Diagnosis & Psychopathology 4 Flashcards
Priority 1
Name the 10 Axis II personality disorders.
- Schizoid
- Schizotypal
- Narcissistic
- Histrionic
- Borderline
- Antisocial
- Paranoid
- Obsessive-Compulsive
- Avoidant
- Dependent
Describe some common historical/etiological factors among personality disorders.
- 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
Compare and contrast Kernberg’s and Kohut’s understandings of Narcissistic Personality Disorder.
- 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
Describe the three dimensions of Antisocial Personality Disorder indicated by research.
- interpersonal manipulativeness and glibness
- unemotional and unempathetic affective disposition
- impulsivity, need for stimulation
Describe treatment approaches to Anorexia Nervosa
- 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
Discuss prevalence rates and other factors associated with Bulimia Nervosa.
- 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)
Describe Ganser Syndrome.
- 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.
Describe the category of Paraphilias.
- 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.
Describe the category of Sexual Dysfunctions.
- disturbance in sexual desire and psychophysiological changes in the sexual response cycle
- cause marked distress or interpersonal problems
Describe the category of Gender Identity Disorders.
- acute and chronic identification with opposite gender
- persistent discomfort with assigned sex or gender role
Describe some treatment approaches to Paraphilias.
- 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
What are the four stages of the sexual response cycle and the dysfunctions associated with them?
- 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)
Name two sexual pain disorders.
- Vaginismus, a narrowing of the outer third of the vagina, preventing penetration
- Dyspareunia, sexual pain not due to Vaginismus (can occur rarely in males)
What are the most common sexual dysfunctions by sex?
- males: Premature Ejaculation (30%-40% prevalence)
- females: Orgasmic Disorder
Describe sensate focus as a treatment for sexual dysfunction.
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.
Describe types and treatments for Premature Ejaculation.
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
What are Kegel exercises?
- 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
When do hypnopompic and hypnogogic dreams occur?
- hypnopompic: while one is awakening
- hypnogogic: while one is falling asleep
Think: hypnogogic, going to sleep
List three types of breathing-related sleep disorders.
- 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
Name three parasomnias.
- 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)
List five impulse-control disorders.
- 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.
DiffDx: Adjustment Disorder, Acute Stress Disorder, Posttraumatic Stress Disorder.
- 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
Define illusions.
misperceptions/misinterpretations of actual external stimuli
E.g.: hearing the sound of the wind whispering one’s name
Define delusions.
false beliefs firmly held despite clear contrary evidence, not representing widely accepted cultural beliefs
E.g.: belief that aliens are controlling one’s thoughts
Define hallucinations.
sensory perceptions that seem real but that have no external stimuli
- person hallucinating may or may not realize they are doing so
Define magical thinking.
erroneous belief that one’s thoughts or actions will affect specific outcomes
Define ideas of reference.
belief that external events have particular meaning to oneself
- not as firmly held as delusions of reference
Discuss current understanding of the etiology of obesity.
- 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
Describe common elements in current behavioral treatments for obesity.
- self-monitoring
- reinforcement of activity increase
- slowing of eating rate
- stimulus control
- adherence to low-fat, high-fiber diet
- reinforcement for short-term goals
Describe four types of epileptic seizure.
- 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)
Relaxation training and EMG biofeedback are effective for tension headaches; what training approach is effective for migraine headaches?
thermal hand warming biofeedback, in which a person learns to warm his or her hands
Describe behavioral and cognitive approaches to treatment of chronic pain.
- 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
Describe approaches to treatment of chronic pain using antidepressants.
- 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
Compare neuropathic and nociceptive pain.
- neuropathic: pain related to nerve functioning
- nociceptive: pain related to injury
Describe factors associated with primary hypertension.
- 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.
Describe three treatments for primary hypertension.
- relaxation
- medication
- biofeedback
What factors are associated with Premenstrual Syndrome and Premenstrual Dysphoric Disorder?
- 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
Describe Selye’s (1953) general adaptation syndrome.
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
Describe the “Type A” personality.
Constellation of personality characteristics associated with highest risk of heart attacks:
- anger
- hostility (overt or covert)
- aggression
Is depression associated with heart disease?
Yes, as much as Type A personality.
Describe the Sickness Impact Profile.
- a 136-item survey (self- or interviewer-report)
- assesses impact of disease on physical and emotional functioning (quality of life)
- higher score = greater dysfunction
