6.3 Psychological disorders

Question 1

social phobia

Answer 1

fear of feeling embarrassed or humiliated while in front of others (eating in public, using a public restroom

symptoms: AVOIDANCE

Question 2

OCD

Answer 2

obsessions or compulsions (or both)

obsession = intrusive, uncontrollable thoughts or impulses that cause distress or anxiety (e.g. fear of germs, fear of having harmed somebody)

compulsion = repeated physical or mental behaviors performed in response to an obsession, in order to reduce the distress or prevent something bad from happening. if not performed, the person feels intense ANXIETY and conviction something bad will happen

Question 3

PTSD

Answer 3

feeling of intense fear, horror, or helplessness when confronting an extremely TRAUMATIC EVENT that involved death or threatened DEATH to self or others. more than 1/2 of people experience trauma, but only a small subset develop PTSD. more common in women than men, more common in males who served in army and Latino men’

the traumatic event is “RELIVED” in dreams and flashbacks – multisensory (sounds, smells) – with physiological symptoms (HR, BP),

avoids reminders of the event, avoids people

chronic HYPERVIGILANCE -> increased startle response, insomnia, anger, poor concentration

symptoms at least 1 month

Question 4

acute stress disorder

Answer 4

like PTSD, less than 1 month, as little as three days

Question 5

adjustment disorder

Answer 5

stressor NOT trauma

symptoms last less than six month after the stressor is eliminated

increased likelihood in low SES

Question 6

somatic symptom disorderS (separate from anxiety disorders)

Answer 6

physical (somatic) symptoms without rooted pathophysiology

not improved with medical treatment

HYPOCONDRIASIS -> lacks precision

treated with skepticism, divided into four types:

1. somatic symptoms disorder
2. illness anxiety disorder
3. conversion disorder
4. factitious disorder

Question 7

factitious disorder

Answer 7

aka Munchhausen Syndrome

falsification of evidence of illness, inflicting harm in order to receive attention, requires evidence that the behavior does not always have benefits. inflicts pain on others = factitious disorder imposed on another

Question 8

Conversion disorder

Answer 8

change in sensory or motor function with no discernible physical cause

CONVERSION = anxiety -> tremor, weakness, seizures, difficulty eating or talking

Question 9

somatic symptom disorder

Answer 9

chief complaint is 1+ somatic symptoms (chronic pain, headaches, fatigue) with evidence of diminished functioning stemming from excessive preoccupation with and/or anxiety about symptoms

Question 10

illness anxiety disorder

Answer 10

somebody who overly anxious about their health, heath-related behaviors, seeks treatment

predominantly psychological

NO SYMPTOMS!

Question 11

Bipolar and related disorders (DRAW TABLE - p. 207)

Answer 11

manic | hypomanic | MDE | dysthymic syndrome

Question 12

manic episode

Answer 12

1 week

• abnormally euphoric, unrestrained, irritable
• goal-directed activity or psychomotor agitation
• severe enough to require hospitalization, psychotic features
• may be caused by ADs, ECT, light

Question 13

bipolar I disorder

Answer 13

experienced 1 manic or mixed episode

spontaneous manic episode (not triggered by AD treatment or caused by another medical condition)

may include a swing to depressive episode, partial or moderate depression, or (not often) no depression at all

Mixed = depression + manic every day for a week (severe enough to cause hospitalization, impair work)

Question 14

bipolar II disorder

Answer 14

less extreme mania episodes

1 depressive episode + 1 hypomanic episode, but does NOT meet criteria for manic or mixed episode

hypomania - at least 4 days of elevated or irritable mood, 3 symptoms of manic episode (but LESS SEVERE)

no psychosis or hospitalization

Question 15

MDE

Answer 15

felt bad than usual for most of the day, nearly every day, for at least two week

at least 5 of the following: depressed mood, decreased interest in activities, significant increase or decrease in weight/appetite, excessive or insufficient sleep, agitated or slowed psychomotor activity, fatigue, loss of energy, feelings of low self-worth, excessive guilt, impair concentration, thoughts of death or suicide

Question 16

cyclothymic disorder

Answer 16

similar to bipolar disorder

not meeting criteria for manic or major depressive episode

cyclic moods, multiple hypomanic episodes, episodes of depressed mood MILDER than MDE

for two years

Question 17

depressive disorders (3 types)

Answer 17

MDD - 1 or more MDEs. 10% attempt suicide, many more contemplate, does not count if 2 month of bereavement, which is normal. “with seasonal pattern”

PDD (dysthymia) - persistent depressive disorder; a chronic form of depression, milder symptoms of MDD most days for at least 2 years; feeling never absent for more than 2 months (a “depressed” person)

Premenstrual dysphoric disorder (PDD) - only in women; worst a week before the onset of menses, and improve or disappear in the week after menstruation; feeling keyed up or on edge, food cravings, overwhelmed feelings, physical symptoms -> muscle pain, swelling of breasts, bloating

Question 18

schizophrenia spectrum + negative symptoms

Answer 18

splitting off from reality, NOT SPLIT IN IDENTITY

• delusions, hallucinations, disorganized thinking, disorganized speech, disorganized motor control, and/or one or more NEGATIVE symptoms: decreased emotional expression (flat affect), avolition (lack of motivation), alogia (decreased speech)

Question 19

delusion

Answer 19

false belief not due to culture

not relinquished despite evidence of its falsehood

e.g. belief one is a movie star

for delusional disorder - one or more delusions present for 1 month, counter-evidence is denied. erotomania (belief somebody is in love with you), grandiosity (belief one has a special talent), persecution (belief you are being followed, drugged, harassed)

Question 20

positive symptoms

Answer 20

delusions, hallucinations, disorganized speech, disorganized behavior

Question 21

brief psychotic disorder

Answer 21

a positive symptoms that last at least 1 day but less than 1 month, NO NEGATIVE SYMPTOMS, full remission within 1 month of onset

Question 22

hallucination versus illusion

Answer 22

illusion - misperception of actual sensory data

Question 23

schizophreniform disorder

Answer 23

middle position

1 positive symptom
1+ negative symptoms

1-6 months

Question 24

schizophrenia

Answer 24

positive and negative symptoms for longer than 6 months

great impairment of work, relationships, and self-care

no complete remission without medication

subside to prodromal level (just below diagnostic threshold)

Question 25

schizoaffective disorder

Answer 25

mood and psychotic features

experiences delusions/hallucinations IN THE ABSENCE OF MOOD SYMPTOMS and DURING A MAJOR MOOD EPISODE

resembles a chronic psychotic disorder overlapping bipolar and depressive disorder

mood symptoms should remit for at least 2 weeks at a time

Question 26

dissociative disorders

Answer 26

a person’s thoughts, feelings, perceptions, memories, or behaviors are separated from conscious awareness and control. disruptions in awareness, memory, identity are extreme and frequent, and cause distress or impair functioning

• triggered by stress or psychological conflicts (begin and end SUDDENLY)
• D identity disorder
• D amensia
• Derealization disorder

Question 27

dissociative identity disorder

Answer 27

alternates between 2+ distinct personality states, accompanied by amnesia/loss of awareness, previously called multiple personality disorder

Question 28

dissociative amnesia

Answer 28

1 episode of forgetting some important personal information, gaps in memory related to severe stress or trauma

dissociative FUGUE - wandering aimlessly during an episode

localized amnesia - everything forgotten during a particular time

generalized - whole lifetime is forgotten

continuous - everything since a given time

systematized - a category is forgotten

begins and ends SUDDENLY, full recovery is possible, may also linger; remission may CAUSE ptsd or suicidal ideation

Question 29

depersonalization/derealization disorder

Answer 29

depersonalization - recurring persistent feeling of being detached from body

derealization - person experiences a feeling that people or objects in the external world are UNREAL

the person realizes the feelings are NOT ACCURATE, “reality testing” is intact, and the incongruity causes distress or impairs functioning

Question 30

Personality disorders

Answer 30

personality traits that deviate from cultural norms, impairs functioning, causes distress

egosyntonic - in harmony with the person’s ego or self-image - consequences that lead to treatment, rather than symptom structure

a difficult/rigid personality becomes a disorder when the pattern causes distress or impairment, present since adolescence, affects nearly ALL personal and social situations, and creates dysfunction in: affect, cognition, impulse control, interpersonal functioning

clustered into 3 categories: A, B, C

A - paranoid, schizoid, schizotypal | IRRATIONAL, WITHDRAWN, COLD, SUSPICIOUS

B - antisocial, borderline, histrionic, narcissistic | EMOTIONAL, DRAMATIC, ATTENTION-SEEKING, INTENSE

C - Avoidant, dependent, OC | TENSE, ANXIOUS, OVER-CONTROLLED

Question 31

paranoid personality disorder

Answer 31

mistrusts and MISINTERPRETS others’ motive and actions without sufficient cause, suspecting others of deception, harm, betrayal, or attack

Guarded, TENSE, self-sufficient (generally in counter-productive/maladaptive ways)

Question 32

schizoid personality disorder

Answer 32

a loner with little interested or involvement in close relationships, even family. appears unaffected emotionally, detached or COLD

Question 33

schizotypal PD

Answer 33

includes limited/inappropriate affect;

MAGICAL or paranoid thinking
old beliefs, speech, behavior, appearance, perceptions
Not many confidantes
in many cases, develops schizophrenia

Question 34

antisocial PD

Answer 34

history of serious behavioral problems
aggression against people/animals
property destruction; lying/theft; rule violation
disregards the rights of others
dishonest, impulsive
physical fights
disregard for safety
financial irresponsibility
lack of remorse

belongs in DISRUPTIVE, IMPULSE-CONTROL, CONDUCT DISORDERS

found in incarcerated men

Question 35

borderline PD

Answer 35

impulsive
moody
unstable in self-image
reckless
extreme mood swings
reactivity
anger
unstable relationships
feels empty, unstable sense of self
terrified of abandonment by others ("don't abandon me!")
self-harm, suicidal behavior
frequent in women
a generalized, severe form of bipolar disorder

Question 36

histrionic PD

Answer 36

strong desire to be the center of attention.

seeks attention through personal appearance and seduction

dramatic emotions, even if they are shallow and shifting

may over-estimate intimacy

vague, suggestible (=easily swayed) in speech

Question 37

narcissistic PD

Answer 37

feels gradiosely self-important, fantasies of beauty, brilliance, and power

desperate need for admiration, feels envy towards and from others

lacks empathy for others, exploitative, entitled, arrogant

Question 38

avoidant PD

Answer 38

inadequate, inferior, undesirable, fears criticism and conflict, ashamed, avoids interpersonal contact, new activities, unless he or she is certain of being liked

restrained and inhibited in relationships

Question 39

dependent PD

Answer 39

feels a need to be taken care of by others

trouble assuming responsibility, making decisions, preferring to gain approval by making others responsible

seeking other’s advice and reassurance regarding decisions

clingy, submissive, afraid to express disagreement

easily taken advantage of, seeks to avoid abandonment

Question 40

Obsessive-compulsive PD

Answer 40

accumulates worthless objects or money

perfectionistic, rigid, stubborn, need for control, resists authority, will not cooperate