An Overview of Psychiatric Conditions Flashcards
What are some general concepts on mental illness that we have come to accept?
- Mental illness is not due to external factors such as parasites, possession, infectious agents
- Emotions, thoughts, and behaviours originate within the brain, therefore disorders of thoughts, emotions, and behaviours are disorders of the brain
- Mental illness is not a sign of personal deficit (such as moral weakness)
Give 2 examples of the boundaries of mental illness
- Hallucinations are a sign of mental illness - but they can also be completely normal (e.g. hypnogogic sleep-related hallucinations, natural part of grieving process)
- Paranoid and grandiose beliefs that persist despite concrete evidence against them are typically sign of mental illness - unless they are shared and culturally sanctioned religious or personal beliefs
Is mental illness just an extreme degree of human behaviour?
No - there are clear pathologies in psychiatry
Describe the event that opened our eyes to the possibility of medicine to cure/manage mental illness?
A patient named Jacques Lh was given Chlorpromazine and 3 weeks later was discharged from an asylum and ready to resume “normal life”
Name a few controversial points in psychiatry that existed today
- Mental illness is a myth and labelling mental illness is just another example of society trying to control people
- Psyciatry takes normal human fallibility or deviant behaviour and medicalizes it
- Electroconvulsive therapy is used as a tool for discipline
- Conflict of interest - psychiatry is paid by pharmaceutical companies to prescribe certain meds
What did a psychiatric epidemiology study done in the US in 2005 show in terms of prevalence of mental illness?
That atleast 50% of people would meet criteria for mental illness at some point in their lives.
What disorders were most common in the study that identified mental illness prevalence in the US?
- Anxiety disorders (as a group)
- Alcohol use
- Major depressive disorder
Name 2 mental illnesses that are more common in women
depression and anxiety
Name 2 mental ilnesses that are more common in men
Alcohol use
Antisocial personality disorder
Name 2 mental ilnesses that are more common in men
Alcohol use
Antisocial personality disorder
At what age does 75% of the population see their first symptoms of mental illness by?
Age 24
What percentage of people who had an active disorder sought treatment?
19%
How common is it to have 2 concurrent disorders?
60% of ppl with a psychiatric condition have 2 concurrent disorders
What is the Mental Status Exam?
A key component of psychiatric evaluation
A cross-sectional description of patient’s mental state - provides data necessary for diagnosis
Name some sections of the mental status exam
- General appearance, accessibility, rapport, behaviour
- Mood and affect
- Speech
- Thought process
- Thought content
- Perceptions
- Cognition
- Insight and judgement
Why do psychiatrists look at general appearance?
Typically ppl with more severe mental illness will look dishevelled/unkempt
Why is establishmet of rapport so important for the Mental Satus Exam?
Because it will produce more reliable results, the person will be more likely to be honest with you
What are some abnormal behaviours that could be observed during meeting with a client?
- social disinhibition (inappropriate or intrusive behaviour)
- irritability and aggression, agitation
- loss of motivation
- social withdrawal
- mental slowing, motor slowing
- abnormal voluntary postures/movements
What is the difference between mood and affect?
Affect - emotional foreground, what is objectively observed
Mood - emotional background, subjective internal feeling state as described by the patient
What components of affect are evaluated during the Mental Status Exam?
- Quality (happy, sad, angry, afraid)
- Range (expanded, narrow, normal)
- Intensity (flattened, normal, exaggerated)
- Stability (fixed or labile)
- Appropriateness (e.g. do they laugh and giggle when talking about upsetting thing?)
How is mood described in the Mental Status Exam?
- Quality (euthymic, dysthymic, euphoric, irritable)
- Stability (does the mood change form one day to the next)
- Reactivity (how responsive is mood to extrinsic factors)
Why is speech examined in the Mental Status Exam?
Quality of speech can reveal a lot about underlying pathology
What are 3 aspects of speech that may be observed during Mental Status Exam?
- Amount (e.g. short responses vs. over-inclusive)
- Rate and pressure (is the speech “pressured” or can the patient be interrupted)
- Prosody (does the speech have a normal range of emotional tone?)
What are 3 aspects of speech that may be observed during Mental Status Exam?
- Amount (e.g. short responses vs. over-inclusive)
- Rate and pressure (is the speech “pressured” or can the patient be interrupted)
- Prosody (does the speech have a normal range of emotional tone?)
What is prosody?
The emotional tone in speech
How does the mental status examination evaluate “thought process”?
By seeing the degree to which thoughts are interconnected and the flow of thoughts
- Normal thoughts are considered to be goal directed
- In mental illness, thoughts can become increasingly disorganized
Define circumstantial thought process
Going into excessive, unecessary detail, but eventually returning to the point
Define tangential thought process:
Wandering form topic to topic and never returning to the original point
Define derailment thought process
Can be referred to as “knights move”
- Slips from one topic to another that is unrelated
e. g. “I don’t think they’ll make the playoffs, they’re not ready. The television is always on the same channel.”
Define incoherent thought process
Unintelligible speech - they are saying real words but none of them are connected
What are the 2 types of hallucinations?
- True hallucinations (perceived as originated outside the body)
- Pseudohallucinations (perceived as originating in the head)
What is a non-psychotic hallucination?
When the person recognizes that they are a product of their own mind
What is not considered a mental disorder in the DSM 5?
Socially deviant behaviour
How does the DSM 5 define mental disorder?
Clinically significant disturbance in cognition, emotion, or behaviour
Usually associated with significant distress or disability
When do neurodevelopmental disorders typically manifest?
Early in development - symptoms seen in grade school
Examples of neurodevelopmental disorders?
ASD
ADHD
Range of neurodevelopmental disorders?
From specific learning disorders to global intellectual challenges
What are the 5 domains of psychosis?
- Delusions
- Hallucinations
- Disorganized thought
- Disorganized behaviour
- Negative symptoms (lol, what?)
How are schizophrenia disorders and other psychotic disorders defined?
By the presence of psychosis (one of the 5 domains of psychosis must be present)
What is a delusion?
Fixed belief that something is true despite contrary evidence
Delusions cannot be corrected despite compelling evidence that they are false
What are some of the discrete types of delusions?
- Persecutory delusions (paranoid)
- Referential delusions
- Grandiose delusions
- Somatic delusions
What is an example of a bizarre delusion?
Clearly implausible (e.g. all of your organs have been removed without you knowing and no scar was left)
What is an example of a non-bizarre delusion?
That you are being surveilled by the police
Example of a persecutory delusion?
e.g. fear that government has installed cameras in your apartment
What are the most common types of delusions?
Persecutory (paranoid) - belief that one is going to be harmed
Example of referential delusions?
Belief that particular gestures or comments are targetted at oneself
e.g. the song on the radio had a message for me, or you were sending me a message when you scratched your nose
Example of grandiose delusions?
Belief that one has exceptional abilities, wealth, or fame
e.g. you are the reincarnation of a religious figure, or you control a large multinational corporation
Example of somatic delusions?
Preoccupation with health and organ function
E.g. the belief that your body is infested with parasites
Name a few additional common delusions to Schizophrenia
Thought insertion (alien thoughts being implanted) Thought withdrawal (thoughts are being removed by outside force) Delusions of control (that your body is being manipulated by an outside force)
What is a hallucination?
A perception that occurs in the absence of external stimulus
What are the most common types of hallucinations in Schizophrenia?
Auditory
hallucinations can occur in any of the senses though
What types of hallucinations are not considered pathological?
Hypnogogic (sleeping)
Hypnopompic (occur in the morning as you’re waking up)
What defines disorganized thought form?
Disorganization of speech - it must be disorganized enough to prevent effective communication
Name a few examples of disorganized behaviour
Negativism
Catatonic posturing
Mutism or stupor
Catatonic excitement
What is negativism?
resistance to instructions
What is catatonic posturing?
Person won’t move, rigid, bizzarely frozen/paralyzed, will maintain this position even if you move them
What is mutism or stupor?
Complete lack of verbal responses or motor responses
What is catatonic excitement?
Purposeless, excessive motor activity without obvious cause
Negative symptoms are prominent in schizophrenia, but less apparent in other psychotic disorders. What are some negative symptoms of schizophrenia?
Hint: stated 5, many of which start with letter ‘a’
- diminished emotional expression (including reductions in prosody, and physical expression of emotions in the face)
- avolition (a decrease in self-directed purpose activity, which may involve sitting for long periods of time with little interest in work or social activity)
- alogia (diminished speech output)
- anhedonia (a diminished capacity for pleasure)
- asociality (a lack of interest in social interactions)
What is the peak age of onset for schizophrenia? (men vs. women)
- early to mid 20s for men
- late 20s for women
Describe what the typical onset of schizophrenia is like for the majority of individuals.
- a gradual onset
- with some signs and symptoms beginning in high school
- most individuals with schizophrenia remain chronically ill, and require daily living supports
What is bipolar disorder characterized by?
- alternating episodes of low mood (depression) and elevated mood (mania or hypomania)
What is a manic episode?
a distinct period of abnormally and persistently elevated mood lasting at least a week
What behaviours/characteristics are usually associated with a manic episode?
- elevated energy despite decreased sleep (sleeping a few hours a night)
- rapid and pressured speech
- distractibility
- impulsive activities with negative consequences (spending sprees, sexual indiscretions, foolish investments)
Between episodes, how do most people with bipolar disorder function?
- “normally”
- fully functional level between episodes
What are the four depressive disorders listed in the DSM-5?
- disruptive mood dysregulation disorder
- major depressive disorder
- persistent depressive disorder
- premenstrual dysphoric disorder
What is disruptive mood dysregulation disorder?
- persistent irritability and extreme behavioural dyscontrol in children
- (one of the four depressive disorders listed in the DSM-5)
What is major depressive disorder?
- discrete episodes of clear-cut changes in behaviour, thoughts, and feelings
- (one of the four depressive disorders listed in the DSM-5)
What is persistent depressive disorder?
- a chronic form of depression that continues for two years or longer
- (one of the four depressive disorders listed in the DSM-5)
What is premenstrual dysphoric disorder?
- a specific form of depression that begins after ovulation and remits within a few days of menses
- (one of the four depressive disorders listed in the DSM-5)
What is depression?
- a syndrome of a discrete two week period of “feeling sad most of the day everyday”
What are the symptoms associated with depression?
- feeling sad most of the day
- no interest in activities
- a change in sleep
- feelings of worthlessness
- fatigue
- difficulty thinking
- thoughts of death
What are the most commonly recommended and most effective treatments for depression?
- cognitive behavioural therapy
- antidepressant medication
Why is “behavioural activation” often essential to recovery from depression?
- While time away from stressful environments such as work can be a welcome relief and represent a first step in treatment. For some people, being able to work is a key component to rebuilding a sense of confidence and self esteem.
- keeping busy can help some people with depression (time away and enforced rest is not always the best thing for some people)
What are the three distinct groups of anxiety disorders that the DSM-5 recognizes?
- Anxiety Disorders
- Obsessive Compulsive Disorders
- Trauma and Stressor-Related Disorders
There are 3 distinct groups of anxiety disorders: obsessive compulsive disorders, trauma and stressor-related disorders, and anxiety disorders. As stated by the DSM-5, what are some anxiety disorders that belong in the anxiety disorder group?
- generalized anxiety disorder
- social anxiety
- panic disorder
- phobias
Obsessive Compulsive Disorder is a distinct group of anxiety disorders. What disorders are considered to be obsessive compulsive disorders?
- body dysmorphic disorder, hoarding disorder, hair pulling, skin picking, and obsessive compulsive disorder
State two disorders that are included within Trauma and Stressor-Related Disorders group of anxiety disorders
- post-traumatic stress disorder
- attachment disorders in children
As a group, anxiety disorders are generally characterized by what (behaviour)?
extreme avoidance of situations that are seen as threatening
Describe social anxiety disorder. What is it?
An excessive fear of judgement in social situations leading to avoidance and social isolation.
(afraid that they they are going to be observed and judged negatively.
Often speak about three domains: performance, interpersonal, observational
- performance includes: getting up in front of an audience - eg. playing instrument or doing presentation
- interpersonal: making small talk at a party
- being observed: standing in line, eating in front of people)
What is panic disorder?
recurrent panic attacks leading to change in behaviour to try to avoid attacks (avoiding malls, bridges)
-panic attacks occur for no reason at all and then the person associates the attack to those contexts that they happened in - so start avoiding those contexts
What is Generalized Anxiety Disorder?
- excessive worry that is difficult to control and manage, is associated with tension, and causes impairment – reassurance seeking and avoidance of uncertainty is common
- characterized by worry about the same thing that every one worries about: finances, school, work, etc. and also minor matters (eg. being late - may drive out to a place the day before to check how much time it takes)
- tend to try to control everything
What does treatment for anxiety disorders invariably involve?
- confronting the avoided activities in a gradual, supportive manner
(panic disorder and social anxiety disorder - exposure therapy, generalized anxiety disorder - worry management (eg. CBT))
What is obsessive compulsive disorder?
- patients have recurrent unwanted thoughts that are neutralized by repeatedly performing specific rituals
- can lead to severe functional impairment
What is body dysmorphic disorder?
- patients are preoccupied with perceived defects in their physical appearance
What is hoarding disorder?
difficulty discarding possessions
what is trichotillomania?
hair pulling disorder
What is excoriation disorder?
- an obsessive-compulsive disorder that involves skin picking
Symptoms in obsessive-compulsive disorder typically fall into one of a number of dimensions. State the 4 dimensions/categories they usually fall into.
- contamination (cleaning)
- harm (checking)
- symmetry (repeating, counting, ordering, arranging)
- taboo thoughts (aggressive, sexual, and religious thoughts)
Describe reactive attachment disorder. (who gets this and how do they act)
children subject to neglect who demonstrate emotionally withdrawn behaviour
- a type of trauma and stressor related disorder
Describe disinhibited social engagement disorder. (who gets this and what is their behaviour)
- children subject to neglect who demonstrate disinhibition in their social interactions with others
- a type of trauma and stressor related disorder
What is post-traumatic stress disorder?
A cluster of symptoms arising from an inability to adequately process a severe traumatic event
- thought of as a failure to recover from acute stress disorder
Describe acute stress disorder.
- symptoms in the immediate aftermath of a traumatic event
- usually the first 30 days after event
- if last longer than 30 days thought of as PTSD
What are the four main symptoms of PTSD?
4 main symptoms of PTSD:
- intrusive re-experiencing (eg. nightmares, flashbacks, physical symptoms, unwanted thoughts)
- Avoidance (avoid talking about it or thinking about it, avoid going places that remind them of the event, avoid people associated with it)
- Cognitive changes (changes the way they see themselves and the way they see the world - lose a sense of safety, experience a disconnection with people in their life)
- Hyperarousal and hypervigilance (easily startled, jumpy)
What does treatment of PTSD usually involve?
- gradual confronting of the stressor
- small steps to recovery
What are Somatic Symptom and Related Disorders?
disorders that present with prominent somatic (physical) symptoms that are believed to arise from primarily psychiatric distress
State 4 Somatic Symptom and Related Disorders.
- Somatic Symptom Disorder
- Illness Anxiety Disorder
- Conversion Disorder
- Factitious Disorder
What is Somatic Symptom Disorder?
- multiple physical symptoms (such as pain and fatigue) that cause significant suffering and are associated with excessive anxiety
What is Illness Anxiety Disorder?
- preoccupation with having or acquiring a serious illness, in the absence of significant symptoms
- a type of somatic symptom and related disorder
What is conversion disorder?
- altered motor or sensory function that is not explained by an underlying neurological condition
(eg. often can’t move and don’t know why - paralyzed but neurologically intact
another eg. may present with blindness or loss of sensation in a body part)
- a type of somatic symptom and related disorder
What is factitious disorder?
- falsification of signs or symptoms to present as ill, in the absence of external rewards
State three types of eating disorders.
- Anorexia Nervosa
- Bulimia Nervosa
- Binge-Eating Disorder
What is Anorexia Nervosa? (what is it characterized by)
characterized by restriction of energy intake leading to significantly low body weight, associated with a fear of becoming fat and a disturbance in the way one’s weight or shape is experienced
What is Bulimia Nervosa?
characterized by recurrent episodes of binge eating and recurrent compensatory behaviours to prevent weight gain (such as vomiting or excessive exercise)
What is Binge-Eating Disorder?
- disorder characterized by episodes of binge eating in the absence of compensatory behaviour (compensatory behaviour = eating disordered behaviours designed to counteract the effects of eating in order to avoid weight gain or to alleviate guilt associated with eating)
How is Anorexia different than Bulimia?
Anorexia can present as either restricting or binge-eating/purging. Unlike patients with binge-eating and purging in the context of Bulimia, patients with anorexia fail to maintain a healthy weight.
How does Anorexia affect the sexes (male versus female)? When does it typically begin?
10 times more common in women than in men
-typically begins during adolescence or early adulthood
Define a binge episode. What is it typically associated with?
Def’n:
- eating in discrete period of time an amount larger than most people would eat
- a lack of control over eating (feeling that one cannot stop or control how much one is eating)
Typically associated with:
- eating more rapidly than normal
- eating until feeling uncomfortably full
- eating large amounts of food when not physically hungry
- eating alone because of embarrassment
- feeling guilty or disgusted with yourself afterwards
How much of the population does insomnia affect approximately?
33 percent
How much of the population does insomnia become a chronic problem?
20%
In many cases, insomnia can be secondary to what
- medical factors?
- psychological factors?
- chemical factors?
- environmental factors?
- medical factors: pain, nocturia
- psychological factors: depression, anxiety, stress
- chemical factors: caffeine, alcohol
- environmental factors: noise, light, temperature, pets
While sleeping pills may be necessary, most cases of insomnia can be managed through what?
cognitive behavioural therapy
What is sleep apnea characterized by?
- characterized by repeated episodes of complete cessation of breathing (apnea) or shallow breathing (hypopnea) during sleep.
- snoring and gasping for air during sleep is typical
What are two types of sleep apnea?
- Obstructive
- Central
What is obstructive sleep apnea?
- sleep apnea due to airway occlusion by soft tissue
What is central sleep apnea?
- sleep apnea due to a failure of respiratory drive
How long do episodes of apnea/hypopnea typically last?
- ten to thirty seconds
- can be longer though
What are risk factors for sleep apnea?
- much more commen in men
- small jaw
- a large neck
- smoking
- alcohol use
- obesity
Untreated apnea presents a risk for what conditions/life circumstances/accidents
- hypertension
- depression
- motor vehicle crashes
- poor job performance
- work related accidents
In some (but not all) cases, what can significantly improve sleep apnea?
- weight loss
What is a personality disorder characterized by?
When does it usually start?
- characterized by a long-standing pattern of inner experience (thoughts, emotions) and behaviours (relationships, impulsivity) that deviates from what would be normally expected
- this pattern begins in adolescence, is pervasive and inflexible, and causes distress and impairment
Personality disorders are grouped into three clusters based on similarities. What is included in Cluster A?
Cluster A personalities appear odd or eccentric, and include paranoid, schizoid, and schizotypal
Personality disorders are grouped into three clusters based on similarities. What is included in Cluster B?
Cluster B personalities appear dramatic, emotional, or erratic, and include antisocial, borderline, histrionic, and narcissistic
Personality disorders are grouped into three clusters based on similarities. What is included in Cluster C?
Cluster C personalities typically appear anxious and fearful, and include avoidant, dependent, and obsessive-compulsive personality disorders
Paranoid Personality Disorder is part of Cluster A: the “odd and eccentric” group of personality disorders. Describe Paranoid Personality Disorder.
- disorder where an individual has a pattern of distrust and suspicion; others tend to be interpreted as malevolent (reads hidden demeaning or threatening meanings into benign remarks, suspects others are deceiving or harming)
Schizoid Personality Disorder is part of Cluster A: the “odd and eccentric” group of personality disorders. Describe Schizoid Personality Disorder.
- detachment from social relationships (neither desires or enjoys close relationships, prefers to be alone, lacks close friends and seems indifferent to praise or criticism)
Schizotypal Personality Disorder is part of Cluster A: the “odd and eccentric” group of personality disorders. Describe Schizotypal Personality Disorder.
- eccentric behaviours, discomfort in close relationships, and cognitive or perceptual distortions (odd, superstitious beliefs; vague, overelaborated speech)
Antisocial Personality Disorder is part of Cluster B: the “dramatic, emotional, erratic” group of personality disorders. Describe Antisocial Personality Disorder.
disregard for and violation of the rights of others (deceitfulness, lack of remorse, consonant with psychopathy or sociopathy)
-no moral compass
Borderline Personality Disorder is part of Cluster B: the “dramatic, emotional, erratic” group of personality disorders. Describe Borderline Personality Disorder.
impulsivity and unstable relationships, self-image, and emotions (fears of abandonment, recurrent self-harm, chronic feelings of emptiness, difficulty with anger)
Histrionic Personality Disorder is part of Cluster B: the “dramatic, emotional, erratic” group of personality disorders. Describe Histrionic Personality Disorder.
excessive emotionality and attention seeking (needing to be the center of attention; seductive, inappropriate behaviour, dramatic and exaggerated emotions)
Narcissistic Personality Disorder is part of Cluster B: the “dramatic, emotional, erratic” group of personality disorders. Describe Narcissistic Personality Disorder.
- grandiosity, a need for admiration and a lack of empathy (fantasies of success and power, a belief that one is unique, of high status; a sense of entitlement)
Avoidant Personality Disorder is part of Cluster C: the “anxious and fearful” group of personality disorders. Describe Avoidant Personality Disorder.
feelings of inadequacy, hypersensitivity to rejection, and social inhibition (avoids social situations, sees self as socially inept)
Dependent Personality Disorder is part of Cluster C: the “anxious and fearful” group of personality disorders. Describe Dependent Personality Disorder.
submissive and clinging behaviour, needing to be taken care of (needs excessive advice and support from others)
Obsessive Compulsive Personality Disorder is part of Cluster C: the “anxious and fearful” group of personality disorders. Describe Obsessive-Compulsive Personality Disorder.
preoccupation with orderliness, perfectionism, and control (perfectionistic, preoccupied with rules and order)
Treating Mental Illness: Medications vs. Therapy
Think about: What’s more important in the treatment of diabetes: lifestyle and diet changes or insulin?
- it depends!
- mental illnesses represent a diverse range of conditions, and different people, with different conditions, under different circumstances, will need different treatments.
How are medications typically classified?
for example: what was the first antidepressant drug used for?
by their primary indications (which is fundamentally dictated by economic pressures, backed by science)
- first antidepressant drug was used to treat tuberculosis
What is psychodynamic therapy?
typically a long term therapy that looks at your past to understand your present
What is cognitive behavioural therapy?
- therapy that is brief, goal focused and includes “homework” done in the course of treatment
(tries to change the way you view the world by changing the way you think and how you act in the world)
