Mental Disorders - Disorders / Criteria Flashcards

Question

Schizophrenia - Symptoms Changes in self-experience

Answer 1

Thought insertion - 'thoughts come into my mind from outer space' Thought withdrawal - 'it doesn't allow me to think about what i want to think about. it blocks my mind' Delusions of control - 'they inserted a computer in my brain - it makes me turn to the left or the right' Somatic passivity experiences - 'i have tingling feelings in my legs caused by electric currents from an alternator' Made emotions - 'it puts feelings into me: joy, happiness, embarrassment, depression. it just puts it in and i feel the glow spread over me

Answer 2

- involves a disturbance of speech, communication or content of thought - poverty of thought, flight of ideas, perseveration, loosening of associations, neologisms - unusual or dysfunctional ways of thinking - P has trouble organizing their thoughts or connecting them logically

Answer 3

Prevalence - fairly uniform across regions and cultures - 0.5 - 1% - social and cultural factors may influence diagnosis? Age of onset - between 16-35 Lower social class and IQ - not really influential factors but higher proportions of lower social class P's and harsh effect on IQ MZ concordance = 50% DZ concordance = 17% Non-twin siblings = 9%

Answer 4

More likely for no remission (no ending of symptoms) vs remission Lots of studies show that no remission is much higher than remission

Answer 5

- 25 year follow up study - ScZ vs Mood disorder - 2, 4.5, 7.5, 10, 15, 20 years - mood was always higher than ScZ - longer follow up periods - better complete recovery (normally?)

Answer 6

- introduction of second-generation anti-psychotic drugs - affected mortality of ScZ P's - examined the LT contributions of anti-psychotics to mortality - found that LT treatment with anti-psychotics is associated with lower mortality compared to no A-P use Clozapine - lower mortality than other drugs!

Answer 7

Distinct period of abnormally & persistently elevated, expansive or irritable mood lasting at least 1 week (or any duration is hospitalization is necessary) During mood disturbance, three or more of the following have persisted and present to a significant degree - inflated SE, decreased need for sleep, more talkative than usual, subjective experience that thoughts are racing, distract-ability, increase in goal-directed activities, excessive involvement in pleasurable activities that have a high potential for painful consequences Symptoms don't meet criteria for a mixed episode Mood disturbance is severe enough to cause marked impairment in occupational functioning or in usual activities OR to necessitate hospitalization to prevent harm to self or others Symptoms are not due to direct physiological effects of a substance or a general medical condition

Answer 8

Core Symptom - elevated mood (but may be irritable and suspicious instead) Important symptoms for diagnosis - over activity - pressured speech - decreased need for sleep - inflated self esteem - flight of ideas - distract-ability - reckless spending and other pleasurable activities with likely adverse consequences Criteria - distinct period for at least one week plus other symptoms

Answer 9

Core Symptom - elevated mood (but may be irritable and suspicious instead) Important symptoms for diagnosis - over activity - pressured speech - decreased need for sleep - excessive optimism - inflated self esteem - flight of ideas - distract-ability - perceptual disturbance - extravagant or inappropriate behavior - reckless spending and other pleasurable activities with likely adverse consequences

Answer 10

Alternation between episodes of depression and mania - periods of recovery in between - Kraeplin > a manic episode is defined groundlessly and abnormally elevated mood - additionally, increased energy - over-activity, fast talking, decreased need for sleep - also common for loss of social inhibition & inflate SE

Answer 11

Can occur with or without frank psychotic symptoms - if they are present, can include grandiose, religious or persecutory delusions Many BD P's don't experience psychotic symptoms but it is commonly classified as an affective psychosis Some P's with BD only have recurrent manic episodes without intervening depressive episodes

Answer 12

- less common than unipolar depression - lifetime prevalence is approximately 1% - peak age of onset - adolescence through early 20's (red flag if manic episode onset is after 40 years!) - commonly between 15-30 years - M are equally as affected as W Bipolar II disorder - more common - approximately 5% lifetime prevalence - milder form OR separate disease?

Answer 13

- rare for them to be singular events - 90% are followed by further manic episodes (which equals diagnosis) - these often alternate with depressive episodes - pattern - regular to the P

Answer 14

Manic - median = 4 months | Depressive - median = 6 months

Answer 15

BD - can lead to cognitive decline and residual states BD P's who have 4+ episodes in the course of one year: - fulfill 'rapid cycling' criteria - have a poorer prognosis than those with fewer episodes and longer periods of remission Seasonal variation - depression - more common in Spring and Autumn - mania - more common in Summer

Answer 16

Much stronger for bipolar than unipolar disorders! Specific genetic association - not been consistently replicated - family studies have found a particularly strong genetic associated for BD - first degree relatives of P's with BD - 5-10x increased risk of developing compared to general population Concordance for MZ = 60% Relatives of BD P's also have an increased risk of developing other affective disorders: - Bipolar II, recurrent depressive, schizoaffective disorder

Answer 17

CLINICAL SYNDROME - characterized by low mood - lack of pleasure and even interest in normally enjoyable activities - lack of motivation or drive - variety of non-specific symptoms associated - disturbed sleep, difficulty concentrating, loss of appetite - normally quite slow and unresponsive - sometimes can be quite agitated? - severe episodes - wracked by thoughts of guilt and hopelessness - suicidal thoughts - may or may not act upon them - single most common cause of suicide!

Answer 18

``` Symptoms * Depressed mood * Loss of interest and enjoyment * Increased fatigue Reduced concentration and attention Ideas of guilt and unworthiness Ideas or acts of self-harm or suicide, thoughts of death Sleep disturbance Disturbed appetite / weight change Pessimistic view of the future Reduced SE and self-confidence ``` Features associated with somatic (ICD-10) or melancholic syndrome (DSM-IV) - early morning awakening - mood worse in the morning - psycho motor retardation or agitation - weight loss - loss of libido * = most typical symptoms

Answer 19

``` MILD = two typical and two other symptoms MODERATE = two typical and three or four others SEVERE = three typical and four or more others ```

Answer 20

Diagnosis is based on the presence of a sufficient number of symptoms that commonly co-occur - depressive episodes - part of a long-term pattern of affective changes - up to 90% of P's with one episode will experience another Normally there are intervals of recovery between episodes BUT - Dysthymia - milder form of low mood often accompanied by feeling tired and exhausted - chronic?

Answer 21

Five (or more) of the following symptoms have been present during the same 2 week period and represent a change from previous functioning At least one of the symptoms is either: 1) Depressed mood 2) Loss of interest or pleasure *do not include symptoms that are clearly due to general medical conditions, mood-incongruent delusions or hallucinations*

Answer 22

Depressed mood most of he day, nearly every day as indicated by either subjective report or observation made by others (note in children or adolescents - can be irritable mood) Markedly diminished interest or pleasure in all, or almost all activities of the day, nearly every day (subjective account or observation by others) Significant weight loss when not dieting or weight gain or decrease/increase in appetite nearly every day (in kids - consider failure to make expected weight gains) Insomnia or hypersomnia nearly every day Psychomotor agitation or retardation nearly every day - observed by others, not merely subjective feelings of restlessness or being slowed down Fatigue or loss of energy nearly every day Feelings of worthlessness or excessive or inappropriate guilt (which may be delusional) nearly every day (not merely self-reproach or guilt about being sick) Diminished ability to think or concentrate or indecisiveness, nearly every day (subjective account or observed by others) Recurrent thoughts of death (not just fear of dying), recurrent suicidal ideation without a specific plan, or a suicide attempt or a specific plan for committing suicide

Answer 23

5-25% (DSM-IV-TR, 2000) - 70% of cases - depression persists for about 1 year - 15% of us suffer from depression at some point during their lifetime - typically lasts 4-8 months - frequently people relapse!

Answer 24

- it is a major public health problem in industrialised countries - growing problem in the developing world WHO - every year about 120 people throughout the world suffer from depression - only 25% of these have access to effective treatment

Answer 25

Most family studies of recurrent or unipolar disorder found a relative risk for UD in first degree relatives of 1.5-3 - weaker genetic contribution than other disorders - Common and moderately heritable - Recurrence and early age of onset characterise the cases with greatest familial risk Earlier age of onset: - (before 30) have a higher likelihood of suffering from UD too - genetic liability leads to earlier onset? - associated with higher rates of relatives with alcoholism - weak genetic association?

Answer 26

Twin studies - shared environment plays a small role | Estimates of 37% + for heritability

Answer 27

Small positive associations have been suggested between the polymorphism in the serotonin transporter promotor regions (5-HTTLPR) and: - bipolar, suicidal behaviour, depression related personality traits - not MDD yet!

Answer 28

- overlaps with the neuroticism (personality dimension) with regards to genetic susceptibilities - useful quantitative trait or endophenotype

Answer 29

A genetic predisposition, individual stressors and other aspects of the person's unique environment play equally important parts

Answer 30

"An enduring pattern of inner experience and behaviour that deviates markedly from the expectations of the individuals culture, is pervasive and inflexible, has an onset in adolescence or early adulthood, is stable over time and leads to distress or impairment"

Answer 31

The pattern is manifested in two (or more) of the following areas: (1) Cognition - i.e. ways of perceiving & interpreting self, other people and events (2) Affectivity - i.e. the range, intensity, liability and appropriateness of emotional response (3) Interpersonal functioning (4) Impulse Control B. The enduring pattern is inflexible & pervasive across a broad range of personal and social situations C. The enduring pattern leads to clinically significant distress or impairment in social, occupational or other important areas of functioning D. The pattern is stable and of long duration & its onset can be traced back at least to adolescence or early adulthood

Answer 32

Both take a categorical approach to personality disorders Assume that groups of commonly coinciding symptoms yield qualitatively distinct syndromes

Answer 33

- Based on the symptoms that are present in addition to the general criteria - Recognises 10 different personality disorders which are grouped into 3 clusters - Cluster A, B and C

Answer 34

'Odd-Eccentric' Paranoid Personality Disorder Schizoid Personality Disorder Schizotypal Personality Disorder

Answer 35

Characterised by irrational suspicions and mistrust of others 0.5 - 2.5%

Answer 36

Lack of interest in social relationships, see no point in sharing time with others, anhedonia, introspection Less than 1%

Answer 37

Characterised by odd behaviour or thinking Ideas of reference, odd beliefs, unusual perceptual experience, odd speech / behaviour 3%

Answer 38

'Dramatic, Emotional or Erratic' Antisocial Personality Disorder Borderline Personality Disorder Histrionic Personality Disorder Narcissistic Personality Disorder

Answer 39

Pervasive disregard for the rights of others, lack of empathy and (generally) a pattern or regular criminal activity Deceitfulness, impulsivity, aggressiveness, recklessness, lack of remorse 3% in Males, 1% in Females

Answer 40

Extreme 'black & white' thinking, instability in relationships, self-image, identity & behaviour often leading to self-harm and impulsivity Affective instability, anger, feels empathy, dissociative symptoms 3% in Females, 1% in Males

Answer 41

Pervasive attention-seeking behaviour including appropriate seductive behaviour and shallow or exaggerated emotions Centre of attention, suggestibility 2-3%

Answer 42

A pervasive pattern of grandiosity, need for admiration and a lack of empathy Characterised by self-importance, pre-occupations with fantasies, belief that they are special, including a sense of entitlement and a need for excessive admiration and extreme levels of jealousy & arrogance Less than 1%

Answer 43

'Anxious-Fearful' Avoidant Personality Disorder Dependent Personality Disorder Obsessive-Compulsive Disorder

Answer 44

Pervasive feelings of social inhibition & social inadequacy, extreme sensitivity to negative evaluation and avoidance of social interaction Preoccupation with criticism, inhibition when making new contacts, inferior self-image, low risk taking 0.5 - 1%

Answer 45

Pervasive psychological dependence on other people Doesn't take responsibility, needs for reassurance, lack of confidence in own judgements, actions & opinions, needs company, submissive & clingy behaviour Unknown %

Answer 46

Not the same as OCD - personality!!!! Characterised by rigid conformity to rules, moral codes and excessive orderliness Perfectionism, dedication to work, conscientiousness, lack of flexibility and efficiency 1%