PSYC 507: Psychopathology Flashcards
Anxiety Disorders
- Group of irrational mental health conditions characterized by excessive fear, worry, or nervousness to an anticipated or imagined danger.
- 4 D’s : Divate from norms, Dysfunction in daily living, cause Distress and Dangerous
- Future focued
- Includes: GAD, social anxiety, panic, phobias
- Commonly treated with CBT, Exposure, ACT and when necessary anti-anxiety medication.
- Be aware operant behaviors that lead to escape/avoidance
- Important to recognize and address because anxiety disorders are highly treatable and therapy can significantly impove an individuals well-being.
Ex: Sarah, a 32-year-old with social anxiety disorder, experiences intense fear of judgment in social settings. To manage these negative feelings of self-worth, she avoids social gatherings and is forced to struggle through presentations at work. Leads to isolation and stress.
Anxiety Sensitivity
- Fear of feeling and experiencing anxiety-related sensations associated with anxiety because of the belief they will have harmful consequences.
- Addressing anxiety sensitivity is necessary bc the sensitivity it can exacerbate real anxiety disorders such as GAD, social anxiety, panic and phobia disorders and separation anxiety.
- Use of exposure therapy is highly affective
- Important because it helps identify individuals who are at risk for developing anxiety disorders and early detection/prevention.
Ex: Kate experiences anxiety sensitivity arriving at school. Kate has many friends but has social anxiety when entering new environments and has always been slow to warm. Her anxiety sensitivity arises when she first arrives to school because she sees other students arriving at the same time. Kate begins to feel her heart rate increase, shortness of breath and begins to sweat.
Bipolar I vs Bipolar II Disorder
Bipolar I: At least 1 manic (LASTING at least 1 week, or requiring hospitiatlization) and often accompanied by major depressive episode (not requried for diagnosis)
- Manic episode involved abnoramlly elevated or.irritable mood, increased energy, decreased need for sleep, impulsive and risk taking behaviors.
- Causes significant impairment in funtioning and my include psychotic features.
Ex: Your client Mindy is a brilliant judge who has been acting exceptionally erractic latety. Mindy has experienced hypomanic episodes and is prone to dreprssion but refuses medication bc of how it makes her feel. You know she experiences a lot of stress from work and are concerned for her saftey. Today, Mindy was a no show for your session and in responce to your follow up sent a text saying she booked a last minute trip to Mexico with some new friends. You are concerned Mindy is experiencing a manic epidsode.
Bipolar II: Current or past hypomanic episode (is less severe than mania) and one major depressive episode.
- Hypomania lasts as least 4 days and while noticiable to others does not cause severe functioning impairment or psychosis.
- Bipolar II has the potential to develop into Bipolar I if left untreated
Ex: Your client Mindy is seeking therapy to help her juggle the stress of being a judge. Her cases are exceptionally stressful and intense and over the past year Mindy has not been coping well. She has expereinced episodes where she doesn’t sleep for a few days but then crashed out and experiences a very low mood. One time Minday admitted herself to a wellness rehab to find tools to calm her mind and catch up on sleep.
Borderline Personality Disorder
Cluster B Personality Disorder characterized by pervasive patterns of instability of:
- interpersonal relationships
- self-image
- emotions
- marked impulsivity
- Often diagnosed in early adulthood
- Often has components of suicidal behaviors and self-injury
- Treatment involves DBT (dialectical behavior therapy) which helps with emotional regualtion and social-emotinal skills as well as medication when necessary
Ex: David …………….
Case Study
(single case / not case assessment)
- Pertains to study / research using sample size of 1for novel application of treatments
- Useful for studying unique case outcomes for new treatment
- Patient results may point toward ability to conduct research in a larger population
- Never establish a cause/effect relationship because cannot generalize results of 1 for validaty
Ex: You client is participating in a case study where her non-suicidal self-injury of cutting is being treated with narriative therapy. While the results of this study can never be used to exstable a caual relationship, the outcomes of her case study could be useful in expanding research in this treatment area.
Categorical vs Dimensional Diagnosis
Refers to 2 approaches for understanding and diagnosing mental health condidtions.
Categorical Diagnosis Approach:
- Categorizes mental health conditions into and organized framwork with distinct criteria with no overlapping features to form an “Ancoring Diagnosis” .
- Person meets diagnosis based on specified criteria or does not.
Dimensional Diagnosis Approach:
- Looks at mental health conditions along a spectrum that allows for severity and frequency to vary such as Depression as Mild, Moderate, Severe
- Symptoms nuanced to the individual and allow for comoribidty
This is imporatnt bc both are value and necessary to understand for individualized treatment plans and client outcomes.
Ex: A client comes in presenting problems with sleeping, decreased appetite, disinterest in hobbies and doesn’t feel like they have much of a future. From the categorical approach, the therapist can provide a diagnosis of depression. From a dimensional model, the clinician can assess the severity of sx’s of depression with a scale.
Comorbidity
- Presence of 2+ disorders in one individual at the same time
- Common in mental health where disorders interact and categories are blurred resuliting in a dimensional assessment
- Many disorders present concurrently and must be treated as such as anxiety with a subastance use disorder.
Important to understand in case an anchoring diagnoisis is useful and when creating holistic and integrate treatment plans where addressing underlying and co-occouring conditions is necessary.
Ex: Your client presents to therapy meeting criteria for anxiety, OCD and an eatting disorder. Your choose a multi-facited approach to treatment utlizing CBT, ACT and ERP aiming to work on all presenting disorders at once.
Diagnosis
- The process of identifying and labeling a mental health condition based on a client’s symptoms, behaviors and history.
- Diagnostic make it possible for clinicians to communicate clearly with one another and allow for the client to receive psychoeduction of their presenting problems.
- Recognize that a diagnosis may not always be accurate of an individual’s symptoms or may carrly negative connotations and/or social stigmas
- Important bc it helps clinicians determind evidence based interventions with validate and support the client in understanding their expereinces and couldp provide hope for the future.
Ex: Your client is a 40 year old presenting to therapy with persistent saddness, fatigure and a sense of hopelessness with lost interest in all activites. You are able to disgnosis her with a depressive disorder and educate her on the symptoms of the disorder which offers her hope that she isn’t “just going crazy like my husband says”.
DSM-5
Dianostic and Statistical Manual of Mental Disorders is a comprehensive guide published by the APA that is the primary resource for diagnosis by mental health practitioners.
- Provides standardiezed criteria for identifying disorders which lead to assessemnt, treatment planning and fileds of research.
- The DSM-5 is important in the practise of mental health bc it provides a common language for effective communicaiton between professionals and cleints.
Ex: Your client presents to therapy after being the victim of a traumatic event. They report not wanting to sleep bc of nightmares but also not wanting to be awake bc of flashbacks. They are constantly agitated and have taken a leave of abscense from work bc they can’t deal with the distress caused by going into work. Your client knows something is wrong and just wants to get back to feeling like they did before the attack. Using the DSM-5 criteria, you are able to diagnose your cleint with PTSD and create an effective, evidence based treatment plan.
Diathesis Stress Model
The Diathesis-Stress Model explains how biological vulnerabilities (diathesis) interact with environmental stressors to influence the development of mental disorders.
Diathesis (predisposition or vulnerability ) to developing a disorder due to genetic, biological, or psychological factors that are expressed in genes based on your environmental influencers.
- Explains how mental health can be a result of one’s biological (nature/genotype), environmental (nurture/phenotype) conditions and personality traits based on the expression of a person’s cells.
- Hypothesizes that individuals who develop disorders have a genetic predisposition and vulnerability which is activated by stress in the environment.
- Biopsychosocial explanation of how one individual can develope a disorder while another may not who expereince similar stressors.
Ex: You client David is going through an emotionally stressful divoice. Due to his family history of depression and his natually anxious personality, you work with him to understand that his genetically vulnerable (high diatheseis) and may be at risk of developing a mental disorder making it necessary to provide psychoeducation and tools for self-care and mindfulness during your session.
Differential Diagnosis
- Process of distinguishing between two or more conditions with similar symptons to identiy the most acccuate diagnosis
- Tools like DSM-5 and structured interviews support this process allowing for categorical vs dimensional diagnosis
- Specifiers help direct differential diagnosis options
Important when ruling out alternative explanations to ensure the most appropriate treatment is provided and avoids unnecessary interventions or harm to the client, especially important with culturally diverse populations
Ex: A therapist working with a 45 year old female expereincing fatigue, difficulty concentraiting and feelings of worthlessness might explore whether these symptoms are due to a major depressive disorder, GAD or a medical condition like menopause.
Dissociative Disorders
- Group of disorders characterized by disruptions or abscense of consciousness (short or long), memory, identiy or perception of the environment in response to trauma or severe stress
- Serves as a defense mechanism to copy with the overwhelming expereince
- Treatment involves trauma-focused therapy such as eye movement desensitization and reprocessing (EMDR) or CBT.
- Dissociative Identiy (previously multi-personality disorder, appears as two or more personalitys that control a persons behavior)
- Dissociative Amnesia (looks more like amnesia where periods of time or details are forgotten)
- Depersonalization (Feeling detached from oneself, as if watching oneself from the outside as if things are foggy or unreal)
Ex: You’re client shares that they cannot recall much about ages 6-10. In session you already learned that your client was being molested during this time and help her understand that the reason she cannot recall those ages are because her brain blocked access to these distressing memories as a defense mechanism, even though the information still exists at some level that she is now able to recall.
Dopamine
- “feel good” Neurotransmitter that plays a key role in the pleasure pathway of reward, motivation, regulation in mood and body movement.
- Abnormal levels of dopamine are associated with Parkinson’s and schizophrenia (too much) or depression and addiction (too little).
- Important to understand Dopamine and NTs when developing an effective treatment plan combining psychopharmacology and therapy that aims to maintain a balanced mental and emotional state for the client.
Ex: Your client is a 32-year-old woman presenting with a lack of motivation, pleasure, and energy. Clinical assessments and observation show that a dopamine deficiency may be present where medical psychopharmacology would be useful in addition to Behavior Activation Therapy.
Eating Disorders
- A group of disorders characterized by persistent disturbances in eating behaviors and attitudes toward food, body weight or shape.
- 4 D’s : Diviate from norms, Dysfunction in daily living, Distress and Dangerous and results for a number of reasons: Biological (genetics, brain chemestry), Psycological (perfectionism, control issues), Social & Cultural (family standards, sports, society beauty standards), Environmental (body shaming).
- DSM-5 primary disorders include anorexia nervosa, bulimia, and binge eating and restrictive eatting
Important to understand bc they require a comprehensive treatment approach including nutritional couseling, psychotherapy and medical monitoring.
Ex: You are a counselor at a rehabilitation center specilzing in EDs. Your client is a 16 year old boy who presents to therapy bc his parents will not allow him to continue on the cross country team unless he agrees to nutritional couseling, psychotherapy and medical monitoring. Your client is diagnosed with anorexia and lives on a severly restricted diet while maintaining 7-14 mile daily running schedule. He says that he “feels gross” and cannot run for as long as he wants when he eats as much as other people. The boys parents are concerned bc he is no longer growing and seems to be lossing his hair.
GABA
- Nurotransmitter that is central nervous system depressant
- Reduces Neuro Excitablitly promoting clamness of mind by regulating mood, anxiety and sleep.
- Low GABA linked to anxiety, sleep problems, and panic, as the brain becomes overstimulated
- Important to understand GABA and NTs when developing an effective treatment plan combining psychopharmacology and therapy that aims to maintain a balanced mental and emotional state for the client.
Ex: Your client is asking how she can stop recurring panic attacks outside of therpay. You provided the client with psychoeducation that her body is not producing enough GABA leading to heightened anxiety which can be influencing her panic attacks. You offer to connect her with a psychiatrist to discuss this more.
Heritability
- The extent to which genetics is attributed to an individual’s condition as opposed to the environment.
- 0-1 is the range where higher values indicate a stronger genetic predispostion of a condition which can be expressed due to environments conditions such as stress.
- Some disorders have a high heritability like schizophrenia, depression and substance use
- Important to understand bc education and prevention is key and by understanding the interplaly between biological and environmental contribution, clinitians are better able to accurately assess and treat a client.
Ex: Your client shares that her grandmother was diagnosed with schizophrenia and she is very concerned that if she experiences too much stress the condition may be expressed within her. You work with your client to impliment stress managment principles that regulating her nervous system to best prevent as much as possible genetic expression of schizophrenia.
HPA Pathway/Axis
Hypothalamic Pituitary Adrenal Anix
- Critical system in the body that regulates the sympathetic nervous system responsible for fight, flight or freeze responces.
Includes the Hypothalamus, Pituitary gland and Adrenal glands to regulate cortisol levels that impact a person’s mood, energy, immune function and sleep. When dysreguated, can be linked a number of mental and health disorders.
This is important in couseling bc it connect bilogical stress response to mental health allowing clinicians to address both pyhsiological and psychological aspects of health.
Ex: You client is a 50 year old female who is exhausted, experiencing mood swings with high irritability, gaining weight, she cant sleep and has a low sex drive. Through bloodwork she learns that her cortisol levels are through the roof resulting in dysregulation of her nervous system and adrenal fatigue. With suppliments, vitamins and behavior activation therapy, you client greatly improves her daily functioning.
Idiographic vs Nomothetic
assessment / understanding
- Two different ways to understand and assess individuals from an individualistic or group perspective.
Idiographic Assessment (micro and dimentional)
- Understanding of an individual, emphasizing unique personal experiences, characteristics and the specific context of a clinent
including culture
- Used in case studies (audience of 1) and qualitative research
Nomothetic Assessment (macro and categorial)
- Understanding of groups to discovering general patterns by focusing on commonalities across groups made up of individuals.
- Used in standardized assessment and diagnostic criteris.
Both approaches are important for a layered approach and best practise of providing throught insight to a client.
Ex: Client comes in with depression (sx’s). From a nomothetic assessment approach, the clinician checks for sx’s being present that are based on the norms listed in the DSM for depression. From an idiographic assessment, clinician can consider unique characteristics of psycosocial and addressing model to create an effective treatment plan for this specific client.
Mania
- Mania is a mental state characterized by an abnormally elevated mood, energy and exaggerated behavior that signifcantly impairs functioning.
- Required criteria for Bipolar 1 when lasting 1+ week
- Symptoms include inflated self-esteem, infallibility, decreased need for sleep, rapid speech and can in extream cases include delusions or hallucinations.
This is important to address in counseling bc it can lead to sever consequences if untreated.
Ex: Mindy is feeling euphoric and has only slept a few hours over the past few days but somehow is still full of energy. Instead of going to work today she decided instead to take a roadtrip to Savanaha. When questioned about missing work and an important presentatin she explaims “YOLO!”. Mindy did not return for 3 days.
Mood Disorders
Moods disorders are characterize by pervasisve emotional disturbances such as intense feelings of sadness, euphoira or irritability that contain the 4 Ds:
- Diviate from norms
- Cause dysfunction to daily living
- Cause distress
- Dangerous
Important to recognize and divided into 1) Depressive Disorder or 2) Bipolar Diorders for treatment
- Impacted by inadaquate serotonine & dopamine, biological heritability and biopyschosocial impacts. Treatment may include CBT and psychopharmacology.
Important to addressing both emotional and cognitive aspect of mood disorders in order to approriate treat a client for life-long health.
Ex: Your client lost her husband two years ago and since them has experienced persistent sadness, loss of interest in all activities that used to bringher joy, and unhealth thoughts that maybe its time for her to join her husband. Your client has a the mood disorder of depression.
Obsessive Compulsive and Related Disorders
- A group of mental heath conditions characterized by intrusive, unwanted, recurring thoughts (obsession = anxiety) or sensations that drive an individual to repeatedly perform a behavior (compulsions).
- Common ex include: OCD, body dysmorphia and hoarding
- The compulsionary behavior is performed to reduce anxiety.
- 4 D’s
- These disorders diviate form cultural norms, significantly impair daily functioning, cause distress and can be dangerous.
- Treatment involves exposure exposure with responce prevention, CBT and if necessary anit-axiety medication.
Important to understand OCD and the role of these behaviors as the negative reinforcers of behaviors in creating strategies to help individuals tolerate anxiety without relying on compulsions.
Ex: Miranda, a 27-year-old who has an extreme fear and overwhelming thoughts of covid contamination and have consistent and intrusive thoughts that compelled to wash her hands upwards of 5 times an hour, despite knowing it is irrational.
Panic Attack
- A sudden episode of intense anxiety or fear that escalates quickly and can occcure unexpectedly or in response to a trigging event.
- HPA gland releasing a rush of cortizal which launches fight, flight or freeze response system. Sx include rapid heart rate, dizziness, shaking, feelings of choking, nausea, shortness of breath, fear of dying.
- Can occure in any anxiety disorder as well as mental disorders.
- Treatment includes CBT, exposure therapy, mindfulness and breathing techniques and medication when necessary.
- Important to understand and treat panic attacks bc they can be debillitating and lead to avoidance behaviors.
Ex: Kate is a 14 year old girl with social anxiety and randomly experiences panic attacks. The attacks come on quickly and are debilitating, freezing Kate where she is. The most recent attack happend while pulling up to school when suddenly Kate had a crushing fear of being “seen” and could NOT get out of the car. Her heart rate increased rapidly, she began sweating and shaking. She would not let her mother roll down a window for fear of being seen and she could not bring herself to open to doof for fresh air. After 15 minutes and only by focusing on her breathing, was Kate able to calm herself down enough to roll the window down for fresh air.
Personality Disorder
- A group of mental health conditions that are characterized by enduring patterns of inner experiences and outward behaviors that deviates significantly from cultural norms.
- 4 D’s
- Does not fluctuate and return to base line. Is consistent over time.
- Personality disorders may develop as a response to trauma and are highly impacted by an individuals environment
DSM-5 divides disorders into 3 clusters:
**(A) odd/eccentric **- paranoid, schizoid
(B) dramatic/emotional - borderline, narcisssitic, antisocial
(C) anxious/fearful - avoidant, obsessive-compulsive
Ex: David has Borderline Personality Disorder. Living a double life, David fathers and hids a child from his extended family for almost 10 year. He creates multiple profiles on dating sites despite being married, and believes that no one is onto his games. While very charming, David also sufferes from depression and anxiety and spends way more than her earns.
Positive vs Negative Symptoms
- ## Terms used to describe the 2 main categories of symptoms in Cluster A Personality Disorders
- Distinguising between the two symptoms is critical because they guide individualized treatment strategies and support diagnosis.
- **Positive symptoms ** refer to the presence of abnormal behaviors and emotions that are not typicallly observed in the general population such as hallucinations, delusions, paranoi or disorganized thinking and speech.
- Negative symptoms refer to the absence of normal emotion and behavior that should be present in the general population such as social withdrawal, low speech or flat affect, a lack of concentration.
Important to understand for treatment bc the distinction guides comprehensive and individualed treatment plans such as if a client with positive sympotoms requires referral to a psychiatrist for medication
Ex: Annie’s cousin schizophrenia
