Psyc 507 – Psychopathology Flashcards
ADHD
diagnosed on Axis I, this is a developmental disorder marked by an inability to focus attention, overactive and impulsive behavior, or both. The primary cause of ADHD is thought to be biological, possibly relating to the frontal lobes of the brain.
Children with this disorder may have school difficulties as a result of their inability to focus and hyperactivity. ADHD is typically treated with stimulant medications and behavioral therapy.disorder often appears before child starts school…many children show a lessening of symptoms as they move into mid-adolescence …adults with ADHD may continue to have interpersonal problems and substance abuse issues
Ex:Sam is referred to counseling for constantly disrupting class by talking excessively and interrupting the teacher, poor grades, will not sit or stay still, and annoys other kids by interrupting their games, symptoms are suggestive of ADHD.The therapist uses behavioral therapy to reduce impulsivity, hyperactivity, and improve attention skills.
Anxiety Disorders
diagnosed on Axis I, these are a group of disorders in the DSM characterized by anxiety (emotional/physiological response to an anticipated or imagined danger) and avoidance of anxiety-provoking stimuli. Includes GAD, OCD, PTSD, panic disorder, and phobias.
Anxiety disorders are typically treated with medication (benzodiazopenes and SSRIs) and CBT (exposure therapy). Often overlaps with mood disorders.
Melanie came to therapy presenting problems with anxiety and cleanliness. She had recently moved to NYC and had become obsessed with washing her hands after she touched something in public. Melanie stated that after she touched something in public she had the urge to wash her hands and was unable to focus on absolutely anything else until she did so. She estimated that she spent approx. 4 hours each day finding a restroom and washing her hands. The therapist diagnosed Melanie with OCD, as she recognized that she was obsessed with washing her hands, had tried to suppress the urge to wash her hands, but then was overcome with the compulsion to wash her hands.
Assessment interview
(Component of Clinical Assessment) is an initial interview in which the counselor is gathering information about the patient and beginning to form a conceptualization of their case and their particular problems. Interviews may be structured, in which case a certain order of questions is strictly adhered to, or they may be unstructured, in which the interviewer is free to follow their own course of questioning. Structured interviews are generally more reliable and valid, but lack the freedom of unstructured interviews to pursue a topic of interest or an instinct the interviewer has.
Patient enters therapy with depression and anxiety. Therapist uses a mix of structured and unstructured techniques for the assessment interview. This allowed him to obtain broad picture of the problem through the use of the structured questions as well as the freedom to explore areas of interest with the unstructured questions
Axis I vs. Axis II
the first two axes of a DSM multi-axial diagnosis.
Axis I : extensive list of clinical syndromes that typically cause significant impairment. Most common are anxiety disorders & mood disorders not necessarily lifelong, often cause more pain and discomfort for individuals rather than the people around them ex: depression, schizophrenia, social phobia
. Axis II: long-standing problems that are frequently overlooked in the presence of the disorders on Axis I. They are also difficult to treat. On Axis II are personality disorders and mental retardation.
Axis II disorders tend to be more lifelong, are harder to treat and often (especially in the case of personality disorders) cause more distress for the people around the individual suffering from one than to the individual themselves.
Ex: Austin came into therapy presenting issues with anxiety. After her first couple of sessions the therapist also noted symptoms of borderline personality disorder. In her notes the therapist noted that Austin had an Axis I diagnosis of generalized anxiety disorder and an Axis II diagnosis of borderline personality disorder. First to treat would be the Axis I disorder.
Bipolar I vs Bipolar II
originally diagnosed by Kraeplin and called manic depressive psychosis, bipolar disorder is a mood disorder diagnosed on Axis I that is characterized by alternating periods of depression and mania or by mania alone.
In Bipolar I, the person has at least one episode of full mania, characterized by Sustained mood that is elevated (heightened), expansive (grand, superior) or irritable, Mania may include psychotic symptoms (delusions and hallucinations). Manic episodes often alternate with major depressive episodes.
In Bipolar II, the person experiences periods of hypomania, a less severe form of mania, that alternate with major depressive episodes. (No psychotic symptoms)
Ex: Client was hospitalized for manic episode-she was frantically pacing, did not sleep for days, and held the belief that she was God. During interview client says she has never felt better in her life. A few days later the client’s mood had totally turned. She was irritable, slow in speech, lethargic and questioning the reason of living any longer. Therapist diagnoses with Bipolar I Disorder.
Case study
a type of research in which one takes an in-depth look at one individual and their history, difficulties, and symptoms.
Strengths: provides detailed info, provides insight for further research, may offer tentative support to a theory, offer opportunities to study unusual problems that don’t occur regularly enough to allow for a large # of observations, helpful in studying disorders that are very rare.
Limitations: can’t generalize the results to the wider population, researcher’s own subjective thoughts/biases can influence the case study, difficult to replicate, time consuming
EX: Client in therapy is Diagnosed with DID. Therapist would like to use a case study to document her rare disorder to help provide insight for further research on this disorder.
EX: Therapist Kate is treating a client displaying symptoms of Dissociative Identity Disorder. She is a new therapist, and not being completely familiar with this disorder, she read numerous case studies to aid in her treatment. The DSM also helped Kate, but did not provide information in a clinical context
Clinical assessment
the process of gathering and evaluating relevant psychological, social, emotional, and physical data about a client.
- objectives: determine a diagnosis, conceptualize a current problem (look at research after hearing client’s info), understand sociocultural context of symptoms (look at environmental aspects), tailor a treatment strategy
- sources: patient self-report, clinician observations, spouse/parent/sibling report, formal psych testing, school/legal/medical records
- assessment tools may be nomothetic (compared to norms) or idiographic (specific to the individual)…good assessment uses both
Clinically relevant example: Louise came to therapy presenting symptoms of depression. At her first visit to the counselor, she filled out a Beck Depression Inventory in which she identified her depressive symptoms. The therapist, after reviewing the BDI, then asked her open-ended questions to aid in a diagnosis and undercover any environmental aspects of his disorder. The counselor used her nomothetic understanding of depression and Louise’s idiographic information during the clinical assessment to aid in a diagnosis and treatment plan.
Comorbidity
the presence of two or more disorders in one individual at the same time. A person may have two or more Axis I disorders, two or more Axis II disorders, or one or more disorder on both axes. Comorbidity is not uncommon due to borders between diagnostic categories being blurred. In addition, some disorders frequently present together, and it’s important to be aware of these so the therapist can check for them.
Clinically relevant example: Austin came into therapy presenting symptoms of BPD and emotionally irregularity. She had recently attempted suicide after a particularly difficult period a month ago. Austin frequently went out with the few friends she had left and partied. Knowing the comorbidity of BPD and substance-related disorders, the therapy probed Austin on her drinking patterns.
Competency to Stand Trial
legal decision as to whether a person charged with a crime has the capacity to understand the charges against them and the ability to assist their lawyers in preparing a defense. This has nothing to do with the insanity plea – competency to stand trial is about the person’s mental state at the time of the trial, not at the time of the crime. If the person is found incompetent to stand trial, they will be treated until they are competent to stand trial.
Court asks you to complete a psychological evaluation on a 19year old girl. She has a very low IQ (47) and is charged with murdering her younger brother. After therapist assesses her competency to stand trial, it is found that she is incompetent because she is incapable of understanding the court proceedings
Conduct Disorder
diagnosed on Axis I, this is a disorder that is diagnosed in individuals under 18 characterized by repeatedly violating the rights of others, displaying aggression, and other antisocial behaviors. Conduct disorder is more serious than oppositional defiant disorder. It is commonly thought of as the predecessor of antisocial personality disorder. Conduct disorder is tied to severe family dysfunction.
Ex:13 year old client was court ordered to see child therapist because of his 2nd shoplifting offense. He also has a history of drug/alcohol use, getting into fights, vandalism. He has been abusing the neighborhood cats, and has been “the” bully at school since third grade. Appears to meet the criteria for conduct disorder
Diagnosis
a determination that a person’s problems are reflective of a particular disorder or syndrome in a particular classification system (typically the DSM-IV). Diagnostic labels make it possible for clinicians to communicate easily with each other, but they also carry a negative connotation and a social stigma. Diagnoses also may not be accurate or perfectly fit an individual’s symptoms.
Clinically relevant example: Kara was a freshmen in college and came into the counseling center presenting symptoms of an eating disorder. The counselor asked Kara about her eating habits and Kara said that she would go to the cafeteria once a day, by herself, and consume large quantities of food - especially pasta and ice cream. She would then feel so guilty about eating that she would make herself vomit and not eat for the rest of the day. Kara didn’t like to engage in this behavior, but felt that she truly couldn’t stop herself once she started eating. The counselor diagnoses Kara was Bulimia Nervosa based on her symptoms which had lasted for over 6 months.
Diagnostic and Statistical Manual of Mental Disorders (DSM-IV)
a categorical system of diagnosis developed by the American Psychiatric Association and used by most mental health practitioners to diagnose mental disorders. The DSM also contains research on each particular disorder and provides assistance in making a differential diagnosis. Advantages of the DSM include that it allows for easy communication between clinicians and helps to stimulate research; disadvantages include that diagnoses are stigmatizing and there can be significant overlap between disorders.
EX:
Axis I: mental health diagnosis, clinical syndromes most common are mood & anxiety
Axis II: long-standing problems/usually overlooked: mental retardation, personality disorders
Axis III: info concerning relevant medical conditions
Axis IV: special psychosocial/environmental problems person is facing
Axis V: diagnostician makes a global assessment of functioning (GAF) on a 100 pint scale
EX: Client comes to treatment because of feeling depressed after her husband died 2 yrs ago. Client has flat affect and tone as she discussed the depression. She described the difficulty that she is having in her day-to-day functioning at work and school as well as at home with her kids. She has begun having conflicts with her peers, whereas before the death she never did. After clinical assessment and psychometric testing, clinician diagnosed patient with Major Depressive Disorder
Axis I: Major depressive disorder
Axis II: Dependent Personality Disorder
Axis III:Diabetes
Axis IV: Prob. related to social environment (terminated engagement)
Axis V: GAF=55 (current)
Diathesis-stress
this model hypothesizes that individuals who develop disorders have an inherited predisposition towards a disorder which is activated through stress in their environment. The diathesis-stress model is a biopsychosocial explanation of abnormal behavior, one that explains pathology as an interaction of all the influences in a person’s life (biological, genetic, social, emotional, etc.).
Ex: Client, GEORGE comes to therapy because he says he is hearing voices. George always was described as eccentric by others in his life, but when he went to college he began to hear voices. After family history was obtained, found that his mother was diagnosed as schizophrenic. It is believed that George’s genetic predisposition to this disorder along with the stress of going off to college, has activated the expression of the gene.
Dissociative disorders
diagnosed on Axis I, these are disorders characterized by a sudden, gradual, transient, or chronic disruption (dissociation) in the normal integrative functions of consciousness, memory or perception of the environment. Typically, a traumatic event precedes the loss in memory, and dissociation is thought to be a way of coping with this trauma.
- usually begins and ends suddenly and in most there is a profound disturbance in memory
- includes dissociative amnesia, dissociative fugue, and dissociative identity disorder.
Treatment varies: psychodynamic, hypnotherapy, barbiturates
EX: 16 year old Client comes to treatment because her parents are incredibly worried about her behavior. 2 weeks ago she went missing, and was recently found in Oregon in a homeless shelter with no recollection of her identity. Her parents filled the clinician in that she has been under extreme stress at school, her sister just died, and she lost her job, didn’t get into boarding school… Therapist diagnoses her with Dissociative Fugue.
Dopamine
Dopamine is a neurotransmitter that helps control the brain’s reward and pleasure centers. Dopamine also helps regulate movement and emotional responses, Dopamine deficiency results in Parkinson’s Disease, and people with low dopamine activity may be more prone to addiction.
Dopamine plays an important role in disorders such as schizophrenia, ADHD, autism and substance abuse.The dopamine hypothesis of schizophrenia states that certain neurons that use the neurotransmitter Dopamine fire too often, thus producing the symptoms of schizophrenia
Clinically relevant example: The distraught mother of a recently diagnosed schizophrenic came to counseling to figure out “where she had gone wrong” in her son’s upbringing and how she had contributed to his diagnosis. The therapist, understanding the role dopamine is thought to play in schizophrenia, explained this biological theory of schizophrenia to the mother. The therapist also explained how her son would be prescribed an antipsychotic drug that reduces dopamine.activity.
Eating Disorders
Diagnosed on Axis 1– include severe disturbances in eating behavior caused by an intense fear of gaining weight. Eating disorders are serious emotional and physical problems that can have life-threatening consequences
Anorexia nervosa. is characterized by weight loss. (must be 15% below the average for their weight/height/age) It is marked by extreme thinness, distorted body image, sometimes loss of menstrual period (amenorrhea)
Bulimia nervosa. marked by cycles of extreme overeating, known as bingeing, followed by purging or other behaviors to compensate for the overeating. It is also associated with feelings of loss of control about eating. people with bulimia nervosa usually maintain what is considered a healthy or normal weight, while some are slightly overweight.
Eating disorders tend to develop during adolescence, and they are much more common in girls and women. EDs seem to coexist with psychological and medical issues such as low self-esteem, depression, anxiety, trouble coping with emotions, and substance abuse.
Julie’s friend told her that she would probably have a lot of boyfriends if she lost some weight
She began restricting her diet and exercising
As she began to lose weight, boys started noticing her which reinforced the behavior
She also felt a sense of control about losing the weight. Her family sent her to counseling where she was diagnosed with anorexia. She was 5’9 and weighed 90 lbs. She still believed she was fat.
GABA
Gamma amino butyric acid- A major inhibitory neurotransmitter in the nervous system discovered by Frankel- carries inhibitory messages that cause the neuron to stop firing. Benzodiazapines have been found to decrease anxiety by increasing post-synaptic receptor binding of GABA. In addition, individuals who lack GABA may self-medicate with alcohol, which also increases GABA.
Ex: A veteran suffering from symptoms of PTSD had started abusing alcohol shortly after his return to the United States. The psychiatrist explained the use of Alcohol has been shown to bond to GABA receptors, which lowers anxiety.
