the DSM-5 to evaluate whether her clients’ symptoms indicate an official diagnosis. She uses the DSM codes when reporting to insurance companies for reimbursement.

Question 12

Diathesis-stress

Answer 12

From the biopsychosocial model, this model posits that psychological disorders result from an interaction between inherent vulnerability and environmental stress. Diathesis refers to the propensity for the disorder or problem behavior to be expressed. The greater the diathesis and the greater the stress, the more likely you will develop the psychopathology. This is important because it considers a multitude of etiological factors relating to the disease. Clinical example: Dale had his first episode of psychosis after losing his job and girlfriend. He was eventually diagnosed with schizophrenia. Later brain scans showed increased ventricles common in people with schizophrenia. Dale’s relatively psychologically normal life up until the point of intense stress is an example of the diathesis-stress model at work.

Question 13

Differential diagnosis

Answer 13

Discusses in pathology as a part of diagnosis. 2 overlapping disorders trying to figure out which one best fits with the person.

This is discussed in general psychopathology as a part of diagnosing. This is the process of determining which of two or more disorders with overlapping symptoms a particular client has. The goal is to figure out which specific disorder best explains the presenting complaints. The DSM-V has updated to help counselors differentiate between diagnoses easier. It is important to ensure all possible diagnoses are considered and the client is diagnosed correctly.

Question 14

Dissociative disorders

Answer 14

A rare group of disorders characterized by a disruption in the usually integrated functions of consciousness, memory, identity, or perception of the environment known as dissociation. - Key features include depersonalization, derealization, a blurred sense of identity, and a profound disturbance in memory that does not have clear physical causes.- In this family of disorders are dissociative amnesia, dissociative identity disorder (previously multiple personality), and dissociative fugue. - Dissociative Amnesia: memory loss that cannot be explained by a physical or neurological condition - With or without dissociative fugue; usually occurs in response to some sort of stressor or trauma - Dissociative Identity Disorder: presence of 2+ distinct identities w/ recurrent gaps in memory. (Most controversial diagnosis in DSM; VERY rare)-Those w/ a dissociative disorder have increased risk of complications, such as self-mutilation and suicide attempts. Frequently found in the aftermath of trauma. Clinical example: Emilia goes missing. Days later, she is found in another state, applying for a job under the name Stephanie. She is suffering from dissociative fugue.

Question 15

Dopamine

Answer 15

Dopamine is a key neurotransmitter that is involved in the pleasure center of the brain affecting learning, reward, and motivation. - Critical in use/abuse/dependence roles of substances because almost every substance directly or indirectly affects the DA system. - Stimulated by ETOH, nicotine, cocaine, caffeine, and Amphetamines. - Drugs like cocaine and heroin increase dopamine at key neurons, providing the pleasurable feeling that can lead to addiction, especially as naturally produced dopamine declines when it is routinely artificially introduced.- Low dopamine activity is one of the biological reasons for major depressive disorder. - Excessive dopamine activity is thought to contribute to the positive symptoms of schizophrenia, while too little dopamine is thought to contribute to the negative symptoms of schizophrenia. Why: important role in behavior, emotions, and cognitions. Clinical example: Stan has been taking Haldol for over a decade to minimize symptoms of schizophrenia. He begins to experience severe shaking and jerky movements, a side effect of the dopamine-minimizing Haldol.

Question 16

Eating disorders

Answer 16

Part of feeding and eating disorders. Eating disorders are characterized by being preoccupied with food, weight, and appearance, and often struggling with depression, anxiety, obsessiveness, and the need to be perfect. Suffered most often by adolescent women but can present different in men, and more prevalent in certain sports like gymnastics, wrestling, and horse jockeying. Types of eating disorders: - Anorexia nervosa: marked by the pursuit of extreme thinness and by extreme weight loss)- Bulimia nervosa: marked by frequent eating binges followed by forced vomiting or other extreme compensatory behaviors to avoid gaining weight- Binge eating disorder: marked by frequent binges without extreme compensatory acts. - These illnesses are often accompanied by a multitude of health issues and frequently co-morbid with anxiety and mood disorders, certain personality disorders, and substance abuse.- Can be caused by learning, family dynamics, or genetic components. - Treatments include CBT, Interpersonal Psychotherapy (focus on relationship elements and patterns in relationships - for bulimia), family counseling and medication (usually done in conjunction with talk therapy).Clinical example: Clint started using weight loss strategies to maintain his weight class in wrestling. Over time, his thoughts and daily behavior became fixated on losing more weight, even after he reached his weight loss goal. His diet is very regimented and restrictive, and he exercises for hours each day. Clint’s coach refers him to a psychologist who diagnoses him with anorexia nervosa.

Question 17

GABA

Answer 17

Part of biological processes in the brain. gamma-aminobutyric acid (GABA): a neurotransmitter whose low activity in the brain’s fear circuit has been linked to anxiety. It carries inhibitory messages: when GABA is received at a receptor, it causes the neuron to stop firing. This finding led researchers to believe that GABA plays a key role in the reduction of normal, everyday fear reactions.- The anxiety reducing abilities of ethanol and benzodiazepines work by increasing GABA levels. - Low levels of GABA associated with generalized anxiety disorder. - Increasing GABA also vicariously increases dopamine levels in the pleasure pathway. Contributes to tolerance and withdrawal in conditioned compensatory response. Clinical example: Denise has been diagnosed with Generalized Anxiety Disorder. As part of her treatment, she is prescribed Xanax, which increases GABA activity, a deficiency thought to be common amongst people suffering from anxiety disorders.

Question 18

Heritability

Answer 18

A genetics term; the statistical estimate of the proportion of observed variation in a trait or disorder that can be attributed to inherited genetic factors rather than to environmental factors; a factor in the nature vs nurture debate. It is important in the etiology of the disorder and the conceptualization for the client. EXAMPLE: Understanding the heritability of Bipolar I disorder, the therapist asked the client if his family had a history with the disorder. She also explained to him that one of the biological explanations for the disorder suggests that individuals inherit a predisposition for the disorder.

Question 19

HPA Pathway

Answer 19

Discussed in psychopathology as part of the fear response. hypothalamic-pituitary-adrenal (HPA) pathway: one route by which the brain and body produce arousal- pituitary gland secretes ACTH (major stress hormone), which stimulates the adrenal glands which secrete corticosteroids (stress hormones).- This pathway is most associated with PTSD and other trauma/stress disorders.- Cortisol production tends to be elevated in people with BPD, indicating a hyperactive HPA axis in these individuals. Clinical example: Since being attacked in a parking lot, Jenny reacts to stress with heightened anxiety. Her therapist explains that the trauma may have affected her HPA pathway, causing abnormal activity of cortisol and norepinephrine.

This is a term discussed is general psychopathology as a part of a fear response. It is short for Hypothalamic-Pituitary-Adrenal Pathway. When a person’s body is faced with a life-threatening situation, our bodies go into a “fight-flight-freeze” response. The sympathetic nervous system is activated, and epinephrine and norepinephrine are triggered. The hypothalamus releases neurotransmitters triggering a series of reactions in the body. The sympathetic nervous system is triggered through the pituitary gland. Then there is a secretion of ACTH and cortisol which stimulates the adrenal cortex and then corticosteroids. It is associated with individuals that have PTSD and BPD.

Question 20

Idiographic vs. nomothetic assessment/understanding

Answer 20

Part of diagnosis and case conceptualization. An idiographic assessment takes an individualized approach, allowing for the understanding of symptoms in the individual’s cultural context or unique experiences. A nomothetic understanding is a general understanding of the nature, causes, and treatments of abnormal functioning, in the form of laws and principles from trends in a larger population. This is important for good assessment/practice combines idiographic and nomothetic approaches. Clinical example: In her practice, Melanie leans toward an idiographic understanding of her clients, focusing on their individual assets, experiences, and family histories.

Question 21

Insanity

Answer 21

Insanity of defense is NOT a clinical term, but rather a legal term describing an individual who was mentally ill at the time of their crime(s) and is therefore not morally responsible for the act(s). - Developed as an attempt to protect people with mental illnesses from being punished for harmful behavior resulting from their disorder. - The burden of proof lies on the defense - Requires psychological assessment

The insanity defense is a legal term that refers to a condition of the mind that renders a person incapable of being responsible for their criminal acts. A person can plead ngri if they are unable to appreciate the wrongfulness of conduct at the time of the offense due to mental illness or intellectual disability. Insanity pleads can prevent individuals with mental illness from being charged with a crime that was a result of their disorder

Example: Greg Greg had killed someone after suffering a severe psychotic break in which he was extremely paranoid and thought someone was trying to kill him. He was acting in self-defense and was not mentally stable to realize that he was wrong in killing this person. He was able to plead insanity and be committed to a behavioral health hospital to be stabilized instead of prison.

Question 22

Mania

Answer 22

Part of assessment and diagnostic criteria for bipolar disorder. Characterized by an abnormal mood (irritable, expansive, or high) and at least three or more other criteria including inflated self esteem, increased energy, decreased sleep, racing thoughts, pressured or increased speech, or impulsivity and poor judgement. - Manic episodes typically last a week or more, hypomanic 3-4 days. Productivity element huge in hypomania. Hypomania also has more irritability.- Can include psychosis – mood congruent (grandiosity, paranoia) or incongruent (aliens). Mood congruent most common.- Typically mania is experienced as pleasurable by the client- Manic episodes come with increased suicide risk and medication noncompliance- One manic episode makes following episodes more likely - a process called kindling. Important for distinguising between bipolar 1 and 2. Clinical example: Charlie has been awake for 36 hours working on a screenplay he believes is a work of genius. When he runs into a neighbor on a smoke break, he speaks in an energetic, frenzied, barely comprehensible manner. Charlie is experiencing mania.

Question 23

Mood disorders

Answer 23

A class of disorders characterized primarily by severe disturbances in mood. Mood disorders include major depressive disorder, persistent depressive disorder, premenstrual dysphoric disorder, bipolar disorder, and cyclothymic disorder. Inadequate serotonin/dopamine function is part of what causes mood disorders. - Symptoms of these disorders may include depressive or manic episodes. - Depressive episodes may include symptoms such as hopelessness, lack of energy, and anhedonia, inability to concentrate, increased/decreased appetite, etc. - Mania may include euphoria, increased energy, racing thoughts, pressured speech- Etiology includes a variety of causes including genetics, learning, and cognitive errors. - Heritability 30% depressive disorders, 50% bipolar disorders- Treatments include medication, CBT, behavioral activation, and mindfulness-based treatment, amongst others. These are the most prevalent disorders diagnosed after anxiety disorders which are also highly comorbid. Clinical example: Patricia finds it difficult to get out of bed, and finds no pleasure in activities she once enjoyed. These symptoms have persisted for a month. Patricia may be diagnosed with depression, a mood disorder

Question 24

Obsessive-compulsive and related disorders

Answer 24

A disorder in which a person has recurrent obsessions, compulsions, or both. - OCD is characterized by obsessive (repeated, intrusive, uncontrollable thoughts or images that provoke anxiety) and compulsive actions (a repetitive and rigid behavior or mental act that a person feels driven to perform in order to prevent or reduce anxiety). - Thoughts cause anxiety, and behaviors lessen the anxiety felt by the thoughts. - There are different classes of thoughts (contamination, pathological doubt, violent/sexual thoughts) and a wide variety of corresponding compulsions (washing, checking, counting, symmetry, hoarding). - Do not need both for diagnosis but 90% do have both - Almost equal male to female, female slightly higher - Tends to be a chronic lifelong illness, but can be controlled. - Generally attributed to genetic and neurological sources, though can have behavioral and cognitive roots. - Treatment gold standard exposure therapy with response prevention and CBT. Distress can be time consuming so more than 1 hour per day and can cause occupational problems. Clinical example: It takes Maria two hours to leave her house each morning because she feels compelled to perform an elaborate ritual of checking locks and potential dangers in her home to ensure safety before she leaves. To skip her ritual would leave her with unbearable anxiety, sure that something terrible would happen. Maria is suffering from obsessive-compulsive disorder.

Question 25

Panic attack

Answer 25

The abrupt onset of intense fear or discomfort that reaches a peak within minutes and includes at least four of the following symptoms:- Palpitations, pounding heart, or accelerated heart rate- Sweating- Trembling or shaking- Sensations of shortness of breath or smothering- Feelings of choking- Chest pain or discomfort- Nausea or abdominal distress- Feeling dizzy, unsteady, light-headed, or faint- Chills or heat sensations- Paresthesia (numbness or tingling sensations)- Derealization (feelings of unreality) or depersonalization (being detached from oneself) Listen to this podcast.- Fear of losing control or “going crazy”- Fear of dying- 25% of the population has at least one panic attack in their lifetime. - Panic attacks are seen in a variety of disorders such as PTSD, phobias, and can occur in the context of any disorder, designated by a panic attack specifier. Its important to understand what a client’s experience is to better control and prevent future attacks, equipping them with tools and resources for management. Clinical example: Janet is walking her dog when she becomes overcome with the fear that she might get hit by a car. Her heart starts pounding and her palms are sweaty. She feels so dizzy she sits down on the sidewalk and feels sure she will die there. Janet is experiencing her first panic attack.

Question 26

Personality disorder

Answer 26

An enduring, rigid pattern of inner experience and outward behavior that repeatedly impairs a person’s sense of self, emotional experiences, goals, capacity for empathy, and/or capacity for intimacy.- There are high comorbidity rates and treatment is refractory and often unhelpful - Most stigmatized group in psychology due to the difficulty in treating them. - Can be attributed to genetics and/or surroundings, as behaviors may have been previously adaptive and become maladaptive later. - There are three clusters of personality disorder; cluster A (odd/eccentric), cluster B (dramatic/emotional), and cluster C (anxious/fearful). - A: Paranoid Personality Disorder, Schizoid Personality Disorder, Schizotypal Personality Disorder - B: Antisocial Personality Disorder, Borderline Personality Disorder, Histrionic Personality Disorder, Narcissistic Personality Disorder - C: Dependent Personality Disorder, Obsessive-Compulsive Personality Disorder, Avoidant Personality Disorder Clinical example: Dan keeps to itself and avoids getting close to anyone. He is suspicious of all other people and their motives. Dan is suffering from paranoid personality disorder.

Question 27

Positive vs. negative symptoms

Answer 27

Discussed in general psychopathology Labels for classifying symptoms of schizophrenia. Positive symptoms: excesses; bizarre additions to normal thoughts, emotions or behaviors. (delusions, disorganized thinking and speech, heightened perceptions and hallucinations, inappropriate affect.)Negative symptoms: deficits in normal thought, emotions, or behaviors. (poverty of speech (alogia), restricted affect, loss of volition (avolition), apathy, social withdrawal. Positive symptoms fluctuate in presence and severity and tend to go away with treatment but negative symptoms warrant a poorer prognosis. It is important to understanding the maintenance and development of schizophrenia. Clinical example: Lin spent all of his time alone and experienced frequent hallucinations. Lin was experiencing both positive and negative symptoms of schizophrenia.

This is discussed in general psychopathology as a part of schizophrenia symptoms. Positive symptoms include delusions, hallucinations (predominantly auditory), disorganized speech (loose associations, tangential vs circumstantial, derailment or neologisms) and bizarre/disorganized behavior (appearance, affect, actions). Negative symptoms include alogia (short or no words), affective flattening (no facial expression), avolition (lack of motivation or drive) and anhedonia (lack of interest in activities). Positive symptoms tend to fluctuate in presence and severity and the average person in psychosis has these but will generally go away with first treatment. Negative symptoms tend to be a worse prognostic indicator if present and do not go away easily with treatment.

Question 28

Psychosis

Answer 28

A symptom characterized by a fundamental break with reality.- Can include hallucinations (hearing, seeing or feeling things that are not there), delusions (false beliefs, especially based on fear or suspicion of things that are not real), disorganization in thought, speech, or behavior, and disordered thinking. Depending on severity, this may be accompanied by difficulty with social interaction and impairment in carrying out daily life activities.- Most commonly associated with schizophrenia; can also be seen with severe cases of bipolar, depression and PTSD, among other disorders. - Psychosis shouldn’t be considered a symptom of a mental disorder until other relevant and known causes are excluded (CNS issue, disease, drugs) EXAMPLE: A client comes in one day in a frenzy. She looks disheveled and does not make much sense because she keeps jumping around topics. She tells you that she is worried aliens have been watching. You suspect that she may be experiencing psychosis, but you decide to rule out other potential causes first.

Psychosis is an abnormal mental state involving significant problems with reality testing. It is characterized by serious impairments or disruptions in the most fundamental higher brain functions perception cognition and cognitive processing and emotions or affect as manifested in behavioral phenomena such as delusions hallucinations and significantly disorganized speech

Question 29

Primary vs. secondary gain

Answer 29

Part of psychodynamic theory for somatic symptom disorders. Describes the significant subconscious psychological motivators patients may have when presenting with symptoms. Mainly seen in somatic disorder.- primary gain: the gain people derive when their somatic symptoms keep their internal conflicts out of awareness.- secondary gain: the gain people derive when their somatic symptoms elicit kindness from others or provide an excuse to avoid unpleasant activities. Separate for malingering. Important to explaining a client’s motivation behind their behavior. Clinical example: Every time Anna complains of stomach cramps, her mother makes her special food and lets her stay home from track practice. Anna is experiencing secondary gains.

Question 30

PTSD

Answer 30

This is a term from general psychopathology as a part of trauma. There must be history of exposure to a traumatic event. This is considered actual or threatened death, serious injury, or sexual violation resulting from direct experience, witnessing a traumatic event in person, direct experience, or close family/friend. There must be intrusion symptoms, avoidance symptoms, negative alterations in cognitions and mood or alterations in arousal and reactivity. The symptoms persist for longer than 1 month, significant distress/impairment and is not explained by another condition.

Question 31

Remission

Answer 31

Part of illness course. A period during which symptoms of disease are reduced (partial remission) or disappear (complete remission); usually means that the client is no longer experiencing clinical levels of symptoms related to the original issue. Eysenck postulated that ⅔ of patients with mental disorders will spontaneously remit without psychotherapy; this prompted a close examination of the effective of psychotherapy and the common factors included in all psychotherapeutic approaches that are necessary for positive treatment outcomes. EXAMPLE: The female patient was responding well to ACT therapy. She was accepting the fact that her husband had left her for another woman. She was committed to setting goals of adapting to her new life of being divorced. And she was taking action one step at a time. The therapist noted that these positive steps had resulted in a partial remission of her depression as she was functioning much better than she had been.

Question 32

Schizophrenia

Answer 32

Part of psychotic disorders. A chronic and severe mental disorder that affects how a person thinks, feels, and behaves. People with schizophrenia may seem like they have lost touch with reality- Two types of symptoms – positive symptoms (excess of behaviors) or negative symptoms (absence of behaviors), with key symptoms of grossly disorganized behaviors, hallucinations and delusions [pt must have one of those]- Three phases; prodromal (before episode- appears more social at first; only applies to pre-schizophrenia), active (psychotic episode), and residual (partial remission; decrease pos sxs neg sxs remain). - Age of onset is between 16-25; 1% of population; men and women equal; > African Americans vs whites; > lower SES vs high- CLEAR genetic link but environment still plays a role; also altered neurochemistry. - Treatment is generally antipsychotic medication along with various forms of therapy, including family treatment and skills training in order to help prevent relapse. Its important to understanding treatment for client’s who may have this. Clinical example: Will is overcome with the belief that he is a messiah. He spends hours of the day standing rigidly, reciting prophecies. After assessment, he is diagnosed with schizophrenia.

Question 33

Serotonin

Answer 33

Its a part of biological processes. Serotonin is a monoamine neurotransmitter responsible for regulating mood, appetite, sleep, memory, and other cognitive functions. Serotonin activity levels are low in people who complete suicide, suffer from depressive and bipolar disorders, antisocial personality disorders, and eating disorders. - SSRIs can aid in regulating serotonin level and are used to treat depression and OCD. It is important for understanding the intersection of biological processes in certain psychological disorders. Clinical example: Ben has been diagnosed with major depressive disorder. As part of his treatment, he is prescribed an SSRI (selective serotonin reuptake inhibitor) to increase serotonin activity and reduce depressive symptoms.

Question 34

State vs. trait anxiety

Answer 34

Part of anxiety. Refers to the two recognizable ways which anxiety manifests itself. “State” anxiety is in response to a stimulus and is acute; “trait” anxiety is temperamental and related to worldview, more pervasive, and not situationally specific. State anxiety is related to peak performance- Yerkes dodson curve. Important for the roles anxiety can play in explaining behavior.
Example: A client comes in because she just got a new job where she will have to engage in a lot of public speaking. The client has always experienced anxiety about getting up in front of others and speaking, yet she does not struggle with anxiety in other areas. The therapist tells her she likely has state anxiety and begins to employ mindfulness and CBT exercises to help the client with her fear of public speaking.

Question 35

Substance-related disorders

Answer 35

Part of psychopathology and diagnosis. A pattern of long-term maladaptive behaviors and reactions brought about by repeated use of a substance. Significant impairment categorized by the DSM as two or more of the following: Failure to fulfill major role obligations; drug use in situations when it’s physically hazardous; use despite persistent social/interpersonal problems caused by or exaggerated by effects of substance; tolerance; withdrawal symptoms (different for each substance); substance taken in larger amounts than intended; desire or unsuccessful efforts to cut down/control use, significant time spent acquiring, using, or recovering; and social, occupational, recreational activities sacrificed.- High rates of comorbidity with other mental illnesses such as PTSD and depression. Etiology - clear genetic component, DA plays crucial role, learning comes into play (pos/neg reinforcement, cues for cravings), and social and cognitive aspects as well- Treatment includes Motivational interviewing, AA/NA, CBT, exposure with response prevention. Harm reduction may be a better approach than abstinence. It is important to understanding the risk factors that comes with a developing substance use disorder to design treatment even with comorbidity. Clinical example: Lucy has just gotten her second DUI. She cannot pay the fines associated with it because she is already in debt, and has recently lost one of her two jobs after failing a drug test. Many friends have cut her off or distanced themselves because of her behaviors around drinking. Lucy is suffering from an alcohol use disorder.

Question 36

Tolerance vs. withdrawal symptoms

Answer 36

Part of substance use disorder; these are key symptoms to look for when determining a substance related disorder, and can be indicative of physical dependence. Tolerance means that when a person habitually uses a substance, they need to use more of the substance to feel the same effects. Result of adaptive physiological changes in brain and organ systems to accommodate use. Behavioral tolerance can occur through drug-independent learning; context-dependent. Compensatory responses are important to understanding tolerance levels. Withdrawal occurs when a person who routinely uses a substance stops using it for a period of time, and experiences physical symptoms because their body is not habituated to going without the substance. This is important in assessing and understanding Clinical example: Jim is arrested for selling drugs. He is high on opioids at the time. When he has been in custody for several hours, he begins to sweat and shake. He is agitated and eventually vomits. He is experiencing withdrawal. When he does get another dose, he will need twice the amount of heroin as he originally did to feel relief, because he has built tolerance to the drug.

Question 37

Trauma and stress or related disorders

Answer 37

Trauma and stress disorders include posttraumatic stress disorder, acute stress disorder and dissociative disorders. These disorders are marked by an overactive sympathetic nervous system and heightened stress response. In the case of trauma disorders, the disorder is triggered by a traumatic event.-70% of people exposed to at least one trauma in their life-PTSD has 4 core symptoms: intrusion (nightmares, intrusive thoughts, flashbacks, dissociation); negative alterations in cognitions and mood (negative beliefs about self, others and world; distorted cognitions, persistent neg emotional state, diminished interest, detachment, anhedonia); avoidance (triggers and cues of trauma, discussing trauma); and arousal and reactivity (irritability, recklessness, self-destructive bx, hypervigilance, exaggerated startle response, sleep disturbance, difficulty concentrating) Timeframe of sxs > 1 month -Women 2:1 over men; > for lower SES -High rates of comorbidity, often with depression and substance abuse. -Etiology – neurobiology aspects: trauma triggers physical changes in brain and body; cognitive-behavioral aspects: develop fear structures in response to trauma (stimuli, response, cognitions) inadequate processing due to avoidance; and maintenance of PTSD via neg/pos reinforcement-Acute Stress Disorder has the same core symptoms as PTSD but symptoms last < 4 weeks -Treatment typically includes medication (SSRIs, benzos), exposure therapy, and cognitive and behavioral therapies, though other types have been used successfully. Clinical example: Since she was in a bad car accident, Sheila has nightmares that replay the crash. She avoids driving altogether and feels unduly stressed by daily events. She has begun drinking heavily to relax at night. Sheila is suffering from PTSD.