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EPPP, study > Diagnosis & Psychopathology 4 > Flashcards

Diagnosis & Psychopathology 4 Flashcards

Priority 1

1
Q

Name the 10 Axis II personality disorders.

A
  • Schizoid
  • Schizotypal
  • Narcissistic
  • Histrionic
  • Borderline
  • Antisocial
  • Paranoid
  • Obsessive-Compulsive
  • Avoidant
  • Dependent
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2
Q

Describe some common historical/etiological factors among personality disorders.

A
  • Hx of developmental issues, e.g.:
    • poor stress coping
    • poor ego functioning
    • low IQ
    • disorganized family of origin
  • evidence of genetic contribution
    • 5-10 times higher prevalence of Antisocial PD among first degree relatives
    • Schizoid, Schizotypal, and Paranoid PDs have strong evidence of heritability
    • genetic link between Borderline PD and affective disorders
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3
Q

Compare and contrast Kernberg’s and Kohut’s understandings of Narcissistic Personality Disorder.

A
  • Kernberg emphasized envy defended by devaluation, exploitation and contempt as the core drivers of the PD; attitudes and opinions alter in service of impressing others
  • Kohut emphasized an arrested development wherein infantile grandiosity remains unchecked; cohesive self-representation and social values remain undeveloped
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4
Q

Describe the three dimensions of Antisocial Personality Disorder indicated by research.

A
  • interpersonal manipulativeness and glibness
  • unemotional and unempathetic affective disposition
  • impulsivity, need for stimulation
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5
Q

Describe treatment approaches to Anorexia Nervosa

A
  • first goal is to get patient to normal weight
  • CBT approaches focus on:
    • maintenance of normal eating
    • faulty thinking and inaccurate beliefs
  • family therapy may include “family lunch” in which, over a meal, therapist identifies dysfunctional interactions and models effective behavior
  • SSRIs address low serotonin levels
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6
Q

Discuss prevalence rates and other factors associated with Bulimia Nervosa.

A
  • BN relatively rare, at 1% prevalence rate
  • 50% of overweight women binge-eat
  • 30% of BN patients report Hx of sexual abuse (similar to rates of patients with other psychiatric disorders)
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7
Q

Describe Ganser Syndrome.

A
  • a Dissociative Disorder NOS
  • also called the “syndrome of approximate answers”
    • tendency of persons with the syndrome to give inaccurate but not inappropriate answers to questions
    • e.g., “how many legs on a horse” receives the response “five”
  • hallucinations
    • often more florid than those of true psychosis
  • associated with prisoners
  • debated as to whether it is a factitious disorder rather than a dissociative disorder.
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8
Q

Describe the category of Paraphilias.

A
  • repeated, powerful sexual urges or fantasies
  • sexual behaviors involving atypical or bizarre objects, activities, or situations
  • cause marked distress or impairment

NOTE: Paraphilias often occur in persons with personality disorders.

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9
Q

Describe the category of Sexual Dysfunctions.

A
  • disturbance in sexual desire and psychophysiological changes in the sexual response cycle
  • cause marked distress or interpersonal problems
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10
Q

Describe the category of Gender Identity Disorders.

A
  • acute and chronic identification with opposite gender

- persistent discomfort with assigned sex or gender role

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11
Q

Describe some treatment approaches to Paraphilias.

A
  • covert sensitization
    • imaginal pairing exciting objects with aversive stimuli
  • orgasmic reconditioning
    • paraphilic person masturbates in the presence of an appropriately sexually exciting stimulus
  • social skills, assertiveness training, and cognitive restructuring
    • used to cope with abnormal urges when they arise
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12
Q

What are the four stages of the sexual response cycle and the dysfunctions associated with them?

A
  • desire; Hypoactive Sexual Desire and Sexual Aversion Disorder
  • excitement; Female Sexual Arousal Disorder, Male Erectile Disorder
  • orgasm; Female/Male Orgasmic Disorder, Premature Ejaculation
  • resolution (no dysfunctions associated with this stage)
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13
Q

Name two sexual pain disorders.

A
  • Vaginismus, a narrowing of the outer third of the vagina, preventing penetration
  • Dyspareunia, sexual pain not due to Vaginismus (can occur rarely in males)
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14
Q

What are the most common sexual dysfunctions by sex?

A
  • males: Premature Ejaculation (30%-40% prevalence)

- females: Orgasmic Disorder

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15
Q

Describe sensate focus as a treatment for sexual dysfunction.

A

Partners are limited to touching and stroking each other’s naked bodies in a comfortable, relaxed setting, thus relieving expectations. As anxiety is reduced, more sexual activity is added in stages, until sexual intercourse is comfortable.

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16
Q

Describe types and treatments for Premature Ejaculation.

A

Types:

  • primary (lifelong)
  • secondary (arises after period of normal functioning)

Treatments

  • squeeze technique (aka, stop and start):
    • partner squeezes penis prior to ejaculation, inhibiting it
    • over time, the man learns self-control
  • SSRIs:
    • in low dosages, these can prolong ejaculation by 5 to 10 minutes
    • taken daily or four hours before sexual activity
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17
Q

What are Kegel exercises?

A
  • women’s exercises strengthening the pelvic floor (perineum) in anticipation of childbirth and to enhance sexual pleasure
  • muscles are isolated by stopping urine stream, then tightened and relaxed repeatedly as a regular exercise
18
Q

When do hypnopompic and hypnogogic dreams occur?

A
  • hypnopompic: while one is awakening
  • hypnogogic: while one is falling asleep

Think: hypnogogic, going to sleep

19
Q

List three types of breathing-related sleep disorders.

A
  • sleep apnea, e.g., Obstructive Sleep Apnea (OSA)
  • hypopnea, abnormally slow or shallow breathing
  • hypoventilation, abnormal blood oxygen and carbon dioxide levels due to ventilatory impairment
20
Q

Name three parasomnias.

A
  • Nightmare Disorder: repeated awakenings with detailed recollection of long and frightening dreams. (REM sleep)
  • Sleep Terror Disorder: repeated sudden awakenings, usually with panicky scream, high autonomic arousal, but no memory of dreams. Often includes resisting being touched or sitting up. (Non-REM sleep)
  • Sleepwalking Disorder: prominent organized motor activity during sleep, low autonomic arousal, without memory. Onset usually between ages 6 and 12. (Non-REM sleep)
21
Q

List five impulse-control disorders.

A
  • Pathological Gambling
  • Pyromania
  • Kleptomania
  • Intermittent Explosive Disorder
  • Trichotillomania

Note: Characteristic of most of these disorders is the a sense of tension building up before commission of the particular act, e.g., the urge to steal something.

22
Q

DiffDx: Adjustment Disorder, Acute Stress Disorder, Posttraumatic Stress Disorder.

A
  • PTSD/ASD require extreme stressors (trauma), but AD can be in response to any stressor
  • PTSD/ASD require specific symptoms, especially re-experiencing, but AD can involve a range
23
Q

Define illusions.

A

misperceptions/misinterpretations of actual external stimuli

E.g.: hearing the sound of the wind whispering one’s name

24
Q

Define delusions.

A

false beliefs firmly held despite clear contrary evidence, not representing widely accepted cultural beliefs
E.g.: belief that aliens are controlling one’s thoughts

25
Q

Define hallucinations.

A

sensory perceptions that seem real but that have no external stimuli
- person hallucinating may or may not realize they are doing so

26
Q

Define magical thinking.

A

erroneous belief that one’s thoughts or actions will affect specific outcomes

27
Q

Define ideas of reference.

A

belief that external events have particular meaning to oneself
- not as firmly held as delusions of reference

28
Q

Discuss current understanding of the etiology of obesity.

A
  • high heritability
    • non-significant correlation between adopted children and adoptive parents
    • obese first-degree relatives significantly increase risk
  • affects of food intake mediated by metabolism, which is inherited
  • current understanding emphasizes multiple etiologies: neural, hormonal, metabolic (all genetic), behavioral
29
Q

Describe common elements in current behavioral treatments for obesity.

A
  • self-monitoring
  • reinforcement of activity increase
  • slowing of eating rate
  • stimulus control
  • adherence to low-fat, high-fiber diet
  • reinforcement for short-term goals
30
Q

Describe four types of epileptic seizure.

A
  • generalized tonic-clonic: previously called grand mal, bilateral onset, can last up to an hour, followed by deep sleep
  • generalized absence: previously called petit mal, bilateral onset, brief loss of consciousness and few or no other symptoms
  • complex partial: aka psychomotor, focal onset, associated with temporal lobe (but can begin in frontal), impaired consciousness, involuntary mouth movements, walking in circles; person appears clumsy or intoxicated, can follow simple, calm, friendly instructions
  • simple partial: aka Jacksonian, focal onset, no affect on consciousness, limited to one side of body, with movement traveling over body (as seizure moves across motor regions of brain)
31
Q

Relaxation training and EMG biofeedback are effective for tension headaches; what training approach is effective for migraine headaches?

A

thermal hand warming biofeedback, in which a person learns to warm his or her hands

32
Q

Describe behavioral and cognitive approaches to treatment of chronic pain.

A
  • pain meds on a time-contingent, rather than pain-contingent basis
  • family and social reinforcement of well behavior and ignoring of pain behavior
  • reinforcement of increasingly longer physical therapy practice
  • internal locus of control
33
Q

Describe approaches to treatment of chronic pain using antidepressants.

A
  • 50%-90% of pain patients can find at least 50% relief through anti-depressants
  • tricyclics, e.g., amitriptyline (Elavil), most effective if pain is neuropathic or a headache syndrome
  • SSRIs less effective for headaches and migraines
  • can be used with or as an alternative to analgesics
34
Q

Compare neuropathic and nociceptive pain.

A
  • neuropathic: pain related to nerve functioning

- nociceptive: pain related to injury

35
Q

Describe factors associated with primary hypertension.

A
  • African-Americans twice as likely to have hypertension than European-Americans
  • obesity
  • high resting heart rate
  • chronic stress

NOTE: Causes are unknown, although it is highly heritable.

36
Q

Describe three treatments for primary hypertension.

A
  • relaxation
  • medication
  • biofeedback
37
Q

What factors are associated with Premenstrual Syndrome and Premenstrual Dysphoric Disorder?

A
  • some evidence that women who experience PMS and PDD may have higher rates of depressive disorders
    • anti-depressants can be effective treatments for PMS and PDD
  • no personality factors associated with PMS or PDD
  • no clear hormonal differences between women who experience PMS and those who don’t
38
Q

Describe Selye’s (1953) general adaptation syndrome.

A

A.R.E.:

  • Alarm: sympathetic arousal, which when sustained, produces distress symptoms
  • Resistance: stabilization of defenses and reduction of distress symptoms with significant resource cost
  • Exhaustion: susceptibility to organ failure and even death as a result of resource cost in Resistance
39
Q

Describe the “Type A” personality.

A

Constellation of personality characteristics associated with highest risk of heart attacks:

  • anger
  • hostility (overt or covert)
  • aggression
40
Q

Is depression associated with heart disease?

A

Yes, as much as Type A personality.

41
Q

Describe the Sickness Impact Profile.

A
  • a 136-item survey (self- or interviewer-report)
  • assesses impact of disease on physical and emotional functioning (quality of life)
  • higher score = greater dysfunction

EPPP, study (40 decks)

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