Foundational Concept 7A Flashcards
Needed: Biological Bases of Behavior, Personality, Motivation, Attitudes Done: Psychological Disorders
MCAT Behavioural Sciences - Psychological Disorders
Which of the following is an example of a negative symptom seen in schizophrenia?
- (Auditory) Hallucinations
- Disorganised Behavior
- Disturbance of Affect
- Delusions
Why is this a negative symptom?
3) Disturbance of Affect
Negative symptoms are the absence of normal/desired behavior
MCAT Behavioural Sciences - Psychological Disorders
During an interview with a schizophrenic patient, a psychiatrist keeps repeated what the psychiatrist says. This phenomenon is known as:
1. Echolalia
2. Ecopraxia
3. Loosening of Associations
4. Neologisms
Challenge: define each phenomenon
1) Echolalia
Echolalia (repeating another’s words)
Echopraxia (imitating another’s actions)
Loosening of Associations (disorganised thought) Neologisms (speech has no structure or involve invented words)
MCAT Behavioural Sciences - Psychological Disorders
A 42-year-old woman has always been extremely neat and tidy. She works as a secretary and stays long after normal working hours to check the punctuation and spelling of the letters she prepared during the day. Her boss referred her for counseling after she repeatedly got into fights with her coworkers. “They don’t take the job to heart,” she says. “They just joke around all the day”. The most likely preliminary diagnosis for this patient is:
1. Obsessive-compulsive personality disorder
2. Antisocial personality disorder
3. Narcissistic personality disorder
4. Borderline personality disorder
Challenge: define each PD and its cluster
1) Obsessive-Compulsive Personality Disorder
Obsessive-compulsive personality disorder (Cluster C)
-> Focusing on details, loving routine, having a sense that there is only one right way to do things, and a lack of humor
Antisocial personality disorder (Cluster B)
-> Pattern of disregard for and violations of the rights or others
Narcissistic personality disorder (Cluster B)
-> Grandiose sense of self-importance or uniqueness
Borderline personality disorder (Cluster B)
-> Pervasive instability in interpersonal behavior, mood, or self-image
MCAT Behavioural Sciences - Psychological Disorders
Which of the following is true with regard to a major depressive episode?
1. It may less than two weeks
2. It must involve thoughts of suicide or a suicide attempt
3. It may involve a decrease in sleep
4. It must involve feelings of sadness
Why?
Challenge: list all the symptoms of a major depressive episode and criteria for diagnosis
3) It may involve a decrease in sleep
Sleep disturbance is one of the nine cardinal symptoms
At least two weeks with at least five of the following symptoms:
SIG E. CAPS - > Sadness + S(sleep) + I(interest) + G(guilt) + E(energy) + C(concentration) + A(appetite) + P(psychomotor symptoms) + S(suicidal thoughts)
Symptoms must cause significant distress or impairment in functioning
MCAT Behavioural Sciences - Psychological Disorders
A 36-year-old who works from home is referred for evaluation. He is reluctant to venture out to meet with other people and rarely has people in to visit. When selected for a company-wide award, he refused to have his picture taken for the company newsletter. During an assessment, he averts his face and asks the examiner to “stop looking at me”. Although he is average in appearance, he is convinced that his face is ugly and misshapen. The most likely diagnosis for this man would be:
1. Schizophrenia
2. Obsessive-compulsive disorder
3. Body dismorphic disorder
4. Schizoid personality disorder
Why?
3) Body dysmorphic disorder
Central issue is the negative appraisal of his own appearance
MCAT Behavioural Sciences - Psychological Disorders
A young woman of unknown age is brought by Philadelphia police into the local ED for evaluation after they found her wandering in the park. She carries no purse or identification. She is unable to state her name or any details about her life, except that the name phoenix seems familiar. The police in Arizona are contacted and find a missing persons report matching the patient’s description. Based on this information, the most likely diagnosis for this patient is:
1. Depersonalisation/Derealisation Disorder
2. Dissoaciative Identity Disorder
3. Somatic Symptom Disorder
4. Dissociative amnesia with dissociative fugue
Why?
4) Dissociative Amnesia with Dissociative Fugue
Dissociative fugue is characterised by suddent travel or change in normal day-to-day activites, and occurs in some cases of dissociative amnesia. Symptoms include an inability to recall one’s past or confision about one’s identity.
MCAT Behavioural Sciences - Psychological Disorders
In addition to being a freestanding diagnosis, argoraphobia is most often seen in association with which other psychiatric diagnosis?
1. Obsessive-compulsive disorder
2. Avoidant personality disorder
3. Generalised anxiety disorder
4. Panic disorder
Why is it seen in association?
Why?
4) Panic disorder
Agoraphobia, a fear of places/situations in which it would be difficult to escape, is commonly seen in panic disorder. Concerns about having a panic attack in public may make these individuals fearful of leaving their home
MCAT Behavioural Sciences - Psychological Disorders
A 28-year-old male comes to a clinic concerned that he has pancreatic cancer. Review of his medical records show that this is the fourth time in the past year that the patient has appeared for medical attention. No identifible medical problem is found. When confronted with this history, he confesses that he feels relieved after being told all of the tests are negative, but soon becomes worried again that he has cancer. Based on this information, the most likely diagnosis for the patient would be:
1. Major depressive disorder
2. Illness anxiety disorder
3. Conversion disorder
4. Narcisstic personality disorder
2) Illness Anxiety Disorder
Illness anxiety disorder: consumed with thoughts about having/developing a serious medical condition
MCAT Behavioural Sciences - Psychological Disorders
A physician is attempting to diagnose a patient’s mental disorder based on a set of symptoms. The confirmed symptoms currently include appetite disturbance, substantial weight change, decreased energy, a feeling of worthlessness, and excessive guilt.
What two disorders could these symptoms indicate?
1. Major depressive disorder and bipolar disorders
2. Dissociative amnesia and depersonalisation/derealisation disorder
3. Alzheimer’s disease and Parkinson’s disease
4. Specific phobia and panic disorder
What should a physician ask about to distinguish between the two possible disorders?
1. Whether the patient has amnesia
2. Whether the patient has also had manic episodes
3. Whether the patient is irrationally afraid of anything
4. Whether the patient has experienced difficulty performing familiar tasks
Why?
1) Major depressive disorder and bipolar disorders
2) Whether the patient has also had manic episodes
Both have depressive episodes. Bipolar also has manic episodes
MCAT Behavioural Sciences - Psychological Disorders
A mother notices that her teenage son seems to have a phobia for snakes. In the past week, on several occasions, the teenager has had more severe symptoms than usual, without seeing or thinking about a snake. Which disorder could cause this reaction?
1. Schizophrenia
2. Antisocial personality disorder
3. Obsessive-compulsive disorder
4. Panic disorder
4) Panic disorder
Signs of panic and irrational fear without any instigating object present indicates panic disorder.
MCAT Behavioural Sciences - Psychological Disorders
Splitting is a defense mechanism typically seen with which personality disorder?
1. Antisocial personality disorder
2. Borderline personality disorder
3. Histrionic personality disorder
4. Narcissistic personality disorder
What is splitting?
2) Borderline personality disorder
Consideration of others as “all good” or “all bad”
MCAT Behavioural Sciences - Psychological Disorders
A woman comes to the doctor with a two-week history of complete paralysis of her left arm. She has no injury to the extremity, and full neurological workup fails to demonstrate any underlying cause. She seems surprisingly unconcerned about the paralysis, and seems more worried about an argument she had one month ago in which she hit her daughter. Based on this information, the woman’s most likely diagosis is:
1. Conversion disorder
2. Generalised anxiety disorder
3. Ilness anxiety disorder
4. Histironic personality disorder
Why?
1) Conversion disorder (w/ la belle indifférence)
Conversion disorder: unexplained symptoms affeted voluntary motor or sensory symptoms
MCAT Behavioural Sciences - Psychological Disorders
A woman notices her father has started to move his fingers in such a way that it looks like he is rolling something, despite nothing actually being there. She also notes slowed movement and a shuffling gait. Which neurotransmitter is likely to be present in decreased levels in her father’s brain?
1. Epinephrine
2. Histamine
3. Dopamine
4. Serotonin
3) Dopamine
Likely has Parkinson’s disease, which is caused by decreased dopamine production in the substantia nigra (responsible for motor movement)
MCAT Behavioural Sciences - Psychological Disorders
Which of the following is/are true regarding bipolar disorders?
A. They have little, if any, genetic heritability
B. They are associated with increased levels of serotonin in the brain
C. They all require at least one depressive episode for diagnosis
- A only
- B only
- A and C only
- B and C only
Why?
- They are associated with increased levels of serotonin in the brain
They are highly heritable and are associated with increased levels of norepinephrine and serotonin in the brain.
Bipolar I doesn’t require a major depressive episode (only a manic episode). Bipolar II requires at least one hypomanic episode and one major depressive episode. Cyclothymic disorder has at least one hypomanic episode an dysthymia (milder, but long-lasting form of depression)
MCAT Behavioural Sciences - Psychological Disorders
List and define each Cluster A personality disorder (3)
- Paranoid: pervasive distrust of others
- Schizotypal: pattern of odd or eccentric thinking
- Schizoid: pervasive pattern of detachment from social relationships and a restricted range of emotional expression
MCAT Behavioural Sciences - Psychological Disorders
List and define each Cluster B personality disorder (4)
- Antisocial: pattern of disregard for and violations of the rights of others
- Borderline: pervasive instability in interpersonal behaviour, mood, and self-image
- Histrionic: constant attention-seeking behaviour
- Narcisstic: grandoise sense of self-importance or uniqueness
MCAT Behavioural Sciences - Psychological Disorders
List and define each Cluster C personality disorder (3)
- Avoidant: extreme shyness and fear of rejection
- Dependent: continuous need for reassurance
- Obsessive-Compulsive: perfectionistic and inflexible, tending to like rules and order
MCAT Behavioural Sciences - Psychological Disorders
Define a delusion and the five common examples
Delusion: false beliefs discordant with reality
1. Reference: common elements in the environment are directed toward the individual
2. Persecution: person is being deliberately interfered with, discriminated against, plotted against, or threatened
3. Grandeur: person is remarkable in some significant way
4. Thought Broadcasting: thoughts are broadcast to the external world
5. Thought Insertion: thoughts are being placed in their head
MCAT Behavioural Sciences - Psychological Disorders
What are five common anxiety disorders and how can they be identified?
- Generalised Anxiety Disorder: persistent worry and tension
- Panic Disorder: repeated panic attacks
- Social Anxiety Disorder: fear and avoidance of social situations
- Obsessive Compulsive Disorder: intrusive thoughts and repetitive behaviours
- Agoraphobia: fear of being in places of situations where it might be hard for an individual to escape
MCAT Behavioural Sciences - Psychological Disorders
What are the four types of symptoms associated with PTSD?
What is the difference between PTSD and acute stress disorder?
Intrusive (recurrent reliving of the event)
Avoidance (deliberate attempts to avoid the memories)
Negative Cognitive (inability to recall key features of the event, negative mood/emotions, feeling distanced from others, persistent negative view of thr world)
Arousal (increased startle response, irritability, anxiety, reckless behaviour, sleep disturbances)
PTSD requires symptoms to last more than a month.
MCAT Behavioural Sciences - Psychological Disorders
What are three common somatic symptom disorders and how can they be identified?
Somatic Symptom Disorder: at least one somatic symptom that is accompanied by disproportionate concerns about its seriousness
Illness Anxiety Disorder: consumed thoughts about having/developing a serious medical condition
Conversion Disorder: unexplained symptoms affected by voluntary motor or sensory symptoms
MCAT Behavioural Sciences - Psychological Disorders
How do you differentiate between bipolar I, bipolar II, and cyclothymic disorder?
Bipolar I - manic episodes with or without major depressive episodes
Bipolar II - hypomania with at least one major depressive episode
Cyclothymic - combination of hypomanic episodes and periods of dysthymia
MCAT Behavioural Sciences - Psychological Disorders
What are three depressive disorders and their identifiers?
- Major Depressive Disorder: mood disorder characterised by one major depressive episode (SIG E. CAPS)
- Persistent Depressive Disorder: dythymia most of the time for at least two years
- Seasonal Affective Disorder: best characterised as MDD with seasonal onset (not freestanding in the DSM-5)
MCAT Behavioural Sciences - Psychological Disorders
What are the nine key symptoms of major depressive disorder?
SIG E. CAPS
(Sadness +) Sleep + Interest + Guilt + Energy + Concentration + Appetite + Psychomotor Symptoms + Suicidal Thoughts
MCAT Behavioural Sciences - Psychological Disorders
What are three dissociative disorders and their identifiers?
Challenge: What is a dissociative fugue?
Dissociative Amnesia: inability to recall past experiences
Dissociative Identity Disorder: two or more personalities that take control of a person’s behaviour
Depersonalisation/Derealisation Disorder: feels detached from their own mind and body (depersonalisation) and their surroundings (derealisation)
MCAT Behavioural Sciences - Psychological Disorders
What is the diagnostic criteria for schizophrenia?
Delusions, hallucinations, disorganised thought, disorganised behaviour, disturbance of affect, avolition
At least two of these symptoms for at least six months. One of which must be delusions, hallucinations, or disorganised speech.
MCAT Behavioural Sciences - Psychological Disorders
What are the two approaches to understanding psychological disorders?
Biomedical -> any disorder has roots in biomedical disturbances so solution should also be of a biomedical nature
Biopsychosocial -> assumes there are biological, psychological, and social components
MCAT Behavioural Sciences - Psychological Disorders
Define Concordance Rate (in respect to psychological disorders)
The probability that a person with a particular familial relationship to the patient has the same disorder as the patient
MCAT Behavioural Sciences - Psychological Disorders
Define Point Prevalence (in respect to psychological disorders)
The percentage of people in a given population who have a given psychological disorder at any particular point in time
MCAT Behavioural Sciences - Psychological Disorders
Define Lifetime Prevalence (in respect to psychological disorders)
The percentage of people in a certain population who will have been given a psychological disorder at any point in their lives
MCAT Behavioural Sciences - Psychological Disorders
What are the biological bases of Parkinson’s and Alzheimer’s disease?
Parkinson’s: decreased dopamine production in the substantia nigra
Alzheimer’s: abnormal build-up of proteins (beta-amyloid and tau) in and around brain cells
MCAT Behavioural Sciences - Psychological Disorders
What are the two proteins implicated in Alzheimer’s disease, and how do they form?
- Beta-amyloid: Forms plaques outside neurons.
- Tau: Forms tangles inside neurons.
MCAT Behavioural Sciences - Psychological Disorders
What are the biological bases of depression and schizophrenia?
Depression - alterations in neurotransmitter levels, particularly serotonin, norepinephrine, and dopamine.
Schizophrenia - interplay of genetic, neurodevelopmental, and environmental factors. Excessive dopamine activity in certain brain regions
MCAT Behavioural Sciences - Psychological Disorders
What structural changes are associated with depression?
Depression: reduced volume of the hippocampus and prefrontal cortex, decreased myelination
MCAT Behavioural Sciences - Psychological Disorders
What structural changes are associated with schizophrenia?
Schizophrenia: enlarged ventricles, decreased gray matter volume in the frontal and temporal lobes, hippocampus and thalmus. Abnormalities in white matter tracts, including the corpus callosum
MCAT Behavioural Sciences - Psychological Disorders
What structural changes are associated with Alzheimer’s disease?
Alzheimer’s: formation of beta-amyloid plaques and neurofibrillary tangles. Progressive atrophy of the hippocampus and cortical regions involved in memory/cognition, and enlargment of the ventricles
MCAT Behavioural Sciences - Psychological Disorders
What structural changes are associated with Parkinson’s disease?
Parkinson’s: degeneration of the dopamine-producing neurons in the substantia nigra, and atrophy of the basal ganglia.
MCAT Behavioural Sciences - Psychological Disorders
Define and List 4 Positive Symptoms
Positive symptoms add something to behaviour, cognition, or affect.
Delusions (false beliefs discordant with reality)
Hallucinations (perceptions that are not due to external stimuli)
Disorganised thought (loosening of associations)
Disorganised behavior (inability to carry out activities of daily living)
MCAT Behavioural Sciences - Psychological Disorders
Define and List 2 Negative Symptoms
Negative symptoms are the loss of something from behaviour, cognition, or affect.
Disturbance of affect (expression of emotions)
Avolition (decreased engagement in purposeful, goal-directed actions)
MCAT Behavioural Sciences - Psychological Disorders
Criteria for Major Depressive Disorder
At least one major depressive episode
MCAT Behavioural Sciences - Psychological Disorders
Criteria for a Depressive Episode
(Sadness +) SIG E. CAPS
Sleep, Interest, Guilt, Energy, Concentation, Appetite, Psychomotor Symptoms, Suicidal Thoughts
MCAT Behavioural Sciences - Psychological Disorders
Criteria for Persistent Depressive Disorder
Dysthmia for at least two years that does not meet the criteria for major depressive disorder
MCAT Behavioural Sciences - Psychological Disorders
Criteria for Seasonal Affective Disorder
Major depressive disorder (at least one major depressive episode) with seasonal onset (winter)
MCAT Behavioural Sciences - Psychological Disorders
Criteria for Bipolar I Disorder
At least one manic episode
MCAT Behavioural Sciences - Psychological Disorders
Criteria for Bipolar II Disorder
At least one hypomanic episode and at least one major depressive episode
MCAT Behavioural Sciences - Psychological Disorders
Criteria for Cyclothymic Disorder
Hypomanic episodes with dysthymia
MCAT Behavioural Sciences - Psychological Disorders
List five common types of anxiety disorders
Generalised anxiety disorder, specific phobias, social anxiety disorder, agoraphobia, and panic disorder
MCAT Behavioural Sciences - Psychological Disorders
Criteria for Generalised Anxiety Disorder
Disproportionate and persistent worry about many things for at least six months
MCAT Behavioural Sciences - Psychological Disorders
Criteria for a Specific Phobia
Irrational fear of a specific object or situation
MCAT Behavioural Sciences - Psychological Disorders
Criteria for Social Anxiety Disorder
Anxiety due to social or performance situations
MCAT Behavioural Sciences - Psychological Disorders
Criteria for Agoraphobia
Fear of places or situations where it is hard for an individual to escape
MCAT Behavioural Sciences - Psychological Disorders
Criteria for Panic Disorder
Recurrent panic attacks: intense, overwhelming fear and sympathetic nervous system activity with no clear stimulus
MCAT Behavioural Sciences - Psychological Disorders
Criteria for Obsessive-Compulsive Disorder
Obsessions - persistent, intrusive thoughts and impulses.
Compulsions - repetitive tasks that relieve tension but cause significant impairments in a person’s life
MCAT Behavioural Sciences - Psychological Disorders
Criteria for Body Dysmorphic Disorder
An unrealistic negative evaluation of one’s appearance or a specific body part
MCAT Behavioural Sciences - Psychological Disorders
Criteria for Dissociative Amnesia
Severe forms may induce ___
Inability to recall past experience without an underlying neurological disorder
Dissociative fugue - a sudden change that may involve the assumption of a new identity
MCAT Behavioural Sciences - Psychological Disorders
Criteria for Dissociative Identity Disorder
The occurance of two or more personalities that take control of a person’s behaviour
MCAT Behavioural Sciences - Psychological Disorders
Criteria for Depersonalisation / Derealisation Disorder
Feelings of detatchment from the mind andf body, or from the environment
MCAT Behavioural Sciences - Psychological Disorders
Criteria for Somatic Symptom Disorder
At least one somatic symptom, which may or may not be linked to an underlying medical condition, that causes disproportionate concern
MCAT Behavioural Sciences - Psychological Disorders
Criteria for Illness Anxiety Disorder
Preoccupation with thoughts about having, or coming down with, a serious medical condition
MCAT Behavioural Sciences - Psychological Disorders
Criteria for Conversion Disorder
Unexplained symptoms affecting motor or sensory function and is associated with prior trauma
MCAT Behavioural Sciences - Psychological Disorders
Criteria for Personality Disorders
Patterns of inflexible, maldaptive behabiour that cause distress or impaired functioning in at least of: cognition, emotions, interpersonal functioning, or impulse control
MCAT Behavioural Sciences - Psychological Disorders
Criteria for each of the Cluster A Personality Disorders (3)
Paranoid - pervasive distrust and suspicion of others.
Schizotypical - ideas of reference, magical thinking, and eccentricity
Schizoid - detachment from social relationships and limited emotion
MCAT Behavioural Sciences - Psychological Disorders
Criteria for each of the Cluster B Personality Disorders (4)
Antisocial - disregard for the rights of others
Borderline - instability in relationships, mood, and self-image. Includes splitting (characterising people as 100% good or 100% bad).
Histironic - constant attention-seeking behaviour
Narcisstic - grandoise sense of self-importance and need for admiration
MCAT Behavioural Sciences - Psychological Disorders
Define Splitting
Which disorder is it associated with?
Seeing somebody as 100% good or 100% bad (very black-and-white)
Borderline Personality Disorder
MCAT Behavioural Sciences - Psychological Disorders
Criteria for each of the Cluster C Personality Disorders (3)
Avoidant - extreme shyness and fear of rejection
Dependent - continuous need for reassurance
Obsessive-Compulsive - perfectionism, inflexibility, and preoccupation with rules
MCAT Behavioural Sciences - Psychological Disorders
Characteristics of each personality disorder cluster
Cluster A - odd, eccentric, “weird”
Cluster B - dramatic, emotional, erratic, “wild”
Cluster C - anxious, fearful, “worried”
MCAT Behavioural Sciences - Psychological Disorders
Biological Basis of Schizophrenia (5)
Genetic factors, birth trauma, adolescent marijuana use, and family history. There are high levels of dopaminergic transmission
MCAT Behavioural Sciences - Psychological Disorders
Biological Basis of Depression (4)
High levels of glucorticoids and low levels of norepinephrine, serotonin, and dopamine
MCAT Behavioural Sciences - Psychological Disorders
Biological Basis of Bipolar Disorders (3)
High levels of norepinephrine and serotonin. Highly heritable.
MCAT Behavioural Sciences - Psychological Disorders
Biological Basis of Alzheimer’s Disease (5)
Genetic factors, brain atrophy, decreased in acetylcholine, senile plaques of beta-amyloid, and neurofibrillary tangles of hyperphosphorlated tau protein
MCAT Behavioural Sciences - Psychological Disorders
Biological Basis of Parkinson’s Disease (1)
List the six key symptoms of Parkinson’s Disease
Decreased production of dopamine by cells in the substantia nigra (plays a role in motor movement)
Bradykinesia, resting tremor, pill-rolling tremor, masklike facies, cogwhell rigidity, and a shuffling gait
MCAT Behavioural Sciences - Psychological Disorders
Define Echolalia
Repeating another’s words
MCAT Behavioural Sciences - Psychological Disorders
Define Echopraxia
Imitating another’s actions
MCAT Behavioural Sciences - Psychological Disorders
Define Neologisms
Speech that has no structure or involves invented words
MCAT Behavioural Sciences - Personality
Define the Psychoanalytic Theory of Personality
Which psychoanalysts support this theory?
Personality is the result of unconscious urges and desires
Freud - the ego (mediator between the id, superego, and conscious mind) uses defense mechanisms to reduce stress caused by the urges of the id (basic urges of survival and reproduction) and superego (idealist and perfectionist).
Jung - collective unconscious links all humans together and personality is influenced by archetypes
Others, such as Adler and Horney, claim the unconscious is motivated by social rather than sexual urges (Freud’s proposal)
MCAT Behavioural Sciences - Personality
Define the Humanistic Theory of Personality
Name two major concepts that stem from the humanistic theory
Emphasises the internal feelings of healthy individuals as they strive toward happiness and self-realisation
Maslow’s heirarchy of needs and Rogers’s therapeutic approach of unconditional positive regard
MCAT Behavioural Sciences - Personality
Define the Trait Theory of Personality
MCAT Behavioural Sciences - Personality
Define the Social Cognitive Theory of Personality
What is the key phrased used in this theory?
Individuals interact with their environment in a cycle called reciprocal determinisim.
People mold their environments according to their personalities, and those environments in turn shape our thoughts, feelings, and behaviours.
Reciprocal Determinism
MCAT Behavioural Sciences - Personality
Define the Behaviourist Theory of Personality
Personality can be described as the behaviours one has learned from prior rewards and punishments
MCAT Behavioural Sciences - Personality
Define the Biological Theory of Personality
Personality (behaviour) can be explained as a result of genetic expression
