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(C) BD > Lecture 14: Dissociative Disorders > Flashcards

Lecture 14: Dissociative Disorders Flashcards

1
Q

Define dissociation.

A

Segregation of any group of mental processes from the rest of someone’s physiological activity.

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2
Q

What are the 5 core symptoms of dissociative disorders?

A
  • Amnesia
  • Depersonalization
  • Derealization
  • Identity Confusion
  • Identity Alteration
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3
Q

Define depersonalization.

A

Sense of detachment or disconnection from one’s self.

No longer personal.

Often described as stranger in one’s own body.
Feeling like you’re a robot or on autopilot.

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4
Q

Define derealization.

A

Sense of disconnection from familiar people or one’s surroundings.

No longer reality.

Often described as friends and work seeming unreal or unfamiliar.

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5
Q

Define identity confusion.

A

Inner struggle about one’s sense of self/identity

I don’t know who I am anymore
I don’t know which me is the real me

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6
Q

Define identity alteration.

A

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

Like split personalities

May use different names in different situations.
May have a learned skill without recollection of learning that ability.

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7
Q

What falls under dissociative disorders?

A

Dissociative amnesia
Depersonalization/Derealization disorder
Dissociative Identity Disorder

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8
Q

Define dissociative amnesia.

A

Potentially reversible memory impairment that primarily affects AUTObiographical memory (name, address, phone #).

Cannot recall personal info.

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9
Q

Define dissociative fugue.

A

Sudden unexpected travel or wandering in a dissociated state, with subsequent dissociative for the episode.

Subtype of dissociative amnesia

Usually occurs due to looking for the gaps in their memory.

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10
Q

When do we usually see dissociative amnesia?

A

Late adolescence/early adulthood

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11
Q

What is the diagnostic criteria for Dissociative Amnesia?

A
  • Inability to recall important AUTObiographical information, usually of a traumatic or stressful nature, INCONSISTENT with ordinary forgetfulness.
  • Significant distress/impairment in functioning
  • Not caused by something else (Ex: Alzheimer’s)
  • To add on dissociative fugue, must include purposeful travel or bewildered wandering associated with amnesia.

DX: Dissociative Amnesia w/ Dissociative fugue or just DA.

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12
Q

What are the 5 types of dissociative amnesia?

A
  • Localized amnesia
  • Continuous amnesia
  • Generalized amnesia
  • Selective amnesia
  • Systematized amnesia

Systematized example: failure to rememer a category of info, such as all memories related to one’s family.

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13
Q

What is the treatment of choice in dissociative amnesia?

A
  • Phase oriented psychotherapy (Standard of care)
  • Cognitive therapy
  • Hypnosis
  • Group therapy
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14
Q

What is the role of meds in dissociative amnesia?

A

No use in standard treatment.

Benzos/amphetamines/barbs can be used to facilitate interviews.

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15
Q

What are the 3 phases in phase-oriented therapy?

A
  1. Stabilization and safety
  2. Work on traumatic memories
  3. Fusion, integration, resolution, and recovery

Fusion is combining 2+ psychological entities at a point in time, w/ subjective loss of all separateness.

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16
Q

How common is depersonalization/derealization disorder (DDD)?

A

Transient is more common, but it is generally rare in general.
1-3% lifetime prevalence.

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17
Q

What is the main risk factor and comorbidities for DDD?

A

Risk factor: Chronic trauma/stressor exposure

Depression and anxiety

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18
Q

What is the diagnostic criteria for DDD?

A
  • Presence of persistent or recurrent experiences of depersonalization, derealization, or both
  • Reality testing remains intact
  • Causes distress
  • Not due to a condition/mental disorder
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19
Q

What is reality testing?

A

If you ask a patient about reality, they answer appropriately still even while under derealization.

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20
Q

How is DDD treated?

A

Refractory to treatment often.

Psychotherapy often gives mixed results.
SSRIs may be helpful.

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21
Q

Define Dissociative Identity Disorder (DID).

A

Two or more distinct selves with distinct memories, thoughts, opinions, and goals.

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22
Q

What is the common demographic for DID?

A

Women
20s-30s
PTSD (MCC)
Childhood trauma (MCC risk factor)

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23
Q

What is the diagnostic criteria for DID?

A
  • Presence of 2+ distinct identities or personality states.
  • Amnesia must occur
  • Distress/functional impairment
  • Disturbance CANNOT be due to cultural/religious practices
  • Syndrome is not due to other conditions
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24
Q

What are some signs that people may have DID?

A
  • Referring to self in first (we) or third person (they)
  • Depersonalized references
  • Referring to parts of themselves by their roles (the wife, the angry one)
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25
Q

What are the treatment options for DID?

A

Psychotherapy is a mainstay.

Pharmacotherapy is used to manage major symptoms.

ECT for refractory mood disorders. DOES NOT worsen dissociation.

26
Q

Define impulse control disorder.

A

Umbrella term for conditions related to difficulty controlling a temptation or impulse.

Often characterized by the inability to resist the impulse, desire, or drive to perform an act that is OBVIOUSLY HARMFUL.

27
Q

Name some examples of impulse control disorders.

A
  • Pyromania
  • Kleptomania
  • Pathologic gambling
  • Trichotillomania
  • Intermittent Explosive Disorder
28
Q

What impulse control disorders are more common in males? Females?

A

Males: pathological gambling and pyromania
Females: Kleptomania and trichotillomania

29
Q

What are the common symptoms criteria for pathologic gambling?

A

Persistent, recurrent maladaptive gambling behaviors
5+ gambling-related symptoms.

30
Q

What are the common symptoms of trichotillomania?

A
  • Recurrent hair pulling with noticeable hair loss.
  • Tension/anxiety before pulling it out or resisting urge.
  • Pleasure, gratification, or relief when pulling out the hair.
31
Q

What are the common symptoms of Kleptomania?

A
  • Recurrent theft of items not needed
  • Tension/anxiety before stealing
  • Pleasure, gratification, or relief when stealing
  • Stealing NOT due to anger or psychosis.
32
Q

What are the common symptoms of pyromania?

A
  • Recurrent, purposeful fire setting on MULTIPLE occasions.
  • Tension/ anxiety before or resisting the urge.
  • Pleasure after setting fire.
  • Fascinated with fire
  • Fire setting not for monetary gain or reward.
  • Must cause significant distress
  • Not accounted for by any other condition.
33
Q

What are the 5 stages of impulsivity?

A
  1. Urge
  2. Tension
  3. Act
  4. Relief
  5. Guilt
34
Q

Which impulse control disorder does not have pharmacotherapy indicated?

A

Pyromania

35
Q

Which impulse control disorder specifically does not use SSRIs? What does it use instead?

A

Trichotillomania uses TCAs over SSRIs.

36
Q

Which impulse control disorder can be treated with opiate antagonists?

A

Pathologic gambling

37
Q

Define intermittent explosive disorder (IED).

A
  • Discrete episodes of losing control of aggressive impulses.
  • Aggression is out of proportion.
  • Symptoms appear quickly and remit quickly.
  • Between episodes, pts show genuine regret.
  • Not generalized aggressiveness.
38
Q

What is the common demographic for IED?

A

Adolescent male

39
Q

What are the etiologies for development of IED?

A
  • Genetic
  • Exposure to abuse/violence
  • Brain inflammation
  • Decreased serotonergic activity
  • Hx of T. Gondii infection
40
Q

What is the diagnostic criteria for IED?

A
  • Recurrent behavioral outbursts with either verbal/physical aggression 2x a week for 3 months.
  • OR
  • 3+ behavioral outbursts with destruction of property/animals in past 12 months.
  • Aggression is grossly out of proportion.
  • No premeditation or committed to an objective
  • 6+ years old or equivalent developmental level
  • Causes distress
  • Not due to other condition.
41
Q

What is the main difference between conduct disorder and IED?

A

Conduct disorder is persistent and repetitive.

42
Q

How is IED treated?

A
  • Psychotherapy may be helpful, but it is difficult.
  • SSRIs, Anticonvulsants/mood stabilizers
  • Adjunct therapy: antipsychotics, BBs, CCBs
43
Q

Define oppositional defiant disorder.

A
  • Enduring pattern of negativistic, hostile, disobedient behavior.
  • Inability to take responsibility for their mistakes
  • Commonly have problems with peer relationships and in school
  • Typically display MINIMAL PHYSICAL AGGRESSION or VIOLENCE.
44
Q

What are the 3 major subtypes of ODD?

A
  • Angry/irritable: often lose temper, easily annoyed.
  • Argumentative: Habitually argues with authority, intentional rule breaker.
  • Vindictive: vengeful and spiteful behavior + clashing with authority.
45
Q

What is the common demographic for ODD?

A

Males before puberty, equal after.
Average age of onset is 6, with Dx at 14.

46
Q

What is the diagnostic criteria for ODD?

A
  • 6+ months with 4+ symptoms that are shown with others, NOT including a sibling.
47
Q

How does symptom frequency for ODD criteria vary depending on age?

A
  • For ages <5, behavior should occur on most days for a period for 6+ months.
  • For ages >5, beheavior should occur at least once per week for 6+ months.
48
Q

How is severity rated for ODD?

A
  • Mild: symptoms confined to 1 setting.
  • Moderate: symptoms present in 2 settings.
  • Severe: symptoms present in 3 settings.
49
Q

What can ODD progress to?

A

Conduct Disorder

25% of ODD becomes conduct disorder.

50
Q

How is ODD treated?

A

Psychotherapy is first-line therapy.
Pharmacotherapy is only indicated for comorbid conditions.

51
Q

What two types of psychotherapy are especially helpful in ODD?

A

Family therapy
Individual therapy

52
Q

What is conduct disorder?

A

Enduring set of behaviors that evolve over time, characterized by aggression and violation of the rights of others.

Physical destruction, theft, violation of age-appropriate rules.

53
Q

What psychosocial factors are associated with conduct disorder?

A
  • Childhood maltreatment
  • Harsh or punitive parenting
  • Family discord
  • Lack of appropriate parental supervision
  • Lack of social competence
  • Low socioeconomic level
54
Q

What is the common demographic for conduct disorder?

A

More common in adolescent males, but prevalence goes down 12+.

55
Q

What is the diagnostic criteria for conduct disorder?

A
  • Behavior causes functional impairment
  • Not explained by other disorders
  • 3+ of the following 15 criteria for 12+ months (1 must’ve occurred in 6 months)
  • Bullying
  • Animal cruelty
  • Destruction of property
  • Fighting
  • Out late at night
  • Running away from home
  • Actively forcing sex
  • Being cruel
  • Using a weapon
  • Setting Fires
  • Into someone’s home, building or car
  • Not going to school
  • Everyday lying/conning
  • Stealing while confronting a victim
  • Stealing without confronting a victim

Mnemonic: BAD FOR BUSINESS

56
Q

What are the 4 general categories for conduct disorder criteria?

A
  • Trespassing and theft
  • Rule Breaking
  • Aggression
  • Property Destruction

Mnemonic: TRAP

57
Q

What are the 3 onset types for conduct disorder?

A
  • Childhood onset: 1 symptom prior to age 10.
  • Adolescent onset: no symptoms prior to age 10.
  • Unspecified onset: unable to clarify age
58
Q

What are the 3 severity ratings for conduct disorder?

A
  • Mild: relatively minor harm (usually hard to Dx someone as well).
  • Moderate: intermediate harm
  • Severe: Considerable harm to others
59
Q

What is the criteria to add on “with limited prosocial emotions” to conduct disorder?

A
  • 2+ of the following traits over 1+ year in MULTIPLE relationships and settings.
  • Lack of remorse/guilt (lack of concern with consequences)
  • Callous, lack of empathy (unconcerned with others’ feelings.)
  • Unconcerned about performance (blames others usually)
  • Shallow or deficient affect (does not express feelings)
60
Q

What is the triad associated with conduct disorder?

A

ADHD often has comorbid ODD.
ODD can often progress to CD.

61
Q

How do we treat conduct disorder?

A

Psychotherapy, focusing on rewarding good behavior and early therapy.

Pharmacotherapy options
* Atypical antipsychs (resperidone)
* SSRIs
* Anticonvulsants
* Treating ADHD if present.

(C) BD (25 decks)

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