Chapter 7 - Psychological Disorders

Question 1

Schizophrenia

Question 2

Positive Symptoms of Schizophrenia

Answer 2

• Delusions: false beliefs discordant with reality and not shared by others in the individual’s culture that are maintained in spite of strong evidence to the contrary.
• Delusions of Reference: involve the belief that common elements in the environment are directed toward the individual.
• Delusions of Persecution: involve the belief that the person is being deliberately interfered with, discriminated against, plotted against, or threatened.
• Delusions of Grandeur: involve the belief that the person is remarkable in some significant way.
• Hallucinations: perceptions that are not due to external stimuli but have a compelling sense of reality.
• Disorganized Thought: characterized by loosening of associations. Speech in which ideas shift from one subject to another so unable to follow train of thought. Word salad: speech with no structure whatsoever. Many even invent new words, called neologisms.
• Disorganized Behavior: refers to the inability to carry out activities of daily living. Catatonia refers to certain motor behaviors characteristic of some people with schizophrenia. May maintain a rigid posture, refusing to be moved or may include bizarre movements not caused by any external stimuli, echolalia (repeating another’s words), or echopraxia (imitating another’s actions).

Question 3

Negative Symptoms of Schizophrenia

Answer 3

• Disturbance of Affect and Avolition: Affect refers to the experience and display of emotion. Affective symptoms may include blunting, in which there is a severe reduction in the intensity of affect expression; flat affect (emotional flattening), in which there are virtually no signs of emotional expression; or inappropriate affect, in which the affect is clearly discordant with the content of the individual’s speech. Avolition is marked by decreased engagement in purposeful, goal-directed actions.

Question 4

Major Depressive Disorder

Answer 4

• Mood disorder characterized by at least one major depressive episode. A major depressive episode is a period of at least two weeks with at least 5 of the following symptoms: prominent and relatively persistent depressed mood, loss of interest, appetite disturbances, substantial weight changes, sleep disturbances, decreased energy, feelings of worthlessness or excessive guilt, difficulty concentrating or thinking, psychomotor symptoms, and thoughts of death or attempts at suicide.
• Symptoms must cause significant distress or impairment in functioning.

Question 5

Symptoms of a Major Depressive Episode Mnemonic

Answer 5

• SIG E CAPS
  
  • Sadness+
  • Sleep
  • Interest
  • Guilt
  • Energy
  • Concentration
  • Appetite
  • Psychomotor symptoms
  • Suicidal thoughts
• Major depressive disorder = at least one major depressive episode of at least 2 weeks

Question 6

Persistent Depressive Disorder

Answer 6

• A diagnosis is given to individuals who suffer from dysthymia, a depressed mood that isn’t severe enough to meet the criteria of a major depressive episode, most of the time for at least 2 years.

Question 7

Seasonal Affective Disorder

Answer 7

• Categorized as major depressive disorder with seasonal onset. Depressive symptoms are present only in the winter months.
• Often treated with bright light therapy.

Question 8

Bipolar Disorders

Answer 8

• Characterized by both depression and mania
• Manic episodes are characterized by abnormal and persistently elevated mood lasting at least one week with at least 3 of the following: increased distractibility, decreased need for sleep, inflated self-esteem or grandiosity, racing thoughts, increased goal-directed activity or agitation, and involvement in high risk behavior.
• Manic episodes generally have a more rapid onset and a briefer duration than depressive episodes

Question 9

Symptoms of a Manic Episode Mnemonic

Answer 9

• DIG FAST
  
  • Distractible
  • Insomnia
  • Grandiosity
  • Flight of Ideas (racing thoughts)
  • Agitation
  • Speech (pressured)
  • Thoughtlessness (risky behavior)

Question 10

Bipolar I, Bipolar II, Hypomania, and Cyclothymic

Answer 10

• Bipolar I Disorder has manic episodes with or without major depressive episodes
• Bipolar II Disorder has hypomania with at least one major depressive episode
• Hypomania typically does not significantly impair functioning, although the individual may be more energetic and optimistic
• Cyclothymic disorder consists of a combination of hypomanic episodes and periods of dysthymia that are not severe enough to qualify as major depressive episodes

Question 11

Monoamine or catecholamine theory of depression

Answer 11

• This theory holds that too much norepinephrine and serotonin in the synapse leads to mania, while too little leads to depression

Question 12

Generalized Anxiety Disorder

Answer 12

• Defined as a disproportionate and persistent worry about many different things for at least six months.
• These individuals often have physical symptoms like fatigue, muscle tension, and sleep problems that accompany the worry.

Question 13

Specific Phobias

Answer 13

• Most common type of anxiety disorder
• A phobia is an irrational fear of something that results in a compelling desire to avoid it.
• A specific phobia is one in which anxiety is produced by a specific object or situation.

Question 14

Social Anxiety Disorder

Answer 14

• Characterized by anxiety that is due to social situations
• Individuals have persistent fear when exposed to social or performance situations that may result in embarrassment.
• Ex: giving a speech, socializing at a party

Question 15

Agoraphobia

Answer 15

• Characterized by a fear of being in places or in situations where it might be hard for an individual to escape
• Individuals tend to be uncomfortable leaving their homes for fear of panic attack

Question 16

Panic Disorder

Answer 16

• Consists of repeated panic attacks
• Symptoms of a panic attack include fear and apprehension, trembling, sweating, hyperventilation, and a sense of unreality
• Even after treatment for panic disorder, symptoms are common
• Panic disorder is frequently accompanied by agoraphobia because of the pervasive fear of having a panic attack in a public location

Question 17

Obsessive-Compulsive Disorder (OCD)

Answer 17

• Characterized by obsessions (persistent, intrusive thoughts and impulses), which produce tension, and compulsions (repetitive tasks) that relieve tension but cause significant impairment in a person’s life.
• Obsessions raise the individual’s stress level, and the compulsions relieve the stress.
• Ex: A person might obsess about dirt and compulsively wash his hands to neutralize the anxiety produced by the obsession.

Question 18

Body Dysmorphic Disorder

Answer 18

• A person has an unrealistic negative evaluation of his or her personal appearance and attractiveness, usually directed toward a certain body part.
• This body preoccupation disrupts day-to-day life

Question 19

Posttraumatic Stress Disorder (PTSD)

Answer 19

• Occurs after experiencing or witnessing a traumatic event, and consists of intrusion symptoms, avoidance symptoms, negative symptoms, and arousal symptoms.
• Intrusion symptoms include recurrent reliving of the event, flashbacks, nightmares, and prolonged distress
• Avoidance symptoms include deliberate attempts to avoid the memories, people, places, activities, and objects associated with the trauma.
• Negative cognitive symptoms include an inability to recall key features of the event, negative mood or emotions, feeling distanced from others, and a persistent negative view of the world.
• Arousal symptoms include an increased startle response, irritability, anxiety, reckless behavior, and sleep disturbances.
• Symptoms must be present for at least one month. If symptoms last for less than one month it may be acute stress disorder

Question 20

Dissociative Disorders

Answer 20

• The person avoids stress by escaping from his identity
• The person otherwise still has an intact sense of reality

Question 21

Dissociative Amnesia and Dissociative Fugue

Answer 21

• Dissociative Amnesia is characterized by an inability to recall past experiences. The qualifier “dissociative” simply means that the amnesia is not due to a neurological disorder. This disorder is often linked to trauma.
• Some individuals with this disorder may also experience dissociative fugue: a sudden, unexpected move or purposeless wandering away from one’s home or location of usual daily activities. Individuals in a fugue state are confused about their identity and can even assume a new identity.

Question 22

Dissociative Identity Disorder (DID)

Answer 22

• There are two or more personalities that recurrently take control of a person’s behavior
• Results when the components of identity fail to integrate
• In most cases, the patients have suffered severe physical or sexual abuse as young children.

Question 23

Depersonalization/Derealization Disorder

Answer 23

• Individuals feel detached from their own mind and body (depersonalization), or from their surroundings (derealization)
• An out-of-body experience is an example of depersonalization
• Derealization is often described as giving the world a dreamlike or insubstantial quality
• These feelings cause significant impairment of regular activities

Question 24

Somatic Symptom Disorder

Answer 24

• Individuals have at least one somatic symptom, which may or may not be linked to an underlying medical condition, and 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.

Question 25

Illness Anxiety Disorder

Answer 25

• Characterized by being consumed with thoughts about having or developing a serious medical condition.
• Individuals with this disorder are quick to become alarmed about their health, and either excessively check themselves for signs of illness or avoid medical appointments altogether.

Question 26

Conversion Disorder

Answer 26

• Characterized by unexplained symptoms affecting voluntary motor or sensory functions.
• The symptoms generally begin soon after the individual experiences high levels of stress or a traumatic event, but may not develop until some time has passed after the initiating experience.
• Examples include paralysis or blindness without evidence of neurological damage.

Question 27

Personality Disorders

Answer 27

• A personality disorder is a pattern of behavior that is inflexible and maladaptive, causing distress or impaired functioning in at least two of the following: cognition, emotions, interpersonal functioning, or impulse control.
• Personality disorders are considered ego-syntonic, meaning that the individual perceives her behavior as correct, normal, or in harmony with her goals.
• This is in contrast to the other disorders that are ego-dystonic, meaning that the individual sees the illness as something thrust upon her that is intrusive and bothersome.

Question 28

Personality Disorder Clusters

Answer 28

• 3 Clusters:
  
  • Cluster A: paranoid, schizotypal, and schizoid
  • Cluster B: antisocial, borderline, histrionic, and narcissistic
  • Cluster C: avoidant, dependent, and obsessive-compulsive
• Mnemonic: The 3 W’s
  
  • Cluster A – “Weird”
  • Cluster B – “Wild”
  • Cluster C – “Worried”

Question 29

Cluster A of Personality Disorders

Answer 29

• “Weird”
• Marked by behavior that is labeled as odd or eccentric
• Paranoid Personality Disorder: marked by a pervasive distrust of others and suspicion regarding their motives
• Schizotypal: refers to a pattern of odd or eccentric thinking. These individuals may have ideas of reference as well as magical thinking, such as superstitiousness or a belief in clairvoyance.
• Schizoid: pervasive pattern of detachment from social relationships and a restricted range of emotional expression. Show little desire for social interactions, few if any close friends, and poor social skills.

Question 30

Cluster B of Personality Disorders

Answer 30

• Dramatic, emotional, or erratic behavior. “WILD”
• Antisocial: pattern of diregard for and violations of the rights of others. No guilt for actions. Comprise about 20-40% of prison populations.
• Borderline: pervasive instability in interpersonal behavior, mood, and self-image. Interpersonal relationships unstable. Identity disturbance with uncertainty about self-image, sexual identity, long-term goals. Fear of abandonment. May use splitting as a defense mechanism, where they view others as all good or all bad.
• Histrionic: constant attention-seeking behavior. Extroverted.
• Narcissistic: grandiose sense of self-importance, fantasies of success, need for admiration and attention, entitlement. Like themselves too much. Very fragile self-esteem and are concerned with how others view them.

Question 31

Cluster C of Personality Disorders

Answer 31

• Anxious or fearful. “WORRIED”
• Avoidant: extreme shyness and fear of rejection. Individual see’s herself as socially inept and is often socially isolated, despite an intense desire for social affection and acceptance. Individuals stay in the same jobs, life situations, and relationships despite wanting to change.
• Dependent: continuous need for reassurance. Remain dependent on one specific person to take actions and make decisions.
• Obsessive-Compulsive: perfectionist and inflexible, likes rules and order. Not the same as OCD. OCPD is lifelong. OCD is also ego-dystonic, where as OCPD is ego-syntonic.

Question 32

Schizophrenia

Answer 32

• Partially inherited.
• Highly associated with an excess of dopamine in the brain.
• Many medications used to treat schizophrenia, such as neuroleptics, block dopamine receptors.

Question 33

Depressive and Bipolar Disorders

Answer 33

• Depression:
  
  • Abnormally high glucose metabolism in the amygdala
  • Hippocampal atrophy after a long duration of illness
  • Abnormally high levels of glucocorticoids (cortisol)
  • Decreased norepinephrine, serotonin, and dopamine
• Bipolar:
  
  • _​​_Increased norepinephrine and serotonin
  • Higher risk if parent has bipolar disorder
  • Higher risk for persons with multiple sclerosis

Question 34

Alzheimer’s Disease

Answer 34

• Diffuse atrophy of the brain on CT or MRI
• Reduction in levels of acetylcholine
• Reduction in choline acetultransferase (ChAT), the enzyme that produces acetylcholine
• Senile plaques of B-amyloid
• Neurofibrillary tangles

Question 35

Parkinson’s Disease

Answer 35

• Depression and dementia are common but not characteristic
• Decreased dopamine production in the substantia nigra, a layer of cells in the brain that functions to produce dopamine to permit proper functioning of the basal ganglia. Condition can be partially managed with L-DOPA

Question 36

Which hormone and neurotransmitter concentrations are elevated in depression? Which ones are reduced?

Answer 36

• Elevated: cortisol
• Reduced: norepinephrine, serotonin, and dopamine

Question 37

How are dopamine levels related in Schizophrenia and Parkinson’s Disease?

Answer 37

• Dopamine levels are elevated in schizophrenia and reduced in parkinson’s disease
• Thus, treatments for one disorder may cause symptoms similar to those of the other.