Ch 7 - Disorders

Question 1

Two approaches to disorders

Answer 1

• biomedical - intervention for symptom reduction
  
  • does not account for environmental sources of disorder
• biopsychosocial - bio, psych, and social components to the disorder
  
  • broader spectrum approach than biomedical
  • direct therapy - treatment acts directly on an individual
    
    • medication, meet with psychologist
  • indirect therepy - increase social support

Question 2

DSM

Answer 2

• diasnostic and statistical manual of mental disorders
• diagnostic tool
• based on description of symptoms
• not based on theories or treatments
• US has greatest prevalence of
  
  • phobias
  • social and general anxiety
  • major depression
  • alcohol use
  • PTSD

Question 3

Schizophrenia

Answer 3

• psychotic disorder - delusions, hallucinations, disorganized thought, disorganized behavior, catatonia, negative symptoms
  
  • must have one or more continuous symptom for 6 months and 1 month of active delusions, hallucinations, or disorganized speech)
• positive symptoms - behaviors, thoughts, and feelings added to normal behavior
  
  • delusions and hallucinations, disorganized thought and catatonic behavior
• negative symptoms - absence of normal or desired behavior
  
  • disturbance of affect or avolition

Question 4

Positive Symptoms of Schizophrenia

Answer 4

• delusions - false beliefs, not shared by others
  
  • delusion of reference - elements in environment are directed toward them (TV is talking to them)
  • of persecution - beleif that they are being discriminated againts, threatened
  • of grandeur - belief that they are remarkable (inventor, historical figure, icon)
  • thought of broadcasting - belief that thoughts are broadcasted to external world
  • thought insertion - belief that thoughts are placed on one’s head
• hallucinations - perceptions that have a compelling sense of reality but are false
  
  • hearing voices most common
• disorganized thought - loosening of associations, word salad
  
  • neologisms - invent new words
• disorganized behavior - inability to care out activities of daily living
  
  • catatonia - motor behavior impared. rigid posture, random movements
  • echolalia - repeating someone elses words
  • echopraxia - imitating anothers actions

Question 5

Negative symptoms of Schizophrenia

Answer 5

• disturbance of affect -
  
  • affect - experience and display of emotion
  • blunting - reduced intensity of affect
  • flat affect - no signs of emotional expression
  • inappropriate affect - affect does not match the speech
• avolition - decreased engagement in purposeful, goal-directed actions

Question 6

Prodromal phase

Answer 6

• before diagnosis of schizophrenia
• social withdrawal, role functioning impairment, peculiar behavior, inappropriate affect, unusual experiences
• then active symptoms
• slow onset is poor prognosis
• quick onset is better prognosis

Question 7

Major depressive disorder

Answer 7

• mood disorder
• at least one major depressive episode - at least 2 weeks with at least 5 symptoms, one symptom must be depressed mood or anhedonia
• Sad + SIG E CAPS
  
  • persistant depressed mood
  • anhedonia - loss of interest in formerly enjoyable activities
  • appetite disturbances
  • weight change
  • sleep disturbance
  • decreased energy
  • feeling worthless or guilty
  • difficulty concentrating
  • psychomotor symptoms (feeling slowed down)
  • thoughts of death or suicide
• High suicide rate (15%)

Question 8

persistant depressive disorder

Answer 8

• dysthymia - does not meet major depression criteria, but has depressed mood for at least 2 years
• may have occational major depressive episodes

Question 9

Seasonal affective disorder

Answer 9

• seasonal onset of major depressive disorder
• only present during winter
• bright light therapy

Question 10

bipolar disorder

Answer 10

• depression and mania
  
  • manic episodes - abnormal and persistently elevated mood lasting at least one week
  • DIG FAST
    
    • increased distractibility, less sleep, inflated self esteem/grandiosity, racing thoughts, increased agitation and activity, increase talk, high risk behavior
    • grandiosity (all powerful, famous, or wealthy)
    • rapid on set, shorter lasting then depressive episodes
• Bipolar I - manic episodes without depressive episodes
• Bipolar II - hypomania and at least one major depressive episode
  
  • hypomania - not function impairing, but more energetic nad optimistic
• cyclothymic - combo of hypomanic and dysthymia (non major depressive episodes)

Question 11

Catecholamine theory of depression

Answer 11

• too much norepi and serotonin causes mania
  
  • too little causes depression
• aka monoamine theory of depression

Question 12

generalized anxiety disorder

Answer 12

• disproportionate and persistant worry about many different things for at least 6 months
  
  • may lead to physical symptoms

Question 13

Specific phobias

Answer 13

• type of anxiety disorder
• desire to avoid something
• produced by specific object or situation

Question 14

Social anxiety disorder

Answer 14

• anxiety due to social situations
• fear when in social or performing situations

Question 15

Agoraphobia

Answer 15

• anxiety characterized by fear of being in a places or situations where it might be hard to escape

Question 16

panic disorder

Answer 16

• repeated panic attacks
  
  • fear anf apprehension
  • trembling
  • sweating
  • hypervent
  • sense of unreality
• common with agoraphobia

Question 17

OCD

Answer 17

• Obsessive - Compulsive Disorder
• obsessions - persistent, intrusive thoughts and impulses that produce tensions
• compulsions - repetitive tasks
• obsessions raise the stress level and compulsions are used to neutralize the stressor

Question 18

Body dysmorphic disorder

Answer 18

• unrealistic negative evaluation of personal appearence and attractiveness

Question 19

PTSD

Answer 19

• intrusion symptoms - recurrent reliving the event, flashbacks, nightmares
• avoidance symptoms - deliberate attempts to avoid triggers associated with the trauma
• negative cognitive symptoms - inability to recall key features of the event, negative mood, distant from others, negative view on world
• arousal symptoms - increased startle response, irritability, anxiety, self destruction, sleep disturbances
• need symptoms for at least 1 month
• Acute stress disorder - same symptoms for more than 3 days but less than a month

Question 20

Dissociative Disorders

Answer 20

• avoid stress by escaping identity
• dissociative amnesia - inability to recall past events, but no neurological reason
  
  • dissociative fugue - unexpected move or wandering from home, confused about identity, assume new identity sometimes
• dissociative identity disorder (DID) - 2 or more personalities recurrently take control of behaviors
  
  • often due to child sex abuse
• depersonalization/derealization disorder - feel detached from mind and body (depersonalized), or detached from surroundings (derealization)

Question 21

Somatic symptom

Answer 21

• Somatic symptom disorder - physical symptom that causes disproportional concerns about seriousness and increases anxiety
• illness anxiety disorder - consumed in thoughts about developing a major medical condition but no physical symptom
• conversion disorder - unexplained symptoms affecting coluntary motor and sensory functions
  
  • aka hysteria
  • often occurs after witnessing a traumatic event
  • la belle indifference - person not concerned about their unexplained symptoms

Question 22

personality disorder

Answer 22

• behavior pattern that is inflexible and impairs at least two of the following
  
  • cognition, emotions, interpersonal function, impulse control
• eog - syntonic : individual perceives behavior as normal
• ego-dystonic - individual sees illness as something instrusive
• 3 clusters of general personality disorders

Question 23

Cluster A personality disorders

Answer 23

• odd or eccentric behavior
  
  • paranoid - distrust of others, suspicion of motives. May be in prodromal schizophrenia stage
  • Schizotypal - odd or eccentric thinking
    
    • ideas of reference - things talking to them, not as intense at delusions of reference)
    • magical thinking - supserstitions
  • Schizoid - detachment from social relationships and restricted range of emotional expression

Question 24

Cluster B personality disorders

Answer 24

• dramatic, emotional, or erratic behavior
• antisocial - more common in males, disregard for and violations of others rights
  
  • aggressiveness, illegal acts, lack remorse
• borderline - more common in females, interpersonal relationships are intense and unstable
  
  • identity disturbance about sexuality, long term goals, values
  • fear abandonment
  • splitting - view people as all good or all bad
  • suicide and self mutilation are common
• histrionic - attention seeking, may use seductive behavior
• narcissistic - high self importance, need attention, concerned about how others view them
  
  • when not viewed favorably - rage, inferiority, shame, humiliation, emptiness

Question 25

Cluster C

Answer 25

• behavior is anxious or fearful
• avoidant - extreme shyness and fear of rejection
  
  • see themselves as socially inept, and isolated
  • will keep same environment even though they want change
• dependent - continuous need for reassurance
• obsessive-compulsive personality disorder (OCPD)
  
  • perfectionistic and inflexible
  • not the same as OCD
  • OCD is ego-dystonic
  • OCPD is ego-syntonic

Question 26

Bio of schizophrenia

Answer 26

• genetic and increased risk due to hypoxia at birth, weed use as teen
• excess dompamine
• neuroleptics - block dompamine receptors

Question 27

Bio of depression and bipolar

Answer 27

• depression:
  
  • high glucose metabolism in amygdala
  • hippocampus atrophy after prolonged illness
  • high glucocorticoids (cortisol)
  • decrease norepi, serotonin, dopamine
• bipolar :
  
  • increased norepi and serotonin
  • high risk if parent has it
  • high risk for MS patients

Question 28

Bio of alzheimers

Answer 28

• family history
• higher education decreases risk
• beta amyloid gene on chromosome 21
  
  • higher risk for down syndrome patients
• Markers :
  
  • brain atrophy (CT/MRI)
  • flatten sulci on cortex
  • enlarged ventricles
  • deficient blood flow to parietal lobes
  • low ACh and choline acetyltransferase (makes ACh)
  • low metabolism in temp and parietal lobes
  • senile plaques of beta amyloid (misfolded protein in beta sheet)
  • neurofibrillary tangles of protein

Question 29

bio of Parkinsons

Answer 29

• bradykinesia - slow movement
  
  • resting tremor
  • pill rolling tremor
  • maskline facies - mouth partially open and staring eyes
  • cogwheel rigidity - muscle tension that hinders movement of limb
  • shuffling gait and stooped posture
• deceased dopamine production in substantia migra ( layer of cells in brain)
  
  • affect basal ganglia
• L - DOPA : medication that is precursor to dopamine that can increase levels