Psychopathology Flashcards
What are the traditional elements of mental illness?
Infrequency, deviance (from cultural norms, gender roles, etc.), distress (suffering & desire to discontinue behaviour), disability (impairment) and danger (harm to self or others).
How does the DSM-5 define mental illness?
A clinically significant behaviour or psychological syndrome causing present distress / disability / significantly increased risk of suffering, death, pain or loss of freedom. Not merely a culturally sanctioned and expectable response to a particular event, and usually considered a manifestation of behavioural, psychological or biological dysfunction.
In our lifetime, ___% of individuals are diagnosed with a mental disorder of any sort.
48%
What are the 2 broad approaches to treatment?
Biomedical and psychological.
What are some examples of biomedical treatment?
Medication or surgery (lobotomy 🤭), changing some aspect of physical functioning, mental illness perceived as a disease
What are the types of psychological treatments available?
Psychodynamic:
* focus on past, unconscious inner forces driving behaviour, stemming from unresolved childhood conflicts / trauma, hence insight-oriented, guiding patients to discover r/s between root cause and symptoms
Humanistic:
* teaching patient to seek fulfilment and achieve potential
Behavioural:
* focus on present, modify problem behaviours through conditioning, extinguish non-productive behaviours and reinforce good ones through exposure, reinforcement, ignoring & punishment
Cognitive-behavioural:
* focus on how and what we think, belief that thoughts shape behaviour & emotion, how we think abt a situation determines our feelings abt it, hence identify maladaptive thoughts, challenge them, replace with good thoughts
Eclectic:
* integration of multiple types of treatment, mix & match to suit patient’s needs
What is the difference between anxiety and fear / panic?
Anxiety is apprehension about anticipated issues, whilst fear / panic is apprehension about immediate threat or danger.
In the US, ___% of the population have been diagnosed with anxiety disorder in their lifetime.
28%
What are the types of consequences of anxiety disorders?
Financial cost, medical, employment, interpersonal and reduced QOL.
What are the types of anxiety disorders?
Under phobias, there are 3: specific phobias, social phobia (social anxiety disorder - SAD), agoraphobia.
Panic disorder, GAD (generalised AD), OCD, and PTSD.
How is generalised anxiety order characterised?
Apprehensive expectation, generalised & persistent anxiety, constant distress, not isolated to particular situations, wide range of worries
What are the characteristics of panic disorder?
Discrete period of intense fear in the absence of danger, sudden occurrence, builds rapidly, unpredictable, relatively free of anxiety between attacks, sense of imminent danger
Characteristics of agoraphobia?
Marked fear of 2 or more of the following:
- using public transport
- being in open spaces
- being in enclosed spaces
- standing in line / in a crowd
- being outside home alone
causing avoidance, endurance of feared situations with intense anxiety, or requiring accompaniment
Characteristics of social anxiety disorder?
Fear / anxiety about one or more social situations with exposure to possible scrutiny, afraid of negative evaluation by others, hence —> avoidance / endurance w intense anxiety
Characteristics of specific phobias?
Evoked by particular circumstances, usually avoids them, involuntary fear is out of proportion to the situation
What are the 3 obsessive-compulsive related disorders?
OCD, Body Dysmorphic Disorder (BDD), and Hoarding Disorder (HD)
Characteristics of OC related disorders?
Uncontrollable, time intensive and repetitive thoughts and behaviours causing distress.
In what most common aspects does intrusive OCD thoughts manifest?
Contamination, sexual / aggressive impulses, body problems, religion, symmetry / order.
Do people with OCD understand that their thoughts are “silly”?
Yes, 78% understand that their thoughts are “unfounded.”
People with OCD may often ______ to appease their worries.
Engage in cleaning, repeatedly count or touch a body part, or obsessively check
According to DSM-5, how is PTSD characterised?
Exposure to traumatic experience, one or more intrusive symptoms, persistent avoidance of associated stimuli, 2 or more negative changes in mood & cognition, 2 or more marked alterations in arousal & reactivity, lasts over a month, and clinically significant distress & impairment
How effective is exposure therapy in treating trauma?
70 - 80% found it effective. It is prolonged, consistent with systematic desensitisation & relaxation techniques.
What are the 4 phases of Aaron Beck’s Cognitive Therapy?
1) Increasing activities & elevating mood
2) Challenge automatic thoughts
3) Identify negative thinking & biases
4) Change primary attitudes / schemas
Major depressive disorders are 2x more likely to occur in men than women. True or false?
False. Women are 2x more likely.
What are the 2 types of depressive disorders?
Major Depressive Disorder (MDD) and Persistent Depressive Disorder (PDD).
How is MDD characterised?
A person has MDD if they have either a depressed mood or loss of interest, and exhibit 5 or more of the following within 2 weeks:
- depressed mood for most of the day
- diminished interest / pleasure in most activities
- significant weight loss / gain (>5%)
- insomnia / hypersomnia
- psychomotor agitation / retardation
- fatigue / loss of energy
- worthlessness / extreme guilt
- indecisiveness, inability to think
- recurrent thoughts of death, suicide ideation
What is the Negative Triad of perception?
It involves 3 methods of perception: the self (“I am worthless”), the world (“no one likes me because I am worthless”), and the future (“I won’t succeed because I’m worthless”).
What is the difference between psychosis and schizophrenia?
Psychosis is a raw set of symptoms unspecific to any disorder, such as dissociation, disorganised behaviour, lacking in motivation. vs Schizophrenia which is a specific disorder characterised by psychotic symptoms.
What are the 3 symptom clusters of psychoses?
Positive (exceeding typical function: hallucinations), negative (diminished function: lack of motivation) and disorganised.
What is DSM-5’s diagnostic criteria for schizophrenia?
2 or more of the following for over 6 months:
- delusions
- hallucinations
- disorganised speech
- disorganised / catatonic behaviour
- negative symptoms
+ downward drift, where these symptoms emerge gradually
What are 6 types of delusions (positive symptoms)?
Persecution: belief someone wants to harm you
Erotomania: belief someone is into you despite no interaction whatsoever
Grandeur: belief that one is an agent of God, a deity, helms special powers
Reference: belief someone through the TV is talking to you
Somatic: belief of foreign body invasion, suffering from severe disease
Nihilistic: belief that the world is going to end
5 types of hallucinations?
Gustatory, olfactory, auditory, visual and tactile.
What are some signs that someone has disorganised speech / thought?
Echolalia: echoing words, repetition of someone’s words
Loose association: incoherent manner of speaking, stream of consciousness
Neologisms: making up words
Clang association: speaking in rhyme
Echopraxia:
Echo / mimicking of movements
Word salad: able to respond in a coherent manner but words don’t make sense together at all.
What are some examples of negative symptoms of psychotic disorders?
Affective flattening: shallow emotions
Alogia: poverty of speech
Thought blocking: disrupted train of thought, hence diversion to other topics
Avolition: lack of drive
Anhedonia: inability to experience pleasure
What are the 3 phases of psychotic disorders?
Prodromal (beginning of psychosis symptoms but not full break from reality), active and residual (decline in severity but is typically chronic and perseveres for life).
What are the 3 other types of psychotic disorders mentioned in the lectures?
Schizophreniform Disorder:
- short duration of symptoms
- good prognosis
Schizoaffective Disorder:
- independent symptoms of SZ & mood disorder
- similar prognosis to SZ
Delusional Disorder:
- >1 month of delusions
- rare
- better prognosis than SZ
- few / no negative symptoms
About what percentage of the population suffers from schizophrenia at some point in their lives?
0.7 - 1.5%.
What is the typical age range for when men and women have their first psychotic breaks?
Men: 18 - 25 years
Women: 25 - 35 years
In 3/4 of psychotic cases, what is the age range of patients?
15 to 45 years.
To what extent is schizophrenia genetic & biological?
A large extent. There is an 80% heritability index across studies. Linked to brain abnormalities (neurodegenerative hypothesis), enlarged ventricles (reduced bloodflow and brain volume), prefrontal hypometabolism (lack of acitivity on left side)
What is the dopamine paradox in schizophrenia?
Excessive dopamine in subcortical areas –> +ve psychotic symptoms
vs
Reduced dopamine in prefrontal cortex –> -ve psychotic symptoms
different / imbalanced dopaminergic pathways
What are the treatments of psychotic disorders?
Biological: medication to treat +ve & -ve symptoms, but may have side effects like tardive dyskinesia & neuroleptic malignant syndrome
Cognitive: restructuring (challenge delusional beliefs) & rehabilitation (modify over- or under-attention)
What are the 2 types of episodes of someone with bipolar disorder?
Manic and hypomanic.
What does a manic episode consist of?
- 1 week of elevated, expansive or irritable mood
- 3 changes in the following: grandiose self-esteem, reduced need for sleep, overly talkative, racing thoughts, easily distracted, increased activity / agitation, engagement in high risk activities
- impaired functioning, hospitalisation / psychotic features
- not due to substance / medical condition
What does a hypomanic episode consist of?
- 4 days of elevated, expandable or irritated mood
- mood disturbance doesn’t critically impair work or social abilities
- uncharacteristic responses observable by others
- not euthymia
What are the 3 bipolar related disorders, and how are they categorised?
Bipolar I Disorder: at least 1 manic episode (ME) + major depressive episode (MDE)
Bipolar II: hypomanic episode (HME) + MDE
Cyclothymic: persistent depressive disorder (PDD) + HME
How heritable are bipolar disorders?
Very. 70 - 90% chance of inheriting it. Same-sex twins had 93% chance.
What are the 2 broad treatments of bipolar related disorders?
Psychotherapy and biological (psychotropic medication).
What are some medications prescribed to those with bipolar related disorders?
Mood stabilisers like lithium: can result in intense nausea and requires close monitoring as threshold for effect and overdose are close
Anticonvulsants: valproic acid and carbamazepine
Atypical antipsychotics: olanzapine, aripiprazole, etc.
What does psychotherapy for bipolar related disorders entail?
Medication management, self-care (diet, sleep, stress), social skills and interpersonal relationships. This reduces hospitalisation and improves social & occupational functioning.
What is the mortality rate of anorexia nervosa?
10 - 15%. Patients usually die from malnutrition, not suicide.
What are the general characteristics of eating disorders?
Body dissatisfaction, restrictive eating, binge-eating, purging or compensating.
According to DSM-5, what are the 5 types of eating disorders?
Anorexia nervosa, bulimia nervosa, binge eating disorder, avoidant/restrictive food intake disorder and other specified eating disorder.
What are the diagnostic features of anorexia nervosa?
- restricted energy intake, causing low body weight (severity used to be measured based on <15% of body weight, but now using BMI)
- despite being underweight, there is intense fear of being fat
- body dysphoria
What are the 2 types of anorexia nervosa?
Restricting type and binge-eating / purging type.
What are the diagnostic features of bulimia nervosa?
- recurrent binge-eating with lack of self-control
- recurrent inappropriate compensatory behaviour to prevent weight gain
- aforementioned behaviours occur at least once a week for 3 months
- self-evaluation highly influenced by body weight and shape
- severity depends on number of binge-eating and compensatory behaviours per week
Associated features of bulimia nervosa include:
- normal or overweight
- individuals typically restrict caloric intake between binges
- low mood / depression
- low self-esteem
- high rates of smoking (reduce appetite)
- high rates of substance abuse (impulse control difficulties)
What does binge-eating disorder entail?
- recurrent binges 2x a week for at least 6 months
- 3 or more of the following: rapid eating, eating until uncomfortably full, binging when not hungry, eating alone due to embarrassment, feeling disgusted, depressed & guilty after overeating
- does NOT involve compensatory behaviours
Why is diagnosing disorders in childhood so hard?
Rather than seeking help, children act out. Some degree of deviance and irrational behaviour is typical of children, and some psychological disorders in children cause minimal to no conscious distress.
What are some neurodevelopmental disorders discussed in the lectures that originate from childhood?
Intellectual disability, autism spectrum disorder (ASD) and attention-deficit hyperactivity disorder (ADHD).
What are some behaviour disruptive disorders (aka externalising disorders) discussed in the lectures?
Oppositional defiant disorder and conduct disorder.
What is the diagnostic criteria for intellectual disability?
- onset before age 18
- deficits in adaptive functioning in communication, social and practical settings
- deficits in intelligent functioning determined by intelligence tests, appropriate for social and cultural context
- ranges from mild, moderate, severe to profound
How is autism spectrum disorder (ASD) characterised?
deficits in social communication
- nonverbal behaviour
- peer relation development
- social & emotional reciprocity
restricted & repetitive behaviour patterns:
- stereotypic, repetitive speech
- excessive adherence to routines, rituals
- restricted interests with abnormal focus
- hype- or hypo-reactivity to sensory input
-onset in early childhood
RANGES FROM MILD TO SEVERE
What is the diagnostic criteria of AD/HD?
- inattention, hyperactivity & impulsivity
- 3 subtypes: predominantly inattentive, predominantly hyperactive-impulsive, combined type
How does inattention manifest?
- easily distracted
- unsustained attention
- careless mistakes
- difficulty listening
- inability to follow instructions
- difficulty organising
- avoids tasks requiring attention
- loses things
- forgetful
How does hyperactivity manifest?
- fidgetting
- leaving seat when expected to be sitting
- running / climbing excessively
- excessive talking
- blurting out answers
- difficulty waiting turn
- interrupts others
What is the heritability rate of ADHD?
60 - 80%
What are the biological reasons behind ADHD?
Structural abnormalities such as under-responsive prefrontal & striate regions, such as the dorsolateral region.
Excessive dopamine.
What are some treatments for ADHD?
Biological: stimulant medications such as adderall, ritalin and concerta.
Behaviour therapy
How is oppositional defiant disorder (ODD) characterised?
- argumentative
- temper tantrums
- authority problems
- trouble complying with rules
- anger / resentment
- blame externalisation
How is conduct disorder characterised?
More severe than ODD, it manifests in:
- aggression towards animals & people (bullying, animal cruelty, etc.)
- property destruction (vandalism, arson)
- deceitfulness / theft
- serious rule violation
- limited prosocial emotions
- 2 or more of the following over 12 months in more than 1 relationship: lack of remorse / guilt, lack of empathy, unconcerned abt performance, shallow / deficient affect
Externalising disorders can be attributed to genetic vulnerability. However, the manners in which these disorders manifest are influenced by the external environment. True or false?
True.
What is the best predictor of conduct disorder and ODD?
Combination of peer groups & past anti-social behaviour.
What are the familial and sociocultural risk factors of ODD and CD?
Familial: Child abuse, family conflict
Sociocultural: Poverty, dangerous neighbourhoods & past antisocial behaviour
What are the 3 focuses of ODD and CD treatment?
Family, child and prevention.
How does the DSM-5 characterise substance use disorder?
Problematic pattern of use impairing function, including 2 or more symptoms within 1 year:
- failure to meet obligations
- repeated use in dangerous situations
- repeated relationship problems
- continued use despite problems caused
- tolerance
- withdrawal
- substance taken for longer time or in greater amounts than intended
- efforts to reduce or control use are ineffective
- time spent acquiring drugs
- impaired function
- cravings
What are the definitions of 3 important words within substance abuse?
Addiction: severe substance abuse (> 6 symptoms)
Tolerance: larger doses required to achieve same effect
Withdrawal effects: manifests in physical (shaking, flu-like symptoms, pain) and psychological (irritability, anxiety, depression)
What are the 4 drug classes?
Depressants (inhibitory effect), stimulants (increase pleasure, energy), hallucinogens (achieve altered state of consciousness) and cannabis.
What are the common treatments used to treat substance abuse?
Detoxification, antagonist therapy, aversion therapy, motivational interviewing and 12-step program.
