Psychological Disorders Flashcards
Biomedical approach
Therapy is focused around symptom reduction
- narrower than other approaches
- can miss things such as lifestyle causes
Biopsychosocial approach
Assumes that there are biological, psychological, and social components to an individuals disorder
-using indirect therapy and direct therapy
Direct therapy
treatment that acts directly on the individual
-meetings with a psychologist or medication….
Indirect therapy
Aims to increase social support by educating and empowering family members and friends of the patient
disorder with highest % affected
specific phobia
-then social anxiety and major depressive disorder
Schizophrenia - general description
Prototypical psychotic disorder
Need to show signs of disturbance for at least 6 months with at least one month of active symptoms
Positive symptoms
Behaviours, thoughts, feelings added to normal behaviour
- delusions & hallucinations (psychotic dimension)
- disorganized thought & behaviour (disorganized dimension)
Negative symptoms
Absence of normal behaviours
Delusions
False beliefs discordant with reality
- not shared by others in an individuals culture (must be deviant to be considered delusions)
- maintained despite evidence to the contrary
Delusions of reference
belief that common elements in the environment are directed at the individual
Delusions of persecution
Belief that the person is being deliberately interfered with or plotted against in some way
Delusions of grandeur
Belief that the person is special or remarkable in some way
*also present in Bipolar I
Thought broadcasting
Belief that one’s thoughts are being broadcast to the world
Thought insertion
Belief that thoughts are being placed into one’s head
Hallucinations
Perceptions that are not due to external stimuli but have a compelling sense of reality
Most common form of hallucination
Auditory
Disorganized thought
Characterized by a loosening of associations
-rapid shifting of ideas
Word salad - loss of structure to speech
Neologism
New words invented by someone with schizophrenia
Disorganized behaviour
Inability to carry out activities of daily living
-paying bills, keeping appointments etc.
Catatonia
Motor behaviours that are extreme in both senses
-either maintaining an extremely rigid posture or useless and bizarre movements
Echolalia
Repetition of another’s words
-form of catatonia
Echopraxia
Imitation of another’s actions
-form of catatonia
Negative symptoms
Include disturbances of affect and avolition
Affect
experience and display of emotion
Blunting
Severe reduction in the intensity of affect expression
downward drift hypothesis
Schizophrenia causes a decline in socioeconomic status
- this leads to worsening of symptoms
- begins a negative spiral towards poverty and psychosis
Flat affect
Virtually no signs of emotional expression
Inappropriate affect
Affect is clearly discordant with the content of the individuals speech
Avolition
Decreased engagement in purposeful-goal directed activities
Prodromal phase
Period before a diagnosis of schizophrenia
- marked with poor adjustment, social withdrawal, peculiar behaviour, inappropriate affect
- followed by a period of active symptoms
note: if onset is quicker, prognosis is better
Major depressive disorder
Mood disorder categorized by at least 1 major depressive episode -period of at least 2 weeks of 5 of the following •prominent and persistant depressed mood* •anhedonia * •appetite disturbances •decreased energy •feelings of worthlessness •substantial weight changes •sleep disturbances •difficulty concentrating or thinking •psychomotor symptoms •thoughts of death or suicide
Dysthymia
Depressed mood not severe enough to meet the criteria for a major depressive episode
anhedonia
loss of pleasure or interest in activities once found enjoyable
Persistant depressive disorder
Individuals who suffer from dysthymia most of the time during a 2 year period
Also applies to individuals suffering from MDD for 2+ years
Seasonal affective disorder
Major depressive disorder with seasonal onset
- may be related to abnormal melatonin metabolism
- can be treated with bright light therapy
Bipolar I
Presence of manic episodes with or without major depressive episodes
Manic episodes - signs and symptoms (DIG FAST)
Abnormal and persistent elevated mood for 1+ week -has at least 3 of the following •Distractible •Insomnia •Grandiosity •Flight of ideas (racing thoughts) •Agitation •Speech (pressured) •Thoughtlessness (risky behaviour)
More rapid onset than depressive episodes
•may include psychotic symptoms
Hypomania
Typically does not impair functioning to the same degree as mania NOR are there psychotic symptoms
Individual may be more energetic and optimistic
Bipolar II
Hypomania with at least 1 major depressive episode
Cyclothymic disorder
Combination of hypomanic episodes and dysthymia
Monoamine / catecholamine theory of depression
Revolves around the 2 neurotransmitters serotonin and norepinephrine
- high levels = mania
- low levels = depression
Most common psychiatric disorder for women?
Anxiety disorders
Generalized anxiety disorder
Disproportionate and persistent worry about many things
- lasting at lest 6 months
- can have physical symptoms like muscle tension, sleep problems and fatigue
Specific phobias
Most common type of anxiety disorder
Irrational fear of something to the point that you are compelled to avoid it
Focused on a specific object or situation
Social anxiety disorder
Persistent fear when exposed to a social situation or performance situation
Agoraphobia
Anxiety disorder characterized by a fear of being in places or situations where it might be hard for the person to escape
Panic disorder
Repeated occurrence of panic attacks, periods of: •fear and apprehension •trembling •sweating •hyperventilation •sense of unreality •"sense of impending doom"
Frequently accompanied by agoraphobia because of the fear of having a panic attack while in public
Obsessive compulsive disorder
Obsessions: intrusive thoughts and impulses
Compulsions: repetitive tasks that relieve the tension caused by the obsessions
•cause significant impairment in a persons life
Body dysmorphic disorder
Unrealistic negative evaluation of bodily appearance
-usually directed towards a certain body part
Post traumatic stress disorder
Occurs after experiencing or witnessing a traumatic event
-intrusion symptoms, avoidance symptoms, negative cognitive symptoms, and arousal symptoms that are present for at least 1 month
Intrusion symptoms
Recurrent reliving of the event
•flashbacks
•nightmares
•prolonged distress
Avoidance symptoms
Deliberate attempts to avoid objects, places, people associated with the trauma
Negative cognitive symptoms
- inability to recall key features of the event
- negative mood or emotions
- feeling distanced from others
- persistent negative view
Arousal symptoms
- Increased startle response
- irritability
- anxiety
- self destructive/reckless behaviour
- sleep disturbances
Acute stress disorder
Same symptoms of PTSD lasting less than 1 month but longer than 3 days
Dissociative disorders
Avoids stress by escaping from their identity
-otherwise has an intact sense of reality
Examples:
•dissociative amnesia
•dissociative identity disorder
•depersonalization/derealization disorder
Dissociative amnesia
Inability to recall past experiences
-not due to a neurological disorder
Dissociative fugue
Sudden, unexpected move or purposeful wandering away from one’s usual routine
-can be confused about identity or assume a new identity
Dissociative identity disorder
where 2 or more personalities recurrently take over the personality of the individual
- components of identity fail to integrate
- usually the person suffered physical or sexual abuse as a child
Depersonalization/Derealization disorder
Depersonalization: Individuals feel detached from their own mind and body
- out of body experience
- failure to recognize one’s own appearance
Derealization: Individuals feel detached from their surroundings
-world has a dreamlike quality
Somatic symptom disorder
Have at least 1 somatic symptoms (bodily) that may or ma not be linked to another condition but is accompanied with disproportionate concerns about its seriousness
Illness anxiety disorder
Patient is consumed with thought about having or developing a serious medical condition
Conversion disorder
characterized by unexplained symptoms affecting voluntary motor or sensory functions
-usually appear after high levels of stress or a traumatic event
ex: paralysis or blinding without any neurological cause
* la belle indifférence - patient is not concerned
Personality disorder
Behaviour that is inflexible and maladaptive
-causes distress or impaired functioning in at least 2 of: cognition, emotion, impulse control, interpersonal
Ego-syntonic or ego-dystonic
Ego-syntonic
Individual perceives their behaviour as a result of the personality disorder as being correct
Ego-dystonic
Individual sees the personality disorder as something that is thrust upon them and is intrusive
Cluster A disorders
Paranoid, schizotypal, and schizoid personality disorders
Marked by behaviour that is odd or eccentric
“weird” cluster of disorders
Cluster B disorders
Antisocial, Borderline, Histrionic, and Narcissistic personality disorders
Marked by behaviour that is dramatic, emotional, or erratic
“Wild” cluster of disorders
Cluster C disorders
Avoidant, Dependent, and Obsessive-Compulsive personality disorders
Anxious or fearful behaviour is exhibited
“worried” cluster of disorders
Paranoid personality disorder
Marked by a pervasive mistrust of people
-can indicate the prodromal stage of schizophrenia
Schizotypal personality disorder
Pattern of odd or eccentric thinking
- can have ideas of reference (not as extreme as delusions)
- and magical thinking - superstition or belief in magic
like the + symptoms of schizophrenia
Schizoid personality disorder
Pervasive pattern of detachment from social relationships and a restricted range of emotions
-few friends and poor social skills
Like the - symptoms of schizophrenia
Antisocial personality disorder
Pattern of disregard for and violation of the rights of others AND lack of remorse for these actions
- 3x more common in males
- many serial killers or prolific criminals have this disorder
Borderline personality disorder
Pervasive instability in interpersonal behaviour, mood, and self image
- often fear of abandonment
- lack of security in self image, sexuality, goals, values
- suicide attempts and self harm are common
- may use splitting as a way to cope
Splitting
Defense mechanism for individuals with borderline personality disorder in which the view others as either ALL good or ALL bad
-angel vs. devil mentality
Histrionic personality disorder
Constant attention seeking behaviour
-exceptionally extroverted and dramatic
Narcissistic Personality disorder
Grandiose sense of self-importance and uniqueness
- constant need for admiration and attention
- fantasies of success
- feeling of entitlement in interpersonal relationships etc.
- very fragile self esteem
Avoidant personality disorder
Extreme shyness and fear of rejection
- sees themselves as socially inept and isolated despite desire for social affection
- stay in the same job, relationship, etc. despite wanting change
Dependent personality disorder
Continuous need for reassurance
-tend to be dependent on one specific person
Obsessive-compulsive personality disorder
Perfectionist and inflexible, tends to like rules and order
- lack of desire to change
- excessive stubbornness
- maintenance of careful routines
- lack of sense of humour
Biological causes of Schizophrenia
Most potential causes are genetic
Trauma at birth - hypoxemia
excessive marijuana use as a teenager
Excess of dopamine in the brain
-drugs to treat it block dopamine receptors
Biological causes of Depressive disorders
- Abnormally high glucose metabolism by the amygdala
- Hippocampal atrophy (after long duration of illness)
- Abnormally high levels of glucocorticoids
- Decreased: norepinephrine, serotonin, and dopamine
Biological causes of Bipolar disorders
- Increased: norepinephrine and serotonin (mania)
- Higher risk if parent is bipolar (genetic)
- Higher risk for persons with MS
Biological causes of Alzheimer’s - genetics
Mutations in the presenilin genes on chromosomes 1 and 14 contribute to having the disease
Mutations on the apolipoprotein E gene on chromosome 19 contribute the the likelihood of getting the disease
Mutations on the ß-amyloid precursor gene on the chromosome 21 is known to contribute to it
Biological marker of Alzheimer’s diagnosis
- Flattened sulci in the cerebral cortex
- Enlarged ventricles
- Deficient blood flow in the parietal lobes = cognitive decline
- Reduction in acetylcholine AND in choline acetyltransferase (makes acetylcholine)
- Reduced metabolism in the temporal and parietal lobes
- Plaques of ß-amyloid
- Neurofibrillary tangles of tau protein
ß-amyloid
misfolded protein in ß-pleated sheet form that forms plaques in Alzheimer’s patients
Parkinson’s disease - signs and symptoms
Bradykinesia - slowness in movement
Resting tremor - appears when muscles are not in use
Pill-rolling tremor- tremor of the fingers as if rolling something between them
Masklike facies - facial expression with static and expressionless features (open mouth, wide eyes)
Cogwheel rigidity - muscle tension that halts movement
Shuffling gate with stooped posture
Parkinson’s disease - biological basis
Decreased dopamine production in the substantia nigra
- layer of cells in the brain that permit proper functioning of the basal ganglia
- basal ganglia are needed to initiate and terminate movement
Common drug is l-DOPA, precursor that is converted to dopamine in the brain
