Chapter 7: Psychological Disorders Flashcards
What are the two main classification systems to define, diagnose and treat psychological disorders?
- Biomedical approach
- Biopsychosocial approach
What does the biomedical model consider? Why is it limited?
- Only the physical, pathological mechanisms that underlie mental illness.
- Limited since it fails to account many other other sources of disorder (lifestyle, socioeconomic status)
What does the biopsychosocial model consider?
The contributions of the biological factors ALONG with psychology (thoughts, emotions, or behaviors) and social situation (environment, social class, discrimination, or stigmatization)
What percentage of the population of the United States is affected by any mental disorder? Which disorders are the most common?
- 26.2%
- Specific phobia, social anxiety disorder, major depressive disorder
How many diagnostic classes are in the DSM-5?
20
For an individual to be diagnosed with schizophrenia, they can suffer from 5 conditions. What are they?
- Delusions
- Hallucinations
- Disorganized Thought & Disorganized Behavior
- Catatonia
- Negative Symptoms
How many symptoms does an individual need to present to be diagnosed with schizophrenia? How long do the symptoms need to last? What type of disorder is it?
- Psychotic disorder
- 2/5 symptoms, one of which being delusions, hallucinations or disorganized speech
- 2 to 6 months
What are positive symptoms? Give examples.
- Behaviors, thoughts, or feelings added to normal behavior
- Delusions, hallucinations, disorganized thought, disorganized or catatonic behavior
What are negative symptoms? Give examples.
- Involve the absence of normal or desired behavior
- Disturbance of affect and avolition (lack of motivation)
Define delusions.
False beliefs discordant with reality and not shared by others in the individual’s culture that are maintained in spite of strong evidence of the contrary
What type of delusion involve the belief that common elements in the environment are directed toward the individual?
Delusions of reference
What type of delusion involve the belief that the person is being deliberately interfered with, discriminated against, plotted against, or threatened?
Delusions of persecution
What type of delusion involve the belief that the person is remarkable in some significant way, such as being an inventor, historical figure, or religious icon? What disorder is it common in?
- Delusions of grandeur
- Bipolar I
What is thought broadcasting?
The belief that one’s thoughts are broadcast directly from one’s head to the external world
What is thought insertion?
The belief that thoughts are being placed in one’s head
Define hallucinations. What is the most common one?
- Perceptions that are not due to external stimuli but have a compelling sense of reality.
- Auditory
Define disorganized thought.
- Characterized by the loosening of associations
- Ideas shift from one subject to another
- No structure, no train of thought
- Sometimes called a word salad (also seen in Wernicke’s aphasia)
What is neologisms?
When a person with schizophrenia invents new words
Define disorganized behavior.
Refers to the inability to carry out activities of daily living (paying bills, maintaining hygiene)
Define catatonia.
Refers to certain motor behaviors characteristic of some people with schizophrenia
Patients who exhibit catatonic behavior can repeat another’s words or imitate another’s actions. What are these called?
Words: echolalia
Actions: echopraxia
What are the negative symptoms of schizophrenia?
- Disturbance of affect (expression of emotion)
- Avolition (loss of motivation)
What are the affective symptoms of schizophrenia?
- Blunting: severe reduction in the intensity of affect expression
- Flat affect: no signs of emotional expression
- Inappropriate affect: affect is clearly discordant with the content of the individual’s speech
Before a patient is diagnosed with schizophrenia, they will often go through a phase characterized by poor adjustment. What is this called? What is exhibited? What is this followed by?
- Prodromal phase
- Evidence of deterioration, social withdrawal, peculiar behavior
- Active phase of symptomatic behavior
What kind of disorder are major depressive disorders? It is characterized by how many major depressive episodes?
- Mood disorder
- At least one major depressive episode
How long does a major depressive episode need to last? How many symptoms need to be exhibited?
- At least two weeks
- 5 symptoms
Name the 8 most common symptoms of a major depressive disorder.
SIG E. CAPS Sadness Interest Guilt Energy Concentration Appetite Psychomotor symptoms Suicidal thoughts
Define anhedonia.
Loss of interest in all or almost all formerly enjoyable activities
A diagnosis of persistent depressive disorder is given to individuals who suffer from what? What is it? How long does it usually last?
- Dysthymia
- Depressed mood that isn’t severe enough to meet the criteria of a major depressive episode, most of the time for at least two years
How is Seasonal Affective Disorder classified in the DSM?
As major depressive disorder with a seasonal onset
What is related to SAD and how is it treated?
- Related to abnormal melatonin metabolism
- Treated with bright light therapy
What type of disorders are bipolar disorders? What are they characterized by? (2)
- Mood disorders
- Both depression and mania
What are manic episodes characterized by? How long do they last?
- Abnormal and persistently elevated mood
- Lasting at least one week
What are the 7 major symptoms of a manic episode.
DIG FAST Distractible Insomnia (decreased sleep) Grandiosity Flight of ideas (racing thoughts) Agitation Speech (pressured) Thoughtlessness (risky behavior)
Differentiate Bipolar I and Bipolar II disorders.
Bipolar I: manic episodes with or without major depressive episodes
Bipolar II: hypomania with at least one major depressive episode
What is hypomania?
In contrast to mania, does not significantly impair functioning, nor are there psychotic features, although the individual may be more energetic and optimistic
What is cyclothymic disorder?
Combination of hypomanic episodes and periods of dysthymia (persistent mild depression) that are not severe enough to qualify as major depressive episodes
What dos the monoamine (or catecholamine) theory of depression state?
- Too much norepinephrine and serotonin in the synapse leads to mania
- Too little norepinephrine and serotonin leads to depression
What is generalized anxiety disorder? How long does it last? What are the physical symptoms that often accompany it?
- Disproportionate and persistent worry about many different things for at least six months
- Physical symptoms: fatigue, muscle tension, sleep problems
What are specific phobias?
An irrational fear of something that results in a compelling desire to avoid it, which produces anxiety
What is social anxiety disorder?
Characterized by anxiety that is due to social situations, which may result in embarrassment
What is agoraphobia?
Anxiety disorder characterized by a fear of being in places or in situations where it might be hard for an individual to escape
What is panic disorder? A large number of the symptoms are caused by excess activation of which system?
- Repeated panic attacks
- Excess activation of the sympathetic nervous system
What do symptoms of a panic attack include?
Fear and apprehension, trembling, sweating, hyperventilation, sense of unreality
What is obessive-compulsive disorder (OCD)?
Characterized by obsessions (persistent, intrusive thoughts), which produce tension, and compulsions (repetitive tasks) that relieve tension but cause significant impairment
Why is the relationship between obsessions and compulsions key?
Obsessions raise the individual’s stress level, and compulsions relieve this stress
What is body dysmorphic disorder? What kind of disorder is it?
- Obsessive-compulsive and related disorders
- Unrealistic negative evaluation of his or her personal appearance and attractiveness
What are dissociative disorders?
- Person avoids stress by escaping from his identity
- Still has an intact sense of reality
What is dissociative amnesia? Why is it called dissociative? What is it linked to?
- Inability to recall past experience
- Dissociative since it is not due to a neurological disorder
- Linked to trauma
What is dissociative fugue?
Sudden, unexpected move or purposeless wandering away from one’s home or location of usual daily activities. Associated with dissociative amnesia
What is dissociative identity disorder? What have the patients suffered from in most cases?
- Two or more personalities that recurrently take control of a person’s behavior
- In most cases, the patients have suffered severe physical or sexual abuse as young children
What is depersonalization/derealization disorder? Do the patients display psychotic symptoms?
- Individuals feel detached from their own mind and body (depersonalization), or from their surroundings (derealization)
- No hallucinations or delusions
Give an example of depersonalization.
An out-of-body experience
Define derealization.
Giving the world a dreamlike or insubstantial quality
What is a somatic symptom?
Bodily symptom that may or may not be linked to an underlying medical condition
What is somatic symptom disorder?
Have at least one somatic symptom that is accompanied by disproportionate concerns about its seriousness, devotion of an excessive amount of time and energy to it, or elevated levels of anxiety
What is illness anxiety disorder?
Characterized by being consumed with thoughts about having or developing a serious medical condition
In what case would a hypochondriac fit into somatic symptom disorder? In what case would a hypochondriac fit into illness anxiety disorder?
Somatic symptom disorder: if somatic symptoms are present
Illness anxiety disorder: if somatic symptoms are not present
What is conversion disorder?
Characterized by unexplained symptoms affecting voluntary motor or sensory functions (paralysis, blindness). Begin after the individual experiences high levels of stress (trauma).
In conversion disorder, what is la belle indifférence?
A person that is surprisingly unconcerned by the symptom
What was conversion disorder historically called?
Hysteria
What is personality disorder? It causes distress in which areas? (4)
- Pattern of behavior that is inflexible and maladaptive
- Distress in cognition, emotion, interpersonal functioning, or impulse control
What does ego-syntonic? Which psychiatric disorder is this seen in?
- The individual perceives her behavior as correct, normal
- Personality disorder
What is ego-dystonic?
The individual sees the illness as something thrust upon her that is intrusive and bothersome
In addition to general personality disorder, how many personality disorders are there? What are the three clusters?
- 10 personality disorders
- Cluster A: Weird
- Cluster B: Wild
- Cluster C: Worried
Paranoid, Schizotypal and Schizoid Personality disorders belong to which cluster?
Cluster A
Which personality disorder is characterized by a pervasive mistrust of others and suspicion regarding their motives? Which cluster?
- Paranoid
- Cluster A
Which personality disorder is characterized a pattern of odd or eccentric thinking, ideas of reference, and magical thinking? Which cluster?
- Schizotypal
- Cluster A
Which personality disorder is characterized by a pervasive pattern of detachment from social relationships and a restricted range of emotional expression? Which cluster?
- Schizoid
- Cluster A
Antisocial, Borderline, Histrionic, and Narcissistic Personality disorders belong to which cluster?
Cluster B
Which personality disorder is 3x more common in males than in females and is characterized by a pattern for disregard for and violation of the rights of others? Which cluster?
- Antisocial
- Cluster B
Which personality disorder is 2x more common in females than in males and is characterized by a pervasive instability in interpersonal behavior, mood and self-image? Which cluster?
- Borderline
- Cluster B
What is splitting?
Defense mechanism, in which individuals with borderline personality disorder view others as either all good or all bad
Which personality disorder is characterized by constant attention-seeking behavior? Which cluster?
- Histrionic
- Cluster B
Which personality disorder is characterized by a grandiose sense of self-importance, preoccupation with fantasies of success, a need for constant admiration, fragile self-esteem and a concern of how others view them? What cluster?
- Narcissistic
- Cluster B
Which personality disorder is characterized by extreme shyness and fear of rejection? Which cluster?
- Avoidant personality disorder
- Cluster C
Which personality disorder is characterized by a continuous need for reassurance from one specific person to take actions and make decisions? Which cluster?
- Dependent personality disorder
- Cluster C
Which personality disorder is characterized by an individual who is a perfectionist and inflexible, tending to like rules and order? Which cluster?
- Obsessive-compulsive personality disorder
- Cluster C
Differentiate obsessive-compulsive disorder and obsessive-compulsive personality disorder.
OCD: ego-dystonic
OCPD: ego-syntonic
Trauma at birth is said to be a potential cause for schizophrenia. Which one in particular?
Hypoxemia (low oxygen concentration in blood)
Schizophrenia is associated with an excess of which neurotransmitter in the brain? How does medication counteract that?
- Excess dopamine
- Medications block dopamine receptors
Which biomarker levels are high in depression?
- High glucose metabolism in the amygdala
- Abnormally high glucocorticoids (cortisol)
After a long duration of illness (depression), where is there atrophy?
Hippocampal atrophy
Depression is associated with lower levels of which neurotransmitters? Based on what theory?
- Norepinephrine, serotonin, dopamine
- Monoamine theory
Bipolar disorder is associated with higher levels of which neurotransmitters?
- Norepinephrine, serotonin
A patient is at higher risk for bipolar disorder for two reasons. Name them.
- If a parent has bipolar disorder
- If the individual has multiple sclerosis
There are two genetic components to Alzheimer’s disease. What are they?
1) Presenilin genes on chromosomes 1 and 14
2) Mutations in the apolipoprotein E gene on chromosome 19
Why is there a higher risk of Alzheimer’s in individuals with Down syndrome?
B-amyloid precursor protein gene on chromosome 21 contributes to Alzheimer’s
Which disease is linked to diffuse atrophy of the brain on CT, flattened sulci in cerebral cortex, enlarged cerebral ventricles, and deficient blood flow in parietal lobes?
Alzheimer’s
Which neurotransmitter is lower in Alzheimer’s?
Acetylcholine
What is bradykinesia?
Slowness in movement
What is resting tremor?
Tremor that appears when muscles are not being used
What is pill-rolling tremor?
Flexing and extending the fingers while moving the thumb back and forth, as if rolling something in the fingers
What is masklike facies?
Facial expression consisting of static and expressionless facial features, staring eyes and a partially open mouth
What is cogwheel rigidity?
Muscle tension that intermittently halts movements as an examiner attempts to manipulate a limb
What is the biological basis of Parkinson’s?
Decreased dopamine production in the substantia nigra
What is the substantia nigra?
Layer of cells that functions to produce dopamine to permit proper functioning of the basal ganglia
How can Parkinson’s be managed?
L-DOPA, a precursor that is converted to dopamine once in the brain
