Lecture 15 (Chapter 14)

Question 1

Differences between anxiety and fear

Answer 1

Anxiety: Future oriented, mood state, feeling that one can not predict or control upcoming events
Fear: Present oriented, emotional alarm reaction to present danger, emergency “fight or flight” response

Question 2

What is a panic attack

Answer 2

Discrete period of intense fear/discomfort in which at least 4 symptoms develop abruptly and reaches a peak within 10 minutes

Question 3

Symptoms of panic attack

Answer 3

Palpitations, pounding/racing heart
Sweating
Trembling/shaking
Shortness of breath/smothering sensations
Feeling of choking
Chest pain/discomfort
Nausea or abdominal distress
Feeling dizzy, unsteady, faint or light headed
Derealization or depersonalization
Fear of losing control or going crazy
Fear of dying
Paresthesias (numbness)
Chills or hot flushes

Question 4

DSM-V anxiety disorders

Answer 4

Panic disorder with/without agoraphobia
Specific phobia
Social phobia
Generalized Anxiety disorder

Question 5

What is panic disorder

Answer 5

• recurrent unexpected panic attacks
• One month of concern about additional attacks
• Worry about the implications of the attack or its consequences
• A significant change in behaviour related to the attacks

Question 6

Agoraphobia

Answer 6

• Anxiety about being in places/situations from which escape might be difficult or embarrassing in the event of a panic attack
• Situations are avoided or endured with marked distress or anxiety about having a panic attack OR require the presence of a companion

Question 7

Typical agoraphobic situations

Answer 7

• shopping malls
• Crowds
• Elevators
• Restaurants
• Buses
• Theatres

Question 8

What is specific phobia

Answer 8

• Marked and persistent fear that is excessive or unreasonable, cued by a specific object or situation
• Exposure to the phobic stimulus almost invariably provokes an immediate anxiety response (panic attack)
• Phobic situation/object is avoided or endured with intense anxiety and distress

Question 9

Specific phobia types

Answer 9

1. Animal
2. Natural environment (heights)
3. Blood injection injury type
4. Situational (planes)
5. Other (choking, vomiting)

Question 10

Social phobia

Answer 10

• Marked and persistent fear of social or performance situations
• Situations involve exposure to unfamiliar people or to possible evaluation by others
• Individual fears that he/she may do something humiliating or embarrassing

Question 11

Obsessive - compulsive and related disorders

Answer 11

OCD - recurrent and persistent obsessions and/or compulsions
- Symptoms cause marked distress
- Time consuming (more than 1 hour/day)
- Interferes significantly with person’s normal routine

Another example is trichotillomanic and body dysmorphic disorder

Question 12

Obsessions vs compulsions

Answer 12

Obsessions
- persistent and intrusive thoughts, impulses, images
- Inappropriate, caused marked anxiety or distress
- Person usually attempts to ignore or suppress them
… OR neutralize them with some other thought or action

Compulsions
- repetitive behaviours or mental acts
- performed to prevent or reduce anxiety/distress, not to provide pleasure or gratification

Question 13

Body Dysmorphic Disorder

Answer 13

A. Preoccupation with an imagined defect in appearance, or if a slight physical anomaly is present, the person’s concern is excessive
B. Significant distress or impairment

Question 14

Stressor Related Disorders

Answer 14

PTSD: develop after an individual experiences or witnesses a traumatic event

Adjustment Disorder: when an individual experiences significant emotional or behavioral symptoms in response to a stressful or significant life event

Reactive Adjustment Disorder: type of adjustment disorder that occurs after an individual reacts emotionally or behaviorally to a significant life change or traumatic event. an emotional reaction to a life event that may not fit into the more severe categories of mental health disorders

Question 15

Mood Disorders prevalence rates

Answer 15

Lifetime prevalence rates of
depressive disorders:
13% men
25% women
Lifetime prevalence rates of bipolar disorders (not a mood disorder):
less than 1% for men and women
15% complete suicide

Question 16

Types of Mood Episodes

Answer 16

1. Major Depressive Episode
2. Manic Episode
3. Hypomanic Episode
4. Mixed Episode

Question 17

Major Depressive Episode

Answer 17

• Depressed mood
• Loss of interest (anhedonia)
• Significant weight loss or gain
• Insomnia or hypersomnia
• Psychomotor agitation or retardation
• Fatigue or loss of energy
• Worthlessness or guilt
• Diminished ability to concentrate, indecisiveness

Question 18

Manic episode

Answer 18

• Abnormally and persistently elevated, expansive, or
  irritable mood
• Inflated self-esteem and grandiosity
• Requiring very little sleep
• Talkativeness
• Flight of ideas
• Distractibiltiy
• Psychomotor agitation
• Buying sprees, sexual indiscretions, foolish business
  investments

Question 19

3. Hypomanic Episode

Answer 19

Symptoms are milder than a Manic Episode
* Less intense and last at least four days

Question 20

Mixed episode

Answer 20

Both a Major Depressive Episode and a Manic Episode nearly everyday for at least a one week period

Question 21

Major Depressive Disorder

Answer 21

• One or more Major Depressive Episodes
• No history of Manic, Hypomanic or Mixed Episodes

Dysthymic Disorder
* Less severe but more chronic than Major Depressive Disorder
* Symptoms are milder but remain unchanged over long periods of time

Question 22

Bipolar I Disorder

Answer 22

• One or more Manic or Mixed Episodes
• Often individuals have also had one or more Major Depressive Episodes

Question 23

Bipolar II Disorder

Answer 23

• Presence (or history) of one or more Major Depressive Episodes
• Presence (or history) of at least one Hypomanic Episode
• There has never been a Manic Episode or a Mixed Episode

Question 24

Cyclothymic Disorder

Answer 24

• Less severe but more chronic than Bipolar Disorder
• Symptoms of hypomania and depression are milder but remain unchanged over long periods of time

Question 25

DSM-IV specifiers

Answer 25

Specifiers: specifiers help to further refine diagnoses and ensure that treatments are tailored to the individual’s specific needs 1. Chronic 2. Psychotic 3. Melancholic 4. Atypical 5. Catatonic 6. Postpartum Onset 7. Seasonal Pattern 8. Rapid Cycling Pattern

Question 26

Somatoform Disorders:

Answer 26

– Hypochondriasis – Somatization Disorder – Conversion Disorder – Factitious Disorder – Body Dysmorphic Disorder

Question 27

Hypochondriasis DSM-IV Criteria

Answer 27

A. Preoccupation with the belief that one has a serious disease B. The preoccupation persists despite medical evaluation and reassurance C. Not delusional D. Distress or impairment E. Lasts at least 6 months

Question 28

Somatization Disorder

Answer 28

A. History of many physical complaints beginning before age 30 that result in treatment being sought or significant impairment B. Each of the following criteria must have been met: 1. Four pain symptoms 2. Two gastrointestinal symptoms 3. One sexual or reproductive symptom 4. One neurological symptom C. Symptoms cannot be fully explained by a known medical condition D. The symptoms are not intentionally produced or feigned

Question 29

Causes and treatment of somatization disorder

Answer 29

Causes: unclear, anxiety, secondary gain Treatment: gatekeeper physician, work, treatment for anxiety and depression

Question 30

Conversion Disorder

Answer 30

A. One or more symptoms or deficits affecting voluntary motor or sensory function that suggests a neurological or general medical condition B. Preceded by a conflict or stressor C. Not intentionally produced D. Cannot be fully explained by a medical condition E. Significant distress or impairment or warrants medical evaluation

Question 31

Dissociative Identity Disorder

Answer 31

A. The presence of two or more distinct identities or personality states B. At least two of these identities recurrently take control of the person’s behaviour C. Inability to recall important personal information that is too excessive to be explained by forgetfulness

Question 32

Dissociative identity disorder: Host identity, alternate identities and switch

Answer 32

Host Identity: typically the individual’s original or dominant identity, the one most often in control of the person's behavior and awareness Alternate identities: distinct, fully developed personalities or identity states within a person with DID. These identities may have their own unique characteristics, memories, preferences, behaviors, and even physiological responses Switch: A Switch is the process through which one identity transitions or shifts into another identity, taking control of the individual’s behavior and consciousness.

Question 33

Causes and treatment of Dissociative identity disorder

Answer 33

Causes: abuse, neglect, iatrogenic, feigned * Treatment: skillful therapist, build a therapeutic alliance, ground rules, reintegration: process trauma & dissociative defenses, post integration therapy

Question 34

Eating Disorders

Answer 34

* Females 10 x more likely to develop an eating disorder * Around 5% of young women will develop an eating disorder * Course and outcome of eating disorders is highly variable * Eating disorders are associated with serious complications, and have the highest mortality rate

Question 35

Schizophrenia

Answer 35

* Delusions and Irrational thought * Deterioration of Adaptive Behaviors * Hallucinations * Disturbed Emotion * Paranoid, Catatonic, Disorganized, Undifferentiated * Positive vs. Negative symptoms * Chronic, resistant to treatment

Question 36

Factitious disorder

Answer 36

Mental health condition where a person deliberately produces or exaggerates symptoms of illness to assume the sick role. This can include fabricating symptoms, falsifying medical history, or even self-harm to create symptoms. The motivation isn't for external rewards, like financial gain; instead, it often stems from a deep need for attention, care, or validation.