Diagnostics Flashcards
What is the difference between specific and free-floating anxiety?
Specific anxiety is in response to a certain set of circumstances or triggers, whereas free-floating anxiety is a baseline high level of anxiety about everything/general life.
What is the difference between neurotic and normal anxiety?
Normal anxiety is in response to a real life threat, whereas neurotic anxiety is an out-of-proportion response to a stimulus.
What is reactive depression?
Depression in response to a reasonable negative life event (ie. loss)
What is the main motto of someone with ASPD?
“It’s all about me” / “What’s in it for me?”
True or false: people with ASPD will come across as the perfect gentleman, gregarious, accomplished, etc.
True
Why do people with ASPD use terms like “my children” or “my spouse?”
To show ownership, not love
“The quick response by police forced me to take hostages” is an example of what?
Projection
“Everyone does it” or “Everyone is going to die sooner or later. I just hastened the inevitable” is an example of what?
Rationalization
What is a common opening sentence by someone with ASPD?
“I’ve got XYZ hostage, and if you don’t do exactly what I want, I’ll kill her.”T
True or false: people with ASPD are very impulsive.
True.
What is the link between ASPD and Stockholm Syndrome?
People with ASPD are so charismatic and manipulative that they can convince hostages they are protecting them from the police, for example, thereby inducing Stockholm Syndrome.
What is one reason why hostages might develop Stockholm Syndrome?
They expect evil and torture from their hostage takers, and when they don’t receive that - and maybe even receive kindness like food or water - they feel indebted to the hostage takers.
What are two biological (non-psychological/psychiatric) causes of psychotic symptoms?
Late-stage syphilis (CNS infection by Treponema pallidum) and pellagra (niacin (B3)/protein deficiency).
Note: niacin is found in red meat, bananas, poultry, fish, brown rice, and nuts/seeds.
What 3 diagnoses have the strongest hereditary natures?
ADHD, bipolar disorder, and schizophrenia
What is an endogenous mental illness?
A mental illness that arises in the absence of provoking psychosocial stressors
What is dysthymia?
Persistent depressive symptoms
What is an ego-dystonic symptom?
A symptom perceived by the client as negative
What is an ego-syntonic symptom?
A symptom perceived by others - but not by the patient - as negative
What is a principal disorder?
Major psychiatric symptom disorders that are often acute and/or episodic
What is a personality disorder (as opposed to a principal disorder)?
Long-standing personality traits and behaviors that lead to distress or impairment in social, occupational, and relational domains
Why might a co-occurring diagnosis of borderline personality disorder with depression, PTSD, or a panic disorder be inaccurate?
The impact of the principal disorder results in psychological regression, helplessness, or overly dependent behavior that is diagnosed as borderline but resolves with treatment of the principal disorder.
What should you be suspicious of if a client’s psychiatric symptoms appeared out of the blue and were not connected to a psychosocial stressor?
An underlying medical condition and/or drug side effect
What 3 things must you rule out before making a diagnosis?
Substance use/abuse
Medical illness
Influence of negative personality traits (for example, a borderline person might develop severe depression after a social rebuff, but they don’t necessarily HAVE depression)
Your client presents with abdominal pain, jaundice, constipation, and depression. What might they have?
Pancreatic cancer
Your client presents with weight gain, cold intolerance, dry skin, hair loss, puffy face, fatigue, and depression. What might they have?
Hypothyroidism
Your client presents with weight loss, heat intolerance, sweating, tremors, wide-eyed state, and anxiety. What might they have?
Hyperthyroidism
Your client presents with bad breath, urine odor, frequent urination, and depression. What might they have?
Diabetes
Your client presents with weakness, dizziness, light-headedness, sweating, tremors, and acute-onset anxiety. What might they have?
Hypoglycemia
Your client presents with muscular weakness, fatigue, droopy face, and depression. What might they have?
Myasthenia gravis (autoimmune that attacks the communication between the nerves and muscles)
Your client presents with sensory disturbances, paresthesia (tingling/numbness), transient motor disturbances, depression, and euphoria. What might they have?
Multiple sclerosisY
Your client presents with weakness, fatigue, diffuse pain, incoordination, depression, and impaired memory. What might they have?
Pernicious anemia
Your client presents with abdominal pain, weakness, confusion after ingesting alcohol or barbiturates, and anxiety. What might they have?
Porphyria (build-up of red blood cell proteins)
Your client presents with increased skin pigmentation, weight loss, diarrhea, muscle cramps, low blood pressure, and depression. What might they have?
Hypoadrenalism (Addison’s disease)
Your client presents with muscle weakness, swollen/puffy face, excessive hair around the mouth and chin (hirsutism), hypertension, irritability, depression, and euphoria. What might they have?
Hyperadrenalism (Cushing’s disease)
Your client presents with hypotension, headaches, and anxiety. What might they have?
Pheochromocytoma (adrenal gland tumor)
Your client presents with fever, malaise, depression, and agitation. What might they have?
Infection
Your client presents with fatigue, joint pain, and depression. What might they have?
Rheumatoid disorders like fibromyalgia or chronic fatigue syndromes
Your client presents with headaches, weakness, changes in vision, depression, mania, and personality changes. What might they have?
Brain tumor
What is the main difference between grief and clinical depression?
In grief, self-esteem does not usually erode.
What percentage of people who experience loss develop clinical depression?
25-30%
What is anhedonia?
An inability to experience pleasure
What are the 8 core symptoms of depression?
Mood of sadness, despair, emptiness
Anhedonia
Low self-esteem
Apathy, low motivation, social withdrawal
Excessive emotional sensitivity
Negative, pessimistic thinking
Irritability
Suicidal ideation
What is the suicide rate for someone with depression?
9%
Do more men or women get diagnosed with depression?
Women (2:1)
What are the 8 physiological symptoms of depression, and what do they indicate?
Appetite disturbance/weight changes
Fatigue
Decreased sex drive
Restlessness or agitation
Diurnal variations in mood (often feeling worse in the morning)
Impaired concentration and forgetfulness
Pronounced anhedonia
Sleep disturbances
**These indicate the need for antidepressant medication treatment, not just psychotherapy.
What are mood congruent hallucinations and delusions, and what are they NOT indicative of?
The hallucination/delusion content aligns with the mood (ie. delusions you should be executed because of your filth during a depressive episode)
They are NOT indicative of schizophrenia, whose hallucinations and delusions are usually random.
What is double depression?
Dysthymia with periods of major depression
Why does dysthymia result in high suicide risk?
Most treatment only addresses the superimposed major depression (in double depression), and the client is left feeling depressed - still.
What percentage of women experience premenstrual dysphoric disorder?
5%
What is the period of onset for postpartum depression?
2-6 weeks following birth
What other diagnosis puts women at higher risk for postpartum depression?
Premenstrual dysphoric disorder
Childbirth and its subsequent stressful life changes might precipitate the first episode of what disorder?
Bipolar disorder
What are the eight diagnostic criteria of a manic episode?
Racing thoughts
Pressured speech
Grandiosity
Increased energy and goal-directed activity
Engaging in pleasurable activities (hedonistic triad)
Distractibility
Decreased need for sleep
What is relevant about the relationship among ADHD, schizophrenia, and bipolar disorder?
Manic episodes of bipolar disorder may be confused diagnostically with ADHD and schizophrenia.
What differentiates Stage I and Stage II acute mania?
Presence of hostility, anger, and impulsivity; assaultive or explosive behavior; cognitive disorganization; and/or grandiose or paranoid delusions.
What differentiates Stage II and Stage III acute mania?
Psychosis
Is bipolar disorder more prevalent in high or low socioeconomic classes?
High
Is bipolar disorder more prevalent in men or women?
Equal prevalence for bipolar I, more women for bipolar II
What is the average age of onset for the first symptoms of bipolar disorder?
18-20 years old
What percentage of the population has bipolar disorder?
Less than 5%
What is “mixed features” in terms of bipolar disorder?
A manic episode with depressive features or a depressive episode with manic features
What is cyclothymic disorder?
Alternating depressive and hypomanic symptoms that do not meet the diagnostic criteria for major depression or bipolar disorder
What is the difference between a panic attack and anxiety symptoms?
A panic attack is much more intense and lasts only for up to 30 minutes.
Rates of what are significantly higher in clients with panic disorder?
SUDs (3-9x higher) and suicide attempts (18x higher)
Do people with generalized anxiety disorder have panic attacks?
No
Is generalized anxiety disorder precipitated by a life stressor?
Generally not. These people are chronically worried about everything.
If someone is labeled by friends and family as a worrywart, what disorder might they have?
Generalized anxiety disorder
What raises a general dislike of something to a clinical specific phobia?
Avoidance of the object
What is agoraphobia?
An anxiety disorder that causes people to fear being in situations where they might feel trapped, helpless, or embarrassed, or where escape is difficult or help is unavailable
What is the primary characteristic of panic disorder?
Spontaneous panic attacks not associated with a life stressor
What symptoms might result from panic disorder (not what are the symptoms, but what symptoms might panic disorder cause)?
Anticipatory anxiety, agoraphobia, alcohol abuse, and depression
What often precipitates the development of panic disorder?
A significant interpersonal loss in the 6-12mo before the onset of symptoms
What heart problem often coincides with anxiety?
Mitral valve prolapse
What is the locus coeruleus, and what does it do?
It is the brain structure that presses “go” on the sympathetic nervous system activation process - it is often called the “adrenal gland of the brain”
What is the frequency range of attacks in panic disorder?
A few times a month to a few times per day, including during sleep
What is initial insomnia?
Trouble falling asleep
What is middle insomnia?
Waking up in the middle of the night
Which type of insomnia is associated with depression vs anxiety?
Initial insomnia is indicative of anxiety, middle and terminal insomnia are indicative of depression
What is neurotic anxiety?
Anxiety born from repressed conflicts/struggles
What is the age of onset for OCD?
Childhood/adolescence
What are 5 common themes of obsessions in OCD?
Germs/filth
Symmetry
Aggression
Sex
Religion
Body dysmorphic disorder and hoarding disorder are under what class of disorders?
Obsessive-compulsive disorders
What is trichotillomania?
Hair-pulling disorder
What is excoriation?
Skin picking
Is OCD more prevalent in men or women?
Equally prevalent
What are the two most common themes of obsessions in OCD?
Cleanliness (66%) and safety (20%)
What is the primary co-occurring mental illness with OCD?
Depression
What is obsessive compulsive personality disorder characterized by?
Perfectionism, stinginess, emotional rigidity, and workaholism
Between OCPD and OCD, which is ego syntonic?
OCPD
Do patients with OCD enjoy their rituals?
Usually not - they are a huge source of distress and hopelessness, even though they mildly reduce the anxiety that stems from the obsession
What is a functional psychosis?
Mental illnesses that include psychosis, like schizophrenia
What is an organic psychosis?
Medical illnesses that cause psychosis, such as dementia
Why is lupus relevant to psychological diagnostics?
It can cause psychosis
What organ failure is most likely to cause psychosis?
Kidney (renal failure)
What do Huntington’s and Parkinson’s diseases have in common from a psychological perspective?
They are both cerebral degenerative diseases that can cause psychosis.
Is hypoglycemia or hyperglycemia more likely to cause psychosis?
Hypoglycemia
What is a bizarre delusion?
A delusion that is not possible/makes no sense
For example, being surveilled by the FBI is a nonbizarre solution because it could technically happen, but being surveilled by Martians is bizarre because Martians don’t exist.
What is an erotomanic delusion?
A delusion that someone is in love with you when they’re not
What are the timelines for brief psychotic disorder, schizophreniform disorder, and schizophrenia
Brief psychotic disorder: up to 1 month
Schizophreniform disorder: 1-6 months
Schizophrenia: 6+ months
Your client presents with flat affect, lack of initiative, disruption of sleep patterns, and a deterioration of performance at work. What stage of schizophrenia are they in?
Prodromal
Your client presents with florid psychosis - disorganized thinking, delusions, and hallucinations. What stage of schizophrenia are they in?
Active
Your client presents with psychological impairment, such as social isolation and peculiar thinking, after a floridly psychotic episode. What stage of schizophrenia are they in?
Residual
What are the three stages of schizophrenia?
Prodromal, active, and residual
What is catatonia?
A movement disorder, often associated with schizophrenia, in which the person is immobile, stiff, or robotic.
What is a delusion of control or an experience of influence?
A belief that someone or something is controlling your actions
What is the problem with combined hallucinations and delusions of control?
If the hallucinations are telling them to hurt themselves and they believe someone else is controlling their body, they may hurt themselves, but it’s “not them” doing it. In short, it’s a risk factor for harm.
What is a schizoid personality?
A preexisting tendency to want to be alone, isolate, not have relationships, and emotionally detach
What is thought broadcasting?
A delusion that one’s thoughts are being broadcasted to the world
What are experiences of alienation?
A delusion that one’s thoughts, feelings, and actions are not your own
What is a delusional perception or an idea of reference?
A normal perception to which someone attaches a bizarre belief (ie. A cloud in the sky is sending them a private message)
In schizophrenia, which primary neurotransmitter is off, and is it hyperactive or hypoactive?
Dopamine, and it is hyperactive
What are extrapyramidal effects?
Motor system symptoms, including stiffness, twitches, and tremors
What is akathisia, and what is it a common side effect of?
An inability to remain still
It is a common side effect of antipsychotics.
When does acute PTSD become chronic PTSD?
When the symptoms last for more than 3 months
At what time is PTSD classified as “delayed onset?”
When symptoms don’t start for at least 6 months after the traumatic event
What symptoms are associated with the intrusion stage of PTSD?
Recurring memories, nightmares, hypervigilance, and the like
What symptoms are associated with the denial stage of PTSD?
Numbness, dissociation, avoidance, social withdrawal, and the like
What is the repetition compulsion?
The tendency for abused individuals to cling to and gravitate toward their abusers, potentially due to the sensitivity of the separation-stress center in the brain
What adulthood symptoms are frequently seen in people who were neglected as children?
Aggression and self-destructive behaviors
What are the 8 core symptoms of borderline personality disorder?
Ego impairment
Emotional instability
Chaotic interpersonal relations
Feelings of emptiness
Low frustration tolerance
Impulsivity
Primitive defenses, such as acting out
Irritability and anger-control problems