Psych Illness Scripts - Sheet2 Flashcards
Antisocial (Cluster B)
Exploits others; manipulative and irresponsible; difficulty maintaining relationships; criminal activity
Avoidant (Cluster C)
Wants relationships but fears rejection & humiliation; lacking self-esteem
Borderline (Cluster B)
Constantly shifting mood; prominent anger; fear of abandonment; pushes & pulls others simultaneously; self-destructive; dysphoric
Cluster A
Paranoid; Schizoid; Schizotypal. “mad”
Cluster B
Antisocial; Borderline; Histrionic; Narcissistic. “bad”
Cluster C
Avoidant; Dependent; Obsessive-Compulsive. “sad”
Dependant (Cluster C)
Relies on others for decision-making; fears loss of emotional support; destructive relationship
Histrionic (Cluster B)
Excessive emotionality disrupts healthy relationships
Impulse; Temptation; or Drive to act in a manner
consciously resist impulse and on other occasions plan an impulsive act. Increased tension & release of tension reinforcement. Regret & guilt.
Intermittent explosive disorder
Attacks of aggressiveness. M>F. Relatives at risk for disorder. Aura; nonspecific EEG abnormalities; childhood trauma; trauma; encephalitis; hyperactivity. No sx between episodes.
Kleptomania
impulsive stealing. tension; reward/release. Guilt; anxiety; remorse after. Steal items they don’t need & can afford. Fewer than 5% of shoplifters. SSRIs & behavior modification
Narcissistic (Cluster B)
Grandiose; self-important; generally distainful of others
OCD (Cluster C)
Perfectionistic; orderly; driven by logic over emotion
Paranoid personality disorder (Cluster A)
Views others at untrustworthy; exploitive. Self as victim. Protects self.
Pathological gambling
Gambling; lying to hide it; recouping losses; relying on others to pay gambling debts. 3% of US M>F. Onset in adolescence(M) and middle age(F). FHx increases risk. F likely to be married to alcoholic; absent men. Impaired metabolism to catecholamines (NE); stimulation-release mechanism. GA is best Tx.
Pyromania
Fire setting; preoccupation with fire; firefighting equipment; etc. Begins in childhood & increases in destructiveness over time. M>F. Associated with mental retardation; alcoholism; truancy; animal cruelty. (not to be confused with fire setting in other major disorders; e.g. with hallucinations)
Schizoid (Cluster A)
Aloof; prefers to be alone & doesn’t enjoy interpersonal encounters; unable to reach intimacy
Schizotypal (Cluster A)
Eccentric; odd speech/behavior. May believe self to have special abilities; but not delusional
Trichotillomania (an obsessive-compulsive disorder)
Compulsive hair pulling. Scalp most common. Other self-mutilation. Biopsy of hair follicle (trichomalacia). F>M. Comorbid with OCD; depression. Difficult tx.
Bipolar disorder example
Self medication with alcohol; then other drugs. Started in youth. Some blackouts; denial & rationalization.
Blackouts
Temporal lobe spiking. Some patients are more susceptible. Loss of memory & won’t know about them if drinking/using alone.
denial
incoming information that is threatening or contradictory to stored memory is refuted
intellectualization
event or memory is re-conceptualized in sufficiently abstract terms to distance it from original referent and associated conditioned emotional responses
projection
an idea; feeling or behavior inconsistent with one’s self-concept is attributed to another person
regression
stress is responded to using cognitive processes from earlier developmental stages associated with periods of less stressful coping
repression
perceptions of threatening or contradictory experiences are neither recognized or remembered
Acute stress disorder
Person experiences; witnesses; or is confronted with an event that involve actual threatened death or injury and responds with intense fear; helplessness or horror. Results in intrusion; arousal; avoidance. nonspecific somatic distress common. Less than a month.
Agoraphobia
marked persistent fear or anxiety about 2 or more of the following situations; accompanied by avaoidance of the situations: using public transportation; being in open spaces; being in shops; theaters; cinemas; being in a crowd or being outside of the home alone
cognitive behavioral therapy
addresses factors of disorders by educating the pt about how anxiety develops; persists. Identify & confront their misperceptions; relax; interract; disrupt avoidance behaviors that perpetuate sx.
Dissociation
disruption; loss; absense of the usual integration of memory; consciousness and personal identity. Normally occurs when absorbed in a book. Associated with periods of fatigue and monotony like driving without remembering it.
Generalized Anxiety Disorder (GAD)
> 6 mos of uncontrolled worries about health; safety; access to resources; and threats to other people. Mid teens-20s. Sometimes after onset of chronic illness. 5% prevalence 2F>1M
Medical-induced anxiety disorder
Due to another medical condition such as encocrinopathies (pheochromocytoma; hyperthyroidism; hypoglycemia); metabolic problems and neurological problems (such as vestibular dysfunction). Dx can be made if pt’s medical condition is known to induce anxiety; and preceded the onset of anxiety.
Medication-induced anxiety disorder
Brought on by stimulants (cocaine; meth; ADHD meds; caffeine); alcohol (via mini-wthdrawals); and OTC decongestants and cough syrup. Panic attacks predominate.
OCD (Note that obsessive-compulsive disorders in DSM 5 include the following: body dysmorphic disorder; hoarding disorder; trichotillomania; excoriation disorder and body-focused repetitive behavior)
intrusive arousal and avoidance Sx. Rarely fear of doing something bad. Repeated acts. Recognize that fears are irrational and still neutralize them. M6-15; F 20-29 esp postpartum. 2% M>F peds; M=F adults. Common compulsions: checking; washing; counting; confessing; symmetry and precision; hoarding; >50% have multiple compulsions. Obsessions are intrusive thoughts that the patient perceives as unwanted; whereas delusions are unshakeable false beliefs; firmly held.
Panic Disorder
Recurrent panic attacks occuring over at least 1 month involving anticipatory anxiety and avoidance of situations. Sympathetic symptoms & anxiety. Onset in teens-40s. Chronic; relapsing. 1-3% community. 2F:1M.
PTSD
Person experiences; witnesses; or is confronted with an event that involve actual threatened death or injury and responds with intense fear; helplessness or horror. Results in intrusion; arousal; avoidance. nonspecific somatic distress common. At least a month. 8% varied prevalence by exposure risk. F>M with equal exposure. F sexual trauma; M War
PTSD physiology
unique pattern of endocrine dysfunction with low urinary cortisol; high NE metabolites. Partly reversible hippocampal shrinkage. Failure of glucocorticoid receptors to hinhibit initial intense alarm response.
Simple phobias
Fear of a situation or item. No tx until interfering with life. Blood; injury; and injection uniquely associated with vasovagal responses. Onset: animals 7; Blood 9; situations 2-7 & early 20s. 11% prevalence most common. Blood injury & injection more common in males. Treat with short acting benzos for symptomatic relief and densensitization for lasting relief.
Social phobia
Fear/panic with blushing of anticipated humiliation or rejection by others in social situations. Pt desires social activities & relationships. Dread leads to avoidance. Familial modeling; bullied past; humiliation as discipline; and disfiguring lesions associated. Bimodal onset 5yo & adolescence. Chronic. 3-4%. 3F:2M males seek tx. Use beta-blockers to reduce distress for public speaking.
Tx of anxiety disorders
Psychotherapy; SSRIs; MAOIs; dualacting antidepressants; Benzos. Beta blockers.
Major depressive episode
9 vegetative symptoms: SIG E CAPS
sleep; loss of interest; guilt; decreased energy; concentration difficulty; appetite disturbance; psychomotor retardation / agitation; suicidal thoughts. 5 are required for diagnosis.
Bipolar I
One or more episodes of mania (which lasts at least 1 week) with recurrent depressive episodes. Classic manic depression.
Bipolar II
Recurrent depressive episodes and one or more episodes of hypomania (mood with some or all of the features of mania; without psychosis — elevated mood that does not fulfill criteria for mania). The hypomanic episodes must last at least 4 consecutive days; for most of each of those days.
Cyclothymic disorder
Rapidly alternating mood states occurring continuously over a period of 2 years. Moods include symptoms of hypomania or depression but do not meet criteria for a full episode of either one. Not clinically impaired.
Dysthymic disorder (now called PERSISTENT DEPRESSIVE DISORDER)
“Eeyore” — persistently experience symptoms of depressed mood and at least 2 of the other characteristics of major depression. Dysthymic symptoms must be present for > 2 years. May be a lifelong quality or “personality trait.” superimposed episodes of major depression result in “double depression.” Must cause distress / impairment. Resembles borderline personality but less history of abuse.
Premenstrual Dysphoric Disorder
In week prior to menses; pt suffers from symptoms that include: modd lability; irritability; anger; anxiety; depression; sleep problems; over-eating; out of control; etc. Symptoms must be documented prospectively for at least 2 menstrual cycles. Symptoms must disappear after menses; and are not just exacerbation of ongoing interpersonal conflicts.
DSM Qualifiers (Mood disorder “with” …)
- atypical features
- catatonic features
- melancholic features
- postpartum onset
- psychotic features
Somatization disorder aka somatic symptom disorder
Physical complaints without demonstrable physical findings and psychosocial factors sufficient to maintain or worsen the physical complaints. Includes complaints / symptoms in 4 domains: GI; sexual function; “pseudoneurological” and pain. More common in females. Most common symptoms in order: nervousness; back pain; weakness; joint pain; dizziness; extremity pain; fatigue …. Treat with CBT and routine frequent office visits. Do not offer unnecessary testing. Must begin prior to 30. Weekly to bimonthly visits indicated. (this is a learned expression of emotional or other stressor through somatic complaints - alexothymia)
Conversion disorder aka Functional Neurologic Symptom disorder
Alteration or loss of physical functioning with no explanatory pathology (for example focal paralysis; non-epileptic seizures). Common in children; can be associated in time or symbolically to a psychological stressor. Symptoms typically look neurological with pseudo-seizures and unexplained paralyses most common. Often starts under conditions of overwhelming stess such as funerals; etc. Treat with hypnosis; psychotherapy or PT. Unconscious response to stress. Often seen in rural / uneducated patients.
Body dysmorphic disorder (an obsessive-compulsive disorder)
“Imagined ugliness” – preoccupation with minor or imagined physical flaw or deformity. Face most commonly involved. Equal between M and F. Comorbid with anxiety disorders. May lead to repeated cosmetic procedures. Consumers of recreational surgery and they are usually dissatisfied with the results. Treat with SSRIs; CBT.
Factitious disorder / Munchausen’s Syndrome
Purposeful self inflicion of signs of illness or injury to elicit medical attention and care. Often seen in health care workers who are knowledgable. F > M. Munchausen’s syndrome by proxy is when parents make kids sick; may qualify as abuse. In Factitious disorder the rewards for feigning illness are not clear; other than attention. Pt may respond to empathetic interview targetic stresses. Subconscious.
