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Behavioral Dynamics > Dissociative Disorders- Exam 2 > Flashcards

Dissociative Disorders- Exam 2 Flashcards

1
Q

____ intense, irrational fear of a particular object or situation

A

phobia

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2
Q

What pt population are phobias more common in?

A

young women

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3
Q

What is the criteria for a phobia?

A

Persistent (6+ months) of marked fear/anxiety about a specific
object or situation

Phobic object/situation almost always causes immediate fear/anxiety

Phobic object/situation is actively avoided or endured with intense fear or anxiety

Fear/anxiety is out of proportion to the actual danger posed by object/situation

Fear/anxiety or avoidance causes distress or functional impairment

Syndrome is not better explained by another mental disorder

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4
Q

What is first line treatment for phobias? 2nd?

A

CBT with exposure

INfrequently encountered: PRN treatment with BZD

Frequently encountered stimulus: SSRI/SNRI

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5
Q

____ segregation of any group of mental processes from the rest of someone’s psychological activity. Often associated with ____

A

dissociation

psychological trauma as part of the unconscious defense mechanism

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6
Q

What are the 5 core symptoms of dissociative disorders?

A

amnesia

depersonalization

derealization

identity confusion

identity alteration

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7
Q

What is depersonalization?

A

Sense of detachment or disconnection from one’s self

Feeling like a stranger in one’s own body, or like part of your body does not belong to you
Feeling detached from emotions, or like a “robot” or on “autopilot”

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8
Q

What is derealization?

A

Sense of disconnection from familiar people or one’s surrounding

Close relatives or friends, one’s home or workplace may seem unreal or unfamiliar

“watching myself carry out reality”

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9
Q

____ Sense of acting like a different person some of the time

A

identity alteration

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10
Q

_____ potentially reversible memory impairment that primarily affects autobiographical memory. Give an example

A

dissociative amnesia

Cannot recall personal information
Typically affects memories of a traumatic or stressful nature, but can also impact other memories

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11
Q

_____ - sudden unexpected travel or wandering in a dissociated state, with subsequent dissociative amnesia for the episode

A

dissociative fugue

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12
Q

When is dissociative amnesia most often seen?

A

most often seen in late adolescence/early adulthood

both men and women

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13
Q

**What are some comorbidities with dissociative amnesia?

A

MDD (up to 60%), bipolar, substance abuse, other anxiety disorders

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14
Q

____ inability to recall important autobiographical information, usually of a traumatic or stressful nature, inconsistent with ordinary forgetting.

___ is for a specific event

___ is for identity and life history

A

dissociative amnesia

localized/selective amnesia

generalized amnesia

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15
Q

What are some types of dissociative amnesia?

A

localized
continuous
generalized
selective
systematized

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16
Q

What is the treatment for dissociative amnesia? give first line then other.

A

1st line: phase oriented therapy

CBT
Hypnosis
Group therapy

Pharmacotherapy - no use in treatmentPharmacotherapy - no use in treatment

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17
Q

Transient Depersonalization/Derealization Disorder last ____. up to ___ % What kinds of patient is this common in?

A

last 12 months, 20%

Common in patients with a hx of seizures or migraines; psychedelic drugs, medications, head injury

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18
Q

Lifetime, Depersonalization / Derealization Disorder about ___% What gender?

A

1-3%

equally common in men and women

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19
Q

What are risk factors for DDD?

A

acute or chronic trauma, substance abuse, psychiatric disorders, Depression, anxiety, OCD, avoidant or borderline personality disorder

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20
Q

_____ etiology is possible serotonergic involvement, response to traumatic stress, ego defense mechanism in the face of major negative life events

A

Depersonalization / Derealization Disorder

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21
Q

**What is the criteria for DDD?

A

The presence of persistent or recurrent experiences of depersonalization, derealization, or both:

-Depersonalization - experiences of unreality, detachment, or being an outside observer with respect to one’s thoughts, feelings, sensations, body, or actions¹

-Derealization - Experiences of unreality or detachment with respect to surroundings²

During the depersonalization/derealization, reality testing remains intact (aka can respond normally when prompted)

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22
Q

What is the treatment for DDD?

A

Months of treatment!!

Psychotherapy (mixed results): stress management and relaxation techniques

SSRIs may be helpful

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23
Q

Dissociative Identity Disorder is characterized by ??

A

Characterized by the presence of two or more “selves” or “personalities” with distinct memories, thoughts, opinions, and goals

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24
Q

What pt population is most at risk for DID?

A

women in their 20-30s, with a comorbidity of PTSD, depression, substance abuse, personality disorders usually with a childhood trauma

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25
Q

Define the criteria for DID?

A

Presence of two or more distinct identities or personality states, each with its own relatively enduring pattern of perceiving, relating to, and thinking about the environment and itself

Amnesia must occur

Gaps in recall of everyday events, personal information, and/or traumatic events

Syndrome causes distress and/or functional impairment

Disturbance is not part of normal cultural or religious practices
Ex. an “imaginary friend” is not considered indicative of a separate personality state alone

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26
Q

What is the treatment for DID?

A

**Psychotherapy

meds aimed at managing major symptoms

ECT: for refractory mood disorders

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27
Q

Define Impulse Control Disorder

A

Characterized by inability to resist the impulse, desire, or drive to perform a particular act that is obviously harmful to self, others, or both

Act is preceded by mounting tension and/or anticipatory pleasure

Completing action results in immediate gratification and relief

Action is followed by remorse, guilt, self-reproach, dread

Individuals are often secretive about activity

28
Q

How are impulse control disorders and OCD different?

A

Impulse control disorders they want to do (blank) activity vs OCD they DO NOT want to do it but feel the need to do it anyway

29
Q

What are the s/s of pathologic gambling? How many signs do you need?

A

Persistent and recurrent maladaptive gambling behaviors
5 or more of the following:

Preoccupation with gambling

Need to gamble with increasing amounts of money to get desired excitement

Repeated unsuccessful efforts to reduce or stop gambling

Restless or irritable when trying to reduce or stop gambling

Gambles to improve mood or escape from problems

After losing money, returns another day to win the money back

Lies to others to conceal the extent of gambling

Has committed illegal acts to finance gambling

Jeopardizes or loses relationships, jobs, or opportunities because of gambling

Relies on others to provide money to relieve a situation caused by gambling

30
Q

Tension or anxiety immediately before pulling out hair, or when resisting the urge is _____. What will happen next?

A

Trichotillomania

Pleasure, gratification, or relief when pulling hair

31
Q

Kleptomania is the recurrent theft of items (needed/not needed) for personal use or monetary value

A

not needed

feel pleasure, gratification or relief when stealing

32
Q

What are the key points of pyromania? What is the major one?

A

purposeful fire setting

Tension or anxiety immediately before setting fire, or when resisting the urge

Pleasure, gratification, or relief when setting fires, or when witnessing or participating in their aftermath

fascination with fire

**NOT for monetary gain, no real reason other than they want to/due to impaired judgement

33
Q

What is the treatment for Kleptomania?

A

psychotherapy with SSRI or lithium

34
Q

What is the treatment for pyromania?

A

psychotherapy and early intervention programs

35
Q

What is the treatment for pathologic gambling?

A

psychotherapy and SSRIs or Naltrexone, Naloxone

36
Q

What is the treatment for trichotillomania?

A

Clomipramine (Anafranil)

**SSRIs not strongly shown to be beneficial

37
Q

Define Intermittent Explosive Disorder. Do patients show regret?

A

Discrete episodes of losing control of aggressive impulses

Can result in serious assault, property destruction

Aggressiveness is grossly out of proportion for any stressor which may have precipitated the episode

Symptoms appear and remit spontaneously and quickly
Between episodes…
Patients show genuine regret or self-reproach

No generalized impulsivity or aggressiveness

38
Q

genetic predisposition; exposure to abuse/violence as a child; narcissistic defence mechanism
Also see decreased serotonergic activity
Increased rates of brain inflammation, hx of T. gondii infection

What am I?

A

Intermittent Explosive Disorder

39
Q

**What is the criteria for Intermittent Explosive Disorder? How old?

A

Presence of recurrent behavioral outbursts representing a failure to control aggressive impulses, as manifested by either of the following:

Verbal or physical aggression towards property, animals, or other individuals, occurring twice weekly on average for a period of 3 months; the aggression does not result in damage or destruction of property or physical injury

OR

3+ behavioral outbursts involving damage/destruction of property or physical injury against animals or other individuals occurring within a 12-month period

The magnitude of aggressiveness during the outbursts is grossly out of proportion to the provocation or any precipitating stressors

The aggressive outbursts are not premeditated and are not committed to achieve a tangible objective

Chronological age is at least 6 years (or equivalent developmental level)

40
Q

_____ is common in the elderly so will need to rule out demenita/delirium

A

Intermittent Explosive Disorder

41
Q

What is the treatment for Intermittent Explosive Disorder?

A

Psychotherapy and meds

group and family therapy is helpful
(sometimes these patients have problems setting limits with therapists and may have outburst in therapy)

Meds: SSRIs, trazodone, buspirone
lithium, carbamazepine, valproate/divalproex, phenytoin, gabapentin may be helpful
antipsychotics, beta blockers, calcium channel blockers

42
Q

How is Oppositional Defiant Disorder classified?

A

Enduring pattern of negativistic, hostile, disobedient behavior

Frequently argue with adults and authority figures

Often angry, resentful, easily annoyed

Inability to take responsibility for mistakes: places blame on others for their own transgressions or omissions

often have problems with peer relationships and in school

DO NOT display much physical aggression or violent behavior: more verbal aggression, reactive to rules and overt (shouting)

43
Q

What are the 3 major subtypes of ODD?

A

Angry/Irritable
Argumentative/Defiant
Vindictive

44
Q

What type of ODD? _____ often lose their tempers; easily annoyed; feel angry most of the time

A

angry/irritable

45
Q

What type of ODD? _____ in addition to clashing with authority, tend to engage in vengeful and spiteful behavior

A

Vindictive

46
Q

What type of ODD? _____ habitually argue with authority figures; actively refuse to comply with requests; intentionally break rules; purposely annoy others

A

Argumentative/Defiant

47
Q

What is the ages for ODD? What gender?

A

begins as young as 3, average age at onset is 6; identified by age 14

more common in males before puberty; equal post-puberty

48
Q

What is the criteria for ODD?

A
49
Q

For a pt who is younger than 5, what is the timing for ODD? 5 and older?

A

Pt < 5 y/o - Behavior should occur on most days for a period of at least 6 months

Pt 5+ y/o - Behavior should occur at least once per week for at least 6 months, unless otherwise noted

50
Q

How is the severity gauged in ODD?

A

based on the number of settings:

Mild - Symptoms are confined to only one setting

Moderate - Some symptoms are present in at least two settings

Severe - Some symptoms are present in three or more settings

51
Q

Similar to ODD, pt shows less disregard for rules/authority specifically, behavior is not deliberately antagonistic, patients show remorse after outbursts.

What am I?

A

Disruptive Mood Dysregulation Disorder

52
Q

Similar to ODD but the pt is MORE likely to have a physical aggression.

What am I?

A

Conduct Disorder

53
Q

**What is first line treatment for ODD?

A

**Family therapy and individual therapy

meds only indicated for comorbid conditions

54
Q

25% of the time ODD progresses to ____

A

Conduct disorder

may also develop mood disorders, anxiety, ADHD or learning delays

55
Q

_____ Enduring set of behaviors in a child or adolescent that evolves over time, usually characterized by aggression and violation of the rights of others. Physical aggression, destruction of property, thefts, acts of deceit and frequent violation of age appropriate rules

A

Conduct disorder

56
Q

What are some psychosocial factors that point to conduct disorder?

A

Childhood maltreatment
Harsh or punitive parenting
Family discord
Lack of appropriate parental supervision
Lack of social competence
Low socioeconomic level

57
Q

What is the MC pt with conduct disorder?

A

4-12x more common in males

typically starts in adolescence

comorb: ADHD, substance use, anxiety disorders (including PTSD), mood disorders, learning disorders

Risk factors: impulsivity, poor parental supervision, harsh/punitive parental discipline, low IQ, poor school performance; regular alcohol use

58
Q

What is the criteria for conduct disorder? **How many criteria in what time frame?

A

Pattern of behavior in which the basic rights of others or major age-appropriate societal norms or rules are violated, as determined by 3+ of the following 15 criteria in the past 12 months (at least 1 in the past 6 months):

Often bullies, threatens, or intimidates others

Often initiates physical fights

Has used a weapon that can cause serious physical harm to others

Has been physically cruel to people

Has been physically cruel to animals

Has stolen while confronting a victim

Has forced someone into sexual activity

Has deliberately set a fire with intent to cause serious damage

Has deliberately destroyed others’ property (other than by fire setting)

Has broken into someone else’s house, building, or car

Often lies to obtain goods or favors or to avoid obligations

Has stolen items of nontrivial value without confronting a victim

Often stays out a night despite parental prohibitions, beginning before age 13 years

Has run away from home overnight at least twice, or once without returning for a lengthy period

Is often truant from school, beginning before age 13 years

59
Q

What are the different types of onset for conduct disorder? Explain

A

Childhood-onset type - At least one symptom present prior to age 10

Adolescent-onset type - No symptoms present prior to age 10

Unspecified onset - Unable to clarify age at onset of symptoms

60
Q

What is the severity of conduct disorder based on?

A

Mild: few extra conduct criteria other than the ones required to make the dx cause relatively minor harm to others

Moderate: more criteria and intermediate harm to others (stealing w/o confronting a victim, vandalism)

Severe: many extra criteria and considerable harm to others

61
Q

____ is subtype of conduct disorder. What is the criteria?

A

Conduct disorder with limited prosocial emotions

must display 2+ of the following traits persistently for over 1 year, in multiple relationships and settings (need multiple information sources to verify):

Lack of remorse of guilt (lack of concern about consequences)

Lack of empathy

unconcerned about performance: blames others

shallow or deficient affect (do not express feelings or emotions)

62
Q

⅓ to ½ of all children with ADHD have comorbid ____! When are they often seen together?

A

ODD

males, children with divorced parents, and children with low socioeconomic status

63
Q

What is the treatment for conduct disorder?

A

psychotherapy: the earlier the better (kindergarden)

reinforcement of positive, prosocial behaviors

Meds: Risperidone, SSRIs, anticonvulsants

treat other comorbities (ADHD)

64
Q

Psychotherapy for Conduct disorder, helps more with ____ symptoms than ___ symptoms

A

overt (aggression) than covert (lying, stealing)

65
Q
A

Behavioral Dynamics (16 decks)

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