Ch 6.3 Flashcards
America meets criteria for psycho disorder
roughly 1 in 4 adults ( 18+)
psycho disorders health care, economy
important part of culture, comprise a significant component of our health care system, when go untreated, also affect our economy, by impacting our social welfare and criminal justice systems
serious psycho disorders affect
1/17 people, or 6% of US population
psychological disorder
set of behavioral and or psycho symptoms that are not in keeping with cultural norms and that are severe enough to cause significant personal distress and or sig impairment to social, occupational or personal functioning
core components of diagnosis for a ppsychological disorder when cultural norms cannot explain behavior
symptom quanitity and severity, impact on functioning
psyco disorder is diagnosable r
based on specific symptoms and symptom thresholds and treatble or manageable and various types of edication and or therapy
psychopatho recognizes role
of nature ( genetic predisposition) and nurture ( environmental factors) in the occurence and manifestation of psycho disorders culture role
role of culture in prevalence of various psycho disorder
while not exclusive in western cultures, eating disorders appear far more common in wealthier countries that epouse a thin ideal, ike the US than they are n other parts of the world
manifestation of disorder for person
could be influenced by cultural or social factors even though underlying genetic and physiological dynics are similar
universal authority on the classification and diagnosis of psychological disorders
is diagnostical and statistical manual of mental diorders , fifth edition ( DSM-5) published in May 2013
each new edition of DSM
reflects changes in research and clinical perspectives
ex of changes reflected in new editions of DSM
19 yrs since the publication of fourth edition (DSM-IV) research findings and clinical experience prompted the publishers of DSM 5 to combine the four seperate autism disorders in to one Autism spectrum dsorder and to change the symptom categories from 3 to 2 areas
change to autism caused , it is thought to yielded a clearer, more reliable and more accurate means of diagnosis
accurate diagnosis is critical
most insurance companies require a diagnosis based on DSM criteria before they will cover the cost of therapy
Name the 13 categories of psychological disorders
anxiety obsessive compulsive and related trauma and stressor related somatic symptom bipolar and related depressive schizophrenia spectrum and other psychotic dissociative personality feeding and eating neurocognitve sleep wake substance realted and addictive
description: anxiety disorders
characterized by excessive fear ( or specific real things or more general) and or anxiety of real or imagined future things or events with both physiological and psychological symptoms
specific anxiety disorders
seperation anxiety disorder specific phobias social anxiety disorder panic disorder generalized anxiety disorder
description: obsessive compulsive and related disorders
distinct from anxiety in that they involve a pattern of obsessive thoughts or urges that are coupled with maladaptive behavioral compulsions; compulsions are experienced as a necessary/ urgent response to obsessive thoughts or urges, creating rigid , anxiety filled routines
specific obsessive compulsive and related disorders
obsessive-compulsive disorder
body dysmorphic disorder
hoarding disorder
description: trauma and stressor related disorders
traumas and stressors are central to the definition of these disorders, which involve unhealthy or pathological response to one or more harmful life threatening events including witnessing such an event
symptoms of trauma and stressor related disorders
patterns of anxiety , depression, depersonalization , nightmares, insomnia and or heightened startle response
specific trauma and stressor related disorders
posttraumatic stress disorder
acute stress diorder
adjustment disorders
description: somatic symptom disorders
characterized by symptoms that cannot be explained by a medical condition or substance use and are not attributable to another psychological disorder, but that nonetheless cause emotional distress
specific somatic symptom disorders
somatic symptom disorder
illness anxiety disorder
conversion disorder
facitious disorder ( imposed on self or another)
description: bipolar and related disorders
seperate from mood disorders
bipolar and related involve mood swings or cycles called episodes ranging from manic to depressive , in which manic episodes tend to be followed by depressive episodes and vice versa
specific bipolar and related disorders
bipolar 1 disorder
bispolar 2 disorder
cyclothymic disorder
description: depressive disorders
characterized by disturbance in mood or affect
symptoms include difficulties in sleep, concentration and or appetite , fatigue, inablity to experience pleasure (anhedonia)
specific depressive disorders
major depressive disorders
persistent depressive disorder ( dysthymia )
premenstrual dysphoric disorder
description: schizophrenia spectrum and other psychotic disorders
characterized by a general loss of contact with reality which can include positive symptoms such as delusions and hallucinations and or negative symptoms such as flattened affect ( monotone vocal expression)
specific schizophrenia spectrum and other psychotic disorders
delusional disorder brief psychotic disorder schizophreniform disorder schizophrenia schizoaffective disorder
description: dissociative disorders
characterized by disruptions in memory, awareness, identity or perception
many dissociative disorders are thought to be caused by psychological trauma
specific dissociative disorders
dissociative identity disorder
dissociative amnesia
diepersonalizaion/ derealization disorder
description: personality disorders
characterized by enduring maladaptive patterns of behavior and cognition that depart from social norms, present across a variety of contexts, and cause significant dysfunction and distress
patterns permeate the broader personality of the person and typically solidify during late adolescence or early adulthood
specific personality disorders ( cluster A)
paranoid personality disorder
schizoid personality disorder
schizotypal personality disorder
specific personality disorders ( cluster B)
antisocial personality disorder
borderline personality disorder
histrionic personality disorder
narcissistic personality disorder
specific personality disorders ( cluster C)
avoidant personality disorder
dependent personality disorder
obsessive compulsive personality disorder
description: feeding and eating disorders
characterized by disruptive emotional and behavioral patterns around feeding and or eating that negatively impact physical and mental health
specific feeding and eating disorders
anorexia nervosa
bulimia nervosa
binge eating disorder
description: neurocognitive disorders
characterized by cognitive abnormalities or general decline in memory , problem solving and or perception
specific neurocognitive disorders
major and mild neurocognitive disorders (MMND)
MMND due to Alzheimer disease
MMND due to parkinsonès disease
Major of mild vascular neurocognitive disorder
description: sleep wake disorders
characterized by excessive r deficient sleep patterns , abnormalities in circadian rhythm , and or interruptions to normal sleep
specific sleep wake disorders
insomnia
hypersomnolence disorder
narcolepsy
breathing related sleep disorders including various apneas
parasomnias ( such as somnambulism or sleep walking)
description: substance related and addictive disorders
characterized by psychological +/ physioogical dependence on or addiction to one or more substances and behaviors
symptoms: substance related and addictive disorders
tolerance and withdrawal and are generally realted to maladaption of , or damage to the brainès reward system
specific substance related and addictive disorders
substance related disorders
alcohol related disorders
tobacco relate disorders
gambling disorder
9 categories of psychological disorders important
anxiety, obsessive compulsive and related, trauma and stressor related, somatic symptom and related, bipolar and related , depressive, schizophrenia spectrum and other psychotic disorders, dissociatve disorders and personality disorders
anxiety
emotional state of unpleasant physical and mental arousal - a preparation to fight or flee
anxiety in a person with anxiety disorder
is intense , frequent, irrational ( out of proportion) and uncontrollable, causes significant distress or impairment of normal functioning ( at work productivity, success in intimate relationships and so on)
4 types of anxety disorders
panic disorder, generalized anxety disorder, specific phobia and social phobia ( social anxiety disorder)
symptoms mimicking an anxiety disorder
can be caused by general medication conditions, alcohol, certain drugs or medical use or withdrawal
diagnosis if person has a medical condition and has anxiety disorder
anxiety disorder due to a general medical condition
diagnosis if person uses conditions and has anxiety disorder
anxiety disorder due to substance induced anxiety disorder
panic disorder
patient suffers at least one panic attack and is worried about having more of them
can be triggered by certain situations, but they are more often uncued or spontaneous occurring unexpectedly and with sometimes unpredictable frequency
during a panic attack
person commonly experiences intense dread, along with shortness of breath , chest pain ,a choking sensation and cardiac symptoms such as rapid hearteat and palpitations
may also be trembling, sweating, lightheartedness or chills
fear during panic attack
dying of heart attack or stroke during the attack
danger of panic attacks
they can mask other illnesses such as heart attacks and mood disorders
duration of panic attack
brief often less than 30 min in duration
pain during panic attacks
can be excruciating and people with panic disorder live in fear of having more panic attacks
panic disorder if left untreated
debilitating
response to treatment panic disorder patients
respond well
generalized anxiety disorder (GAD)
person feels tense or anxious much of the time about many issues, but does not expereince panic attacks
GAD: source of underlying nervousness
chronic nervousness can seem like moving target, shifting from one situation to another or ther may be no identifiable source
distress and impairment with GAD
often not severe
may include restlessness, tiring easily, poor concentration, irritability, muscle tension , and insomnia or restless sleep
specific and social phobias
sufferer feels strong fear that he or she recognizes to be unreasonable
he or she almost always experiences general anxiety or full panic attack when confronted with feared object or situation
people with phobias
often go great lengths to avoid the triggers they fear and avoidance itself is part of symptom profile
specific phobia
persistent, strong and unreasonable fear of a certain object or situation
four types of specific phobia
situational
natural environment
blood- injection- injury
animal
specific phobia type not listed in four types
other which can depend on a variety of triggers
situational phobia ex triggers
flying, elevator, bridges, crowds ( in Agoraphobia)
natural env t phobia ex triggers
thunderstorms, water, heights, lightning
blood-injection-injury phobia ex triggers
injections, blood , surgical procedures
animal phobia ex triggers
spiders, snakes ,dogs
social phobia
social anxiety disorder
unreasonable, paralyzing fear of feeling embarrassed or humiliated while one is seen or watched by others, even while performing routine activities such as eating in public or using a pulic restroom
specific specifier in social phobia for
speaking
primary symptom of social phobia
avoidance in the form of social isolation
obsessive compulsive and related
feature at least 1 pronounced repititive behavior that exceeds cultural norms and rituals such as grooming practices or maintaining healthy body weight
central of diag obs comp and rel
is unsuccessful attempts to decrease or otherwise manage these behaviors
obs comp and rel without therapeutic intervention
conditions increase over time in terms of severity or level of self harm or both
obsessive compulsive disorder
OCD
obsessions, compulsions or both
obsessions
repeated, intrusive, uncontrollable thoughts or impulses that cause distress or anxiety
personal acknowledge of obsessions
knows these thoughts are irrational and depite attempts to disregard or supress them, typically resorts to responding to them thru a compulsive behavior
compulsions
repeated physical or mental behaviors that are performed in response to an obsession or in accordance with a strict set of rules in order to reduce distress or prevent something dreaded from occuring
person acknowledge of compulsions
knwos that compulsive behavior is unreasonable, being either unrealted to the dreaded event or related but clearly excessive
nonetheless if person does not perform behavior, he or she feels intense anxiety and a conviction that the terrible event will happen
common obsessions
irrational fear of contamination by dirt, germs or toxins
pathological doubt that a task was done, or fear of having inadvertently harmed someone or violated a law
fear of harming someone violently or sexually or otherwise behaving in an unacceptable way
common compulsions
washing self or surroundings repeatedly, sometimes with lengthy ritual
checking repeatedly that a task was done, sometimes with a lengthy ritual
counting to a certain number before certain tasks, or performing a behavior a certain number of times ( such as folding a shirt)
arranging objects or performing actions with perfect symmetry or precision
obs comp DSM
seperated from anxiety disorders
Trauma and stressor related disorders
seperated from anxiety in DSM 5 originally grouped together because anxiety plays role in these dsorders as well
revision in DSM 5 on trauma
intended to facilitate the diagnosis of specific anxiety like disorders on the basis of their etiology and to focus research and clinical practice on a more focused and tailored set of treatment options
etiology
cause or set of causes or causal conditions for a particular disease
post traumatic stress disorder origins
PTSD
when person feels intense fear, horro or helplessnes while experiencing, witnessing or otherwise confronting extremely traumatic event that involves actual or threatened death or serious injury to self or others
estimates of trauma events
that more than 1/2 people will experience at least one traumatic event in their lifetime but only a small subset of those will develop PTSD
statistics of M and F who develop PTSD after trauma event
approx 8% of men and 20% of women will develop PTSD after a trauma
rates of PTSD high prevalence
in males of latino heritage and males who have served in active combat, for whom the estimated prevlence reaches 20%
traumatic event often
relived ( not just remembered) thru dreams and flashbacks which the feels as though the event is currently happening , which can include multi sensory reprocessing such as the intrusion of smells and sounds from the original event contet
after traumatic event some patients
experience mental or physioogical distress such as elevated heart rate or blood pressure when reminded of the event, however indirectly.
person with PTSD
tried to avoid people, places, feelings , thoughts or conversations that are reminders of the event and even avoids people and feeling in general
also chronically physiologically hyperaroused
symptoms of physio hyperarousal
increased startle response, insomnia, angry outburts, poor concentration, extreme vigilance
hypervigilance
enhanced state of sensory sensitivity accompanied by an exaggerated intensity of behaviors whose purpose is to detect activity
may bring about a state of increased anxiety which can cause exhaustion.
diagnosis of PTSD requires duration of symptoms
to be present for more than a month
acute stress disorder ASD
similar to PTSD
symptoms are present for less than a month and for as little as three days
adjustment disorder
less sever shorter term version of condition
group of symptoms, such as stress, feeling sad or hopeless, and physical symptoms that can occur after you go through a stressful life event. The symptoms occur because you are having a hard time coping. Your reaction is stronger than expected for the type of event that occurred
adjustment disorder causes
include a stressor as opposed to trauma
adjjustment disorder symptoms
last less than 6 months once the stressor has been eliminated
diagnosis for adjustment disorder also appears
when subsequent distress appears in some way disproportionate to cause
in all stress disorders, inidvidual
from low SES socioeconomic status communities or who are otherwised disadvantaged encounter more stressor in their everyday lives and thus have an increased risk for disorder in this category
somatic symptom disorder
characterized by distress and decreased functioning due to persistent physical symptoms and concerns which may mimic pysical disease but generally not rooted in any detectable pathophysiology
somatic symptoms and treatment
symptoms do not improve with treatment
symptom or behavior pattern of somatic symptom disorers is commonly refered to as
hypochondriasis
lacks precision because the difference between the disorders is clear
hypochondriasis
group of symptoms, such as stress, feeling sad or hopeless, and physical symptoms that can occur after you go through a stressful life event. The symptoms occur because you are having a hard time coping. Your reaction is stronger than expected for the type of event that occurred
people with somatic symptom disorders
genuinely experience their symptoms and or believe there is something wrong with them
Four sub types of somatic symptom disorder
somatic symptom
illness anxiety
conversion disorder
factitious disorder
somatic symptom disorder
central compain is one or more somatic symptoms such as chronic pain or headaches or fatigue
diagnosis of somatic symptom disorder
requires evidence of diminished functionin stemming from excessive preoccupation with and or anxiety about the ymotoms
consideration of diagnosis
warranted by whether the symptoms in any way coincide with related medical problem or llness and distress and or disruption of daily life caused by symptoms
one reason hypochondriasis can be considered imprecise
refers to concern about both illness and somatic symptoms
illness anxiety disorder vs somatic
differs from somatic in that the somatic aspect of illness is not as central or nonexistent i
ill anx
distress is predominantly physiological with people experiencing persistent preoccupation engossed with both their health condition and health related behaviors , including seeking treatment
conversion disorder
experinces change in sensory or motor function which has no discernible physical or physiological cause that seems to be significantly affected by psycho factors
conv: changes in sensory or motor function include
weakness, tremors, seizures or difficulty talking or eating
symptoms of conv
begin or worsen after an emotional conflict or other stressor
conv: emotion and anxiety individual experiences
is converted in to a symptom
conv : severity
change in function is severe enough to warrant medical ateention or cause sig distress or impairment in work, social or personal functioning
diagnosis of conv
possible for example, when a person suddenly experiences blindness but his or her blink reflex remains intact
conv is form of
form of somatization—the expression of mental phenomena as physical (somatic) symptoms
conv disorder onset age and predisposition
tends to develop during late childhood to early adulthood but may occur at any age. It is more common among women.
factitious disorder names when imposed on self vs other
aka Munchhausen syndrome ( when imposed on oneself)
Munchausen by proxy ( when imposed on someone else)
factitious disorder imposed on self
person fabricated an illness but has gone further step of either falsifying evidence or symptoms of ilness or inflicting harm to him or her self to induce injury or illness
factitious disorder diagnosis
requires that person behaves in such a way without benefit
not only if the person presents illness to others and attracts interpersonal and or medical attention
factitious disorder
person acts as if he or she has a physical or mental illness when, in fact, he or she has consciously created the symptoms
bipola disorder
formerly mania depression
experience cyclic mood episodes at one or both of the extremes or poles ; depression and mania
diagnostic criteria for bipolar and related disorders and depressive disorders
duration mood self image appetite or weight sleep need cognition speech energy or behavior judgment impairment functioning
manic episode: duration
at least one week, nearly every day
manic episode: mood
elevated ,expansive or irritable mood
manic episode: self image
inflated, grandoise
manic episode: appetite
may show diminished appetite or interest in food
manic episode: sleep need
decreased
manic episode: cognition
flight of ideas or racing thoughts; distractibility
manic episode: speech
rapid, pressured
manic episode: energy or behavior
increased E and goal directed activity and or psycomotor agitation
manic episode: judgment
lack of consequential thinking
manic episode: impairment to functioning
sever, marked impairment: may require hospitalization to prevent harm to self and others may include psychotic features
hypomanic episode: duration
at least 4 consecutive days
hypomanic episode: mood
elevated , expansive and irritable mood
hypomanic episode: self image
inflated, grandoise
hypomanic episode: appetitie
may show diminished appetite or interst in food
hypomanic episode: sleep need
decreased
hypomanic episode: cognition
flight of ideas or racing thoughts; distractibility
hypomanic episode: speech
rapid pressured
hypomanic episode:energy or behavior
increased E and goal directed activity and or psychomotor agitation
hypomanic episode: judgment
lack of consequential thinking
hypomanic episode: impairment to functioning
unequivocal observable change that is not typical of the individual ; not severe enough to cause marked impairment or necessitate hospitalization
major depressive episode: duration
at least 2 weeks
major depressive episode: mood
depressed; diminished interest or pleasure of almost all activities
major depressive episode: self image
feelings of worthlessness and excessive guilt
major depressive episode: weight
increase or decrease in body weight by 5% or more in a month
major depressive episode: sleep need
insomnia or hypersomnia
major depressive episode: cognition
diminished ability to think or concentrate; recurrent thoughts of death or suicide
major depressive episode: speech
may manifest muted or flat affect in speech
major depressive episode: energy or behavior
fatigue or loss of E; psychomotor agitation or retardation
major depressive episode: judgment
may include suicide attempt or specific plan for committing suicide
major depressive episode: impairment to functioning
clinically marked distress or marked impairment in one or more areas of functioning
dysthymic syndrome : duration
at least 2 years
dysthymic syndrome: mood
depressed; general feeling of sadness; feelings of hopelessness
dysthymic syndrome: self image
low self esteem
dysthymic syndrome: appetitie
poor appetite or overeating
dysthymic syndrome: sleep need
insomnia or hypersomnia
dysthymic syndrome: cognition
poor concentration
dysthymic syndrome: speech
self deprecation and expressed sense of futility is common
dysthymic syndrome: energy or behavioe
low energy or fatgue
dysthymic syndrome: judgment
difficulty making decisons
dysthymic syndrome: impairment to functioning
clinically significant distress or marked impairments in one or more areas of functioning
unequivocal
unambiguous leaving o doubt
psychomotor agitation
People with psychomotor agitation can’t stay still or remain calm. They use movement to release tension and anxiety. If you have psychomotor agitation, you may regularly fidget, move fast, or move with no reason or purpose.
common signs of psychomotor agitation
emotional distress restlessness tapping starting and ending tasks abruptly fidgeting pacing hand-wringing fast talking racing thoughts crowded thoughts moving objects for no reason
Psychomotor skills
skills where movement and thinking are combined. This includes things like balance and coordination
psychomotor retardation
move, speak, react, and usually think more slowly than normal
speech is noticeably slow and may be punctuated by long pauses or losing the train of thought.
Delayed responsiveness and difficulty following another person’s conversation are also common
manic episode duration and symptoms
for at least one week, person experienced abnormal euphoric unrestrained or irritable mood and a marked increase in either goal directed activity ( with increased energy and productivity at work or in psychomotor agitation stemming from the felt need or urge to be engaged ina goal directed activity but not having the focus or other means to engage in bany acivity
manic: surplus energy
causes agitation and irritability a
result surplus E manic
someone may feel compelled to spend hour shopping online or looking for an activity to absorb the energy
symptoms of manic
may be sever enough to cause psychotic features, hospitalization or impairment of work , social and personal functio
possible cause of manic
by antidepressants, light or electroconvulsive therapy for depression
manic episode
mood state characterized by period of at least one week where an elevated, expansive, or unusually irritable mood exists
person experiencing manic episode
usually engaged in significant goal-directed activity beyond their normal activities. People describe a manic mood as feeling very euphoric, “on top of the world,” and being able to do or accomplish anything. The feeling is like extreme optimism — but on steroids
one disorder which is very related to depression
bipolar disorder
which describes a condition where individual experiences extreme highs to extreme lows
mania
overexcited unrealistically optimistic state
peope hav a ton of E in this state, theya re euphoric and optimistic
high self esteem
bipolar 1 disorder diagnosis
only if there has been a spontaneous manic episode not triggered by treatment by depression or caused by another medical condition or medication
mild forms of mania
hypomania
donèt need to sleep a lot and can get a lot of work done
feel good and deny anything that might be wrong
full mania
begin to make poor decision without any regard for consequences
may engage in reckless behavior like driving too fast
full of grandeur and unrealistic ideas
mania is like
everything going fast forward
they do not sleep
after this they crash
racing thoughts
mania if followed by
intense depressive episodes
bipolar 1 disorder
when hypo mania episodes develops into full mania we have this disorder
when hypomania cycles around without developing into full we have
bipolar 2 disorder
medical conditions often result
in physical symptoms
same thing with psycological conditions and psyco symptoms
possible for psyco disorders to manifest into
physical symptoms
bipolar vs somatic symptom
Bipolar disorder is a type of mood disorder characterized by cycling episodic clinical depression and mania.
Somatic symptom disorder is type of personality disorder characterized by having physical symptom(s) usually without explainable organic causes and is associated with a great degree of anxiety about the physical symptom(s).
illness anxiety vs somatic symptom disorder
People with anxiety illness disorder (IAD) are overly focused on, and always thinking about, their physical health. They have an unrealistic fear of having or developing a serious disease. This disorder occurs equally in men and women.
somatic symptom disorder, the person has physical pain or other symptoms, but the medical cause is not found.
causes illness anxiety disorder
As they focus on and worry about physical sensations, a cycle of symptoms and worry begins, which can be hard to stop. This cycle is unstoppable
People who have a history of physical or sexual abuse are more likely to have IAD.
Somatic symptom disorder
condition where a person experiences physical symptoms and negative thoughts and feelings about these symptoms to the point that they interfere with their daily life. In other words, the symptoms themselves and/or the person’s reaction to them can disrupt their daily life. They may even get depressed!
physical symptoms people with SSD experience
are real, and may include pain and fatigue. They can come and go and they may be mild or severe in nature. These symptoms often have no significant medical cause and may even be normal bodily sensations, like a transient muscle ache from simple over-exertion.
illness anxiety disorder
where a person is overly preoccupied with having or getting a disease. People with this disorder may have no physical symptoms whatsoever
may interpret normal bodily processes such as digestive sounds, sweating, bloating , or awareness of heir own heartbeats as signs of serious illnesss
worry excessively about their health
constantly check body for signs of illness
Somatic symptom disorder and related disorders are characterized by
ersistent physical symptoms that are associated with excessive or maladaptive thoughts, feelings, and behaviors in response to these symptoms and associated health concerns. These disorders are distressing and often impair social, occupational, academic, or other aspects of functioning
Factitious disorder involves
falsification of physical or psychologic symptoms and/or signs in the absence of obvious external incentives (eg, obtaining time off from work, disability payments, or drugs of abuse; avoiding military service or criminal prosecution
Malingering
intentional feigning of physical or psychologic symptoms motivated by an external incentive, which distinguishes malingering from factitious disorders
somatization
the expression of mental phenomena as physical (somatic) symptoms.
Conversion disorder is a form of
somatization
dev of conversion disorder
during late childhood to early adulthood but may occur at any age. It is more common among women
symptoms of conv
often develop abruptly, and onset can often be linked to a stressful event
apparent deficits in voluntary motor or sensory function but sometimes include shaking movements and impaired consciousness (suggesting seizures) and abnormal limb posturing (suggesting another neurologic or general physical disorder)
mixed episode
person has met symptoms for major depressive and manic episodes nearly everyday for at least a week
severity of mixed symptoms
symptoms are severe enough to cause psychotic features, hospitalization or impaired work, social or personal functioning
requirement for diagnosis of bipolar 1 disorder
person experienced at least one manic or mixed episode
bipolar 2 disorder phases
manic phases are less extreme
symptoms of bipolar 2
person will experience cyclic moods including at least one majjor depressive and one hypomanic episode, but has not met criteria for manic or mixture epi
hypomania
for at least 4 days, a person has experienced an abnormally euphoric or irritable mood with at least three of the symptoms for a manic episode , but a less severe level
hypo impairment
impair or distress is less serious there is no psychosis or hospitalization
psychosis
aka psychotic features
severe mental disorder in which thought and emotions are so impaired that contact is lost with external reality
major depressive epi
person has felt worse than usual for most of the day . nearly everyday for at least 2 weeks
major depressive symptoms
at least 5 of the emotional, behav, cognitive and physical symptoms: de^pressed mood or decreased interet in activities, significatnt increase or decrease in weight or appetitie, excessive or insufficient sleep, agitated or slowed psycomotor activity , fatigue or loss of E, feelngs of low self worth or excessive guilt, impaired concentration or decision making and thoughts of death or suicide
diagnosis of bipolar 2
requires depressive and hypomanic episode
bipolar 1 vs 2 main diff
main difference between bipolar 1 and bipolar 2 disorders lies in the severity of the manic episodes caused by each type
all types of bipolar disorders
characterized by episodes of extreme highs and extreme lows. The highs are known as manic episodes. The lows are known as depressive episodes
bipo 1 vs 2 depressive episode
similar between bipolar 1 and bipolar 2 disorder
bipo 1 vs 2 mania
bipolar 1 disorder, the mania is more severe than it is with bipolar disorder 2. Bipolar 2 causes something called hypomania, which is essentially a less severe form of mania. Hypomanic behaviors might be considered atypical for a person, but maybe not abnormal. Manic behaviors, on the other hand, are more extreme and would typically be considered abnormal
manic episode symptoms
exceptional energy restlessness trouble concentrating feelings of euphoria (extreme happiness) risky behaviors poor sleep
Depressive symptoms in bipolar disorder
extended periods of sadness and hopelessness. You may also experience a loss of interest in people you once enjoyed spending time with and activities you used to like tiredness irritability trouble concentrating changes in sleeping habits changes in eating habits thoughts of suicide
cyclothymic disorder compared to bipolar disorder
similar to bipolar disorder but moods are less extreme with symptoms not meeting criteria for manic or major depressive episode
cyclo
experienced cyclic moods including multiple hypomanic episodes as well as episodes of depressed moods that are milder than the major depressive episode
cyclo duration
for at least 2 years
mood swings never absent for more than 2 months
persistent depressive disorder
mlder and more persistent form of major depressive disorder
bipolar 1, 2 cyclo generally involve
cyclig thru ether manic or hypomanic episodes and dsythymic or depressed episodes
dsythymia
persistent mild depression.
depression
state of low mood and aversion to activity that can affect a person’s thoughts, behavior, feelings, and sense of well-being
depressive disorder
more than acute moodiness , persistent pattern of abnormal and often painful mood symptoms severe enouh to caught personal distress and or impairment to social occupational , or personal functioning
affect
person’s observable emotion in the moment
mood
person’s sustained internal emotion that colors his or her view of life
three depressive disorders
major depressive
persistent depressive
premenstrual dysphoric
major depressive
suffered one or ore major depressive episodes
suicidal rates and maj
10% with this disorder attempt suicide and many more contemplate it or devise a suicide plan
symptoms do not indicate maj
if they occur wihin two monhs of bereavement -be deprived of a loved one through a profound absence, especially due to the loved one’s death- as they may be part of a normal grieving reaction
seasonal affective disorder
refered by DSM 5 as MDD with seasonal patterns, episodes of depression occur during certain seasons usually fall and winter
persistent deressive disorder PDD
aka dysthymic disorder or dysthymia
less intense but more chronic form of depression
person with PDD
has experienced milder symptoms of depression most days for at least 2 years, with symptoms never absent for more than two months but wih out a major depressive episode
onset of PDD
typically adolescence or early adulhood
persistence of condition often leaves people feeling like they have always felt thsi way or as if they are depressed person to their core
premenstrual dysphoric disorder diagnosis occurs only
in women
pre symptoms
are often symptoms of major depressive episode, with caveat( notice) that they intensify in the final week before the onset of menses and then improve i and in many cases dissapear in the week after menustration has ended
major depressive episode symptoms
Depressed mood/flattened affect
Loss of interest
Markedly decreased or increase in weight caused by decrease/increase in appetite
Chronic sleep impairment marked by hypersomnia or insomnia
Lethargic in mannerism and behavior and motor activity is agitated or slow
Extreme fatigue and always tired
Lack of self-worth
Marked decrease in concentration, decision-making abilities, and cognition
Thought of self-harm or suicidal ideation (although acting on it is not required)
diagnosis of major depressive episode
must have had at least 5 of the symptoms that lasts at least 2 weeks
symptoms in maj disorder vs episode
symptoms are essentially the same
Most Major Depressive Episodes
end within six months. Some of them are much shorter.
several other conditions that are often linked with Major Depressive Disorder.
diagnosed often also have Bipolar Disorder or Anxiety Disorder
Major Depressive Episode vs Major Depressive Disorder
diagnosis for chronic depression
symptoms which distinguish premens from other two depressive disorders
feeling keyed up or on edge, specific food cravings, a sense of being overwhelmed or out of control as well as physical symptoms of bodyès preperation for menustration : tenderness or swelling in breasts, joint or muscle pain and bloating
schizo spec and other diagnosed
when some1 is experencing one or more of the following symptoms : delusions, hallucinations, disorganized thinking ( as manifested in disorganized speech) disorganized or abnormal motor behavior and one or more negative symptoms
negative symptoms ex
include decreased emotional expression ( presentation of flat affect) , avolition ( lack of motvation or purpose, alogia ( decreased or absent speech)
- symptoms
generally those in which there is a decrease or lack of a typcal behavior or ther characteristics
general profile of schiz + rel disorders
splitting off or distnacing of person from aspects of his or her everyday reality
incorrect association between schizo
and multiple personality disorder which is actually called dissociateive identity disorder
schizo literally means
split mind refers to split in mental functions or split from reality; does ot indicate a split in identity
four disorders in schizo+ rel section
delusional
brief psychotic
schizophreniform
schizophrenia
delusion
false belief that is not due to culture and is not relinquished despite evidence that it is false
belief that is held with strong conviction despite superior evidence to the contrary
ex of delusion
a person may believe he or she is a certain movie star
delusion vs strongly held belief
differs in intensity and plausibility
delusional disordder
one or more delusions have been present for at least a month and counterevidence is gnerally denied or distorted to keep the delusion intact
common delusions
erotomania ( belief someone is in love with you)
grandiosity ( belief you have special talent or insight)
persecution ( belief you are being followed drugged, harrased and so on )
brief psychotic disorder diagnosis
when any positive symptoms are present for at least one day but symptoms last less than one monthsand there are no negative symptoms
positive symptoms ex
delusions, hallucinations , disorganized speech or disorganized behavior
+ symptoms
so called because they are thinking or behaviour that the person with schizophrenia did not have before they became ill and so can be thought of as being added to their psyche. Positive symptoms include hallucinations such as hearing voices and delusions such as paranoid thoughts
Negative symptoms
so called because they describe thoughts or behaviour that the person used to have before they became ill but now no longer have or have to a lesser extent and so have been lost or taken away from their psyche. It describes normal aspects of the person’s behaviour that they no longer have. Negative symptoms can include lethargy and apathy
definitive of brief psychotic disorder
full remission ( period in which symptoms become less severe) within one month of onset
duration of brief psychotic disorder
in the spectrum, represents the schizophrenia of shortest duration
hallucination
false sensory perception that occurs while the persion is concious ( not during sleep or delirium )
delirium
acutely disturbed state of mind that occurs in fever, intoxication, and other disorders and is characterized by restlessness, illusions, and incoherence of thought and speech
hallucinations vs illusions
hallu: occur in absence of related sensory stimuli
ilu: misconceptions of actual sensory stimuli ( which may occur in low light
most common hallu
are auditory or visual
schizopheniform disorder
occupies middle position in schizo spectrum
person experiences at least 1 + symptom but can also experience one or more negative symptoms for at least 1 month and no longer than siz months
remission and pheniform
remission can often occur faster with effective drug treatment
schizo on spectrum of schizo
at the end of the spectrum
chronic version disorder
schizo diagnosed
when someone has been experiencingpositive and sometime negative symptoms longer than months
schizo impact on functioning
is greatest
impairment in work, relationships or self care
schizo symptoms
may subside at times to a prodomal level ( just below the diagnostic threshiold, no complete remission occurs with medication
schizoaffective disorder
combines mood and psychotic symptoms: in this order, both symptoms of schizo and major depressive manic or mixed episode are experienced for at least one month
schizoaff vs major depressive disorder with psychotic features
person experiences delusions and or hallucinations at times in the absence of mood symptoms as well as at different times during a major mood episode
bipolar vs schizoaff
Bipolar disorder is strictly a mood disorder, while schizoaffective disorder is a mood disorder combined with separate psychotic symptoms that are not attached to mania or depression
schizoaff disorder diagnosis is made when
the person has features of both schizophrenia and a mood disorder—either bipolar disorder or depression—but does not strictly meet diagnostic criteria for either alone
schizoaff ressemblles
a chronic psychotic disorder with an overlapiing bipolar or depressive disorder in which mood symptoms fully remit for at least 2 weeks at a time
symptoms mimicking schizo spec and other psychotic disorder can be caused
by general medical condition or by alcohol, drug or medication use or withdrawal
if patient has medical condition or uses substances that could cause symptoms diagnosis
psychotic disorder due to general medical condition or substance induced psychotic disorder
symptoms for psychosis can also occur
with mood or developmental disorders all disorders are ruled out before making diagnosis
during dissociative experience
some of personès thoughts feelings perceptions memories or behaviors are seperated from concous awareness or control in a way that is not explainable as mere forgetfulness
seperation can act as defense against a traumatic situation that was way to overwhelming
dissociative disorder
disruptions in awareness , memory and identity are extrem or frequent and they cause distress or impair the personès functioning
diss can be triggered
by sever stress or psychological conflicts and they usually begin and end suddenly
dissociative identity disorder
alternates between 2 distinct personality states or identities only one of which interacts with other people at a given time
diss id can be experienced
as a possession by another personality or identity as it involves amnesia - loss of awareness or memory- for one or more of the personality states
distinct identities may
vary widely in age, gender and personality traits and they may or may not be aware of each other
dis id disorder previoulsy known as
multiple personality disorder NOT schizophrenia
dissociative amnesia
has had at least one episode of forgetting some imp personal info, creating gaps in memory that are usualyy related to severe stress or trauma
patient with diss amnesia
may wander aimlessly during episode or experience it as a kind of journey in what is called dissociative fugue
dissociative fugue
one or more episodes of amnesia in which an individual cannot recall some or all of his or her past
Dissociative Identity Disorder
describes cases where two or more distinct personalities or distinct identities seem to exist within a single body. And both of these identities have some kind of influence on that person’s thoughts or behaviors.
both identities
have their own mannerisms. They can have different emotional responses
Research indicates that individuals who’ve been diagnosed with Dissociative Identity Disorder
have a history of child abuse, or some other kind of extreme life stressor. And there are a lot of different theories as to how this could happen, but they all seem to center on a central idea, which is that under cases of extreme stress, a person’s conscious awareness disassociates, or separates from, certain painful memories, or thoughts, or feelings
How common is Dissociative Identity Disorder?
Dissociative Identity Disorder is extremely rare
Others wonder if this is a disorder than can be induced
by therapists
maybe a therapist who knows about this disorder, and suspects that someone might have it, might say things like, “Do you ever feel like there is another part of you? “Maybe a part of you that you aren’t always aware of?” And then from there, that can be taken even further. They might ask something like, “Does this part have a name? “Can I speak to this part?” And in response to this, the individuals who are seeking therapy might intentionally or unintentionally play along with what the therapist is saying.
most of the time amnesia
is lcalized , meaning taht everything happened during the particular time period is forgotten but it can also be selective, generalized, continuous or systematized
selective amnesia
only some events during a particular time period is forgotten
generalized amnesia
personès whole lifetime is forgotten
continuous amnesia
everything since a certain time is forgotten
systematized amnesia
only particular categories of info are forgotten such as everything relating to the personès family
dissociative amnesia onset and end
begins and ends suddenly with full recovery of memory but also may linger with some info only gradually if ever fully coming back into conciousness
remission for disso amnesia
means recovery of disturbing memories, amnesia may give way to suicidal idealation or behavor or PTSD or another condition
depersonalization disorder
recurring or persistent feeling of being cut off detatched from his or her body or mental processes as if observing themselves from the outside in something like an out of body experience
derealization disorder
person feels that people or objects in external world are unreal
depersonalization disorder and derealization disorder
person know feeling is not accurate his or her reality testing remains intact and the depersonalization and or derealization plus awareness of incongruity causes distress or impairs functioning
depersonalization disorder and derealization disorder onset
occurs in lae adolescence and almost all cases have first onset before person is 25 years old
remission and onset cna be sudden or graudla with stress or novel situations often playing a role
personality traits
stable patterns of thoughts feeling and behavior that influence how a perso experiences, thinks about and interacts with the people and events in his or her life
a personaliity disorder
is an enduring rigd set of personality traits that deviates from cultural norms, impairs functioning and causes distress either to the person with the disorder or those in his or her life
personality disorder symptoms
a list of prominent traits that characterize each disordered personality
egosyntonic
generaly in harmony with a persons ego or self image
personality disorder and seeking treatment
because many personality disorders are egosyntonic it is usually the consequences of the disorder not symptom structure that causes a person to seek treatment
importance of degree of distress
or imparment is important
personality traits are not simply binary but represent a continuum
traits which a re found in disorders can also be present to a lesser degree in normal people
personality disorders develop when
when the trats cause significant distress or impairment , affects nearly all personal and social situations and creates dysfunction in two or more of the following areas: affect, cognition, impulse control, interpersonal functioning
Cluster A
includes paranoid, schizod and schizotypal personality disorders associated with irrational, withdrawn cold or suspicious behaviors
Cluster B
includes antisocial, borderline, histronic,narcissitic personlaity disorders associated with emotional dramatic and attention seeking behaviors and intense interpersonal conflict
CLuster C
icnludes avoidant, dependent and obsessive compulsive personality disorders associated with tennse anxious over controlled behvaiors
paranoid personality disorder
mistrusts and misinterprets others motives and actions without sufficient cause suspecting them of deceiving, hariming betraying or attacking him or her
paranoid personality patient
tends to be guarded , tense and self sufficeint generally in counterproductive or maladaptive ways
schizoid personality disorder
loner with little interst or involvement in close relationships even those with famly members
schizoid personality patient
unaffected emotionally by interactions with other people appearing instead detached or cold
schizotypal personality disorder
several traits which cause problem interpersonally including limited or inappropriate affect ( effects); magical or paranoid thinking and odd beliefs, speech, behavior, appearance and perceptions
schizotypal personality patient
tends to have no confidantsother than close relatives
many cases eventuallly develop schizophrenia
antisocial personality disorder
has history of serious behavior problems beginning as a young teen including significant aggression against people or animals; deliberate propety destruction;lying or theft and serious rule violation
antisocial personality patient
since age of 15 person has a history of repeatedly dsregarding rights of others in various ways through illegal activities, dishonesty , impulsiveness, physical fights, disegard foor safety , financial irresponsiblity and lack of remorse
antisocial personality disorder DSM and occurence
in DSM listed under disruptive impulse cotrol and conduct disorders
encountered more frequently in men especially incarcerated ( imprisoned) men
borderline personality disorder
person suffers from endurin or recurrent instability is his or her impulse control, mood swings reactivity and anger, which can lead to unstable relationships and damage to both patient and others in his or her life
borderline personality patient emotions
feeling empty with an unstable sense of self, person is terrified of abandon,ment of others whome the person may first idealize and then devalue and demonize
self harming and suicidal behaviors may also occur
link bw borderline and bipolar
evidence shows that this order is more severe and generalized form of bipolar disorder and or linked to childhood sexual abuse
more frequently encountered in women
histrionic personality disorder
stronly desires to be center of attention and often seeks to attract attention thru personal appearance and seductive behavior
expressions of emotion may be dramatic yet the emotions are often shallow and shifting and the person may believe his or her relationships are ore intimate than they are
may be suggestibe and vague in his or her speech
narcissitic personality disorder
feels grandiosely self important with fantasies of wealth beauty brilliance and power
feels desperate need for admiration in a variety of context and feels envy both towards and from others
lack empathy for others may exploit others and feel entitled , arrogant and haughty
avoidant personality disorder
patient feels inadequate, inferior and undesirable and is preoccupied with fears of criticism and conflict
person feels ashamed and avoids interpersonal contact and new activities unless he or she is certain of being liked
person is also restrained and inhibited in relationships
dependent personality disorder
person feels need to be taken care of by others and an unrealistic fear of being unable to take care of him or herself
trouble assuming responsibility and making decisions preferring to gain approval by making others responsible and seeking others advice and reassurance regarding decisions
dangers of dep personality
others often take advantage of the person because he or she is willing to do or tolerate almost anything even abuse in order to gain support and nurturing and avoid abandonment
urgently seeks another relationship if one is loss
obsessive compulsive personality disorder
OCPD
may not have true obsessions or copulsions but may instead accumulate money or worthless objects
obsessive compulsive personality patient
perfectionist, rigid, studboorn, need to controll interpersonally and mentally
resists the authority of others and will not cooperate or delegate to others unless things are done
often workaholic and moralistic beyond the level of surrounding culture or religion
may be depressed and have trouble expressing affection
preoccupation with orderliness and list making caninterfere wth effectiveness ad efficiency
schizo thought
thought disorder
physiological characteristics have physical or neurological basis
mind body dualism framework
view in the philosophy of mind that mental phenomena are, in some respects, non-physical,[1] or that the mind and body are distinct and separable
outdated division between the mind and the body
schizophrenia is a
neurological disorder with a strong genetic basis
twin studies schizo
show that if 1 twin has diseas second twin has 50% chanc of having it if second twin does not have schizo he or she are likely to have lesser form of it
onset of schizo
can happen around adolescence
stress diathesis theory
suggests that while genetic inheritance provides biological predisposition for schizo stressor elicit onset of disease
dopamine hypothesis for schizo
formed from observations
suggests that one pathway for neuro dopa is hyperactive inpeopel with schizo
hyperactive dopa due to
due to overabundance in dopa and to hypersensitive dopa receptors
evidence regarding temporal lobes in people with this condition may explain the presence of positive signs of schizophrenia like auditory hallucinations
antipsychotic medications
dopamine antagonist medications can be found to be helpful for dealing antipsychoticss
hypoactivation of frontal lobes
may be responsible for negative signs of schizophrenia
creating a kind of pseudodepression, flat affect and impaired speech
individuals with schizophrenia brains
have been found to be smaller due to atrophy : schizo individuals display increased ventricles cavities in the brain and enlarged sulci and fissures less folding
depression genetic basis
strong increased risk of developing depression when a first degree family member has it
inked to diminishing functioning in pathways in brainthat involve dopa , serotonin and norepi
antideressants
target and stimulate pathways that are diminished in functioning due to deression
depression and other diseases
can often accompany other neuro diseases such as , such as parkinsonès and traumatic bran injury due to damage to simiilar or overlapping areas in the brain
dementia
general term for neurocognitive disorder in DSM 5
term for severe loss of cognitive ability beyond what would be expected from normal agiang
Alzheimers disease
is the most prevalent form of dementia, affecting a large number of people who reach their 80s and especally their 90s over 50% of thsi latter group
characterized by anterograde amnesia
and retrograde amnesia
anterograde amnesia
inability to form new memories
step wise retrograde amnesia
more recent memories degrading first since the last memories to fae are typically oldest
Alzheimer patients recall
events from decades earlier but forget people ad events that were encountered recently, their visual memory can be impaired as well , such that they may get lost and confused with regard to orientation
living with alz
can be frustrating, confusing and emotionally painful both for the patient and for family members and friends
cortical disease
meaning it affects cortex , outermost tissue of the brain and is caused by formation of neuritic plaques and neurofibrillary tangles
Alz s
cortical disease
neuritic plaques
hard formation of beta amyloid protein
neurofibrillary tangles
clumps of tau protein
why plaques and tagles form
unclear though there is some evidence of partial genetic susceptiility
theory regarding plaque build up
plaque build up reach a critical mass and bein to cause cell death by gunking up neuronal connections , preventig nutrents and waste from travelling to and from some neurons
current treatments Alz
directed at slowing the progress of the illness rather than reversing it
acetylcholine evidence
abnormalities in activity of neuro Ach in hipocampus
hipo plays a major role in formation of new memories
Alz progression
patient loses increasingly older memories as well as language function and spatial coordination, evetually patients are notable to perform daily functions without assistance
Parkinsons disease
movement disorder caused by death of cells thatgenerate dopa in basal ganglia and substantia niagra
syptoms of Parkinson s
resting tremor ( shaking) slowed movement, rigidity of movements and facial expressions and shuffling gait as dsease progresses language is typically spared but depression and visual spatial problems may arise
dementia and Parkinsons
estimated 80% of Parkinsons patients eventually exp dementia as disease progressses
Treatment of parkinsons
L dopa treatment
L dpa
precursor to dopa and used because it can pass thru blood brain barrier entering brainès blood supply ( dopa is not able to pass the barrier
characterstic of most CNS disorders and neurodegenerative diseases
cell death
neural stem cells
have capacity to differentiate into any of the cell types in the nervous system , hold the key to curing damage to CNS caused by trauma or illness
neural stem cells can migrate
and replace dying neurons in the CNS
