6.3 Psychological disorders Flashcards
social phobia
fear of feeling embarrassed or humiliated while in front of others (eating in public, using a public restroom
symptoms: AVOIDANCE
OCD
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
PTSD
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
acute stress disorder
like PTSD, less than 1 month, as little as three days
adjustment disorder
stressor NOT trauma
symptoms last less than six month after the stressor is eliminated
increased likelihood in low SES
somatic symptom disorderS (separate from anxiety disorders)
physical (somatic) symptoms without rooted pathophysiology
not improved with medical treatment
HYPOCONDRIASIS -> lacks precision
treated with skepticism, divided into four types:
- somatic symptoms disorder
- illness anxiety disorder
- conversion disorder
- factitious disorder
factitious disorder
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
Conversion disorder
change in sensory or motor function with no discernible physical cause
CONVERSION = anxiety -> tremor, weakness, seizures, difficulty eating or talking
somatic symptom disorder
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
illness anxiety disorder
somebody who overly anxious about their health, heath-related behaviors, seeks treatment
predominantly psychological
NO SYMPTOMS!
Bipolar and related disorders (DRAW TABLE - p. 207)
manic | hypomanic | MDE | dysthymic syndrome
manic episode
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
bipolar I disorder
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)
bipolar II disorder
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
MDE
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
cyclothymic disorder
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
depressive disorders (3 types)
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
schizophrenia spectrum + negative symptoms
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)
delusion
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)
positive symptoms
delusions, hallucinations, disorganized speech, disorganized behavior
brief psychotic disorder
a positive symptoms that last at least 1 day but less than 1 month, NO NEGATIVE SYMPTOMS, full remission within 1 month of onset
hallucination versus illusion
illusion - misperception of actual sensory data
schizophreniform disorder
middle position
1 positive symptom
1+ negative symptoms
1-6 months
schizophrenia
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)
schizoaffective disorder
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
dissociative disorders
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
dissociative identity disorder
alternates between 2+ distinct personality states, accompanied by amnesia/loss of awareness, previously called multiple personality disorder
dissociative amnesia
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
depersonalization/derealization disorder
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
Personality disorders
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
paranoid personality disorder
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)
schizoid personality disorder
a loner with little interested or involvement in close relationships, even family. appears unaffected emotionally, detached or COLD
schizotypal PD
includes limited/inappropriate affect;
MAGICAL or paranoid thinking
old beliefs, speech, behavior, appearance, perceptions
Not many confidantes
in many cases, develops schizophrenia
antisocial PD
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
borderline PD
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 disorderhistrionic PD
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
narcissistic PD
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
avoidant PD
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
dependent PD
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
Obsessive-compulsive PD
accumulates worthless objects or money
perfectionistic, rigid, stubborn, need for control, resists authority, will not cooperate
