Psychopathology Flashcards
psychopathology
study of the diseases of the mind
abnormal psychology
Incorporates all other areas of psychology (development, cognitive, etc.)
disease
A morbid entity ordinarily characterized by two or more of the following criteria: recognized etiologic agent(s), identifiable group of signs and symptoms, or consistent anatomic alterations
syndrome
A group of symptoms that collectively indicate or characterize a disease, a psychological disorder, or another abnormal condition
disorder
A disturbance or derangement that affects the function of mind or body
diagnosis
the art or act of identifying a disease from its signs and symptoms
symptom
Subjective indication of a disorder; May or may not be directly observable
sign
Objective indication of disorder (Especially as observed and interpreted by an expert rather than by the patient or lay observer); May or may not be expressed by patient
prototypical
description of a disease; way of defining a disorder; PDM description of BPD
polytheic
diagnosis is satisfaction of certain number of criteria; Makes for qualitatively different experiences given same diagnosis
Ex: DSM- here are 9…pick 5
categorical
have or have not
dimensional
exists on continuum- high or low- how psychologists view things
prevalence
how many people have over a certain time (lifetime)
incidence
how many people get it in a given period
criteria
Standards by which to evaluate or test membership (i.e. intensity, frequency, developmental status, duration, pervasiveness, external circumstances)
different prevelances?
Relevant differences by sex, age, culture
-Sex differences: Genetic or biological differences
-Gender differences: Socialization of what is expected
cultural idiom of distress
Way of expressing distress
Experience of fatigue in depression
cultural syndrome
Syndrome found uniquely in cultural group
Koro – genital retraction syndrome
cultural explanation or cause
Understanding why a symptom occurs unique to a culture
other specified disorder
-Not meeting full criteria but clinically significant
-Uncharacteristic presentation
-Reason given why
unspecified disorder
-Not meeting full criteria
-No reason given why
provisional diagnosis
Not enough information, but strong assumption
-Differential diagnosis
-Often noted as “r/o” rule out or “e/f” evaluate for
specifiers for all disorders in DSM
-Mild: mild to moderate distress, little interference
-Moderate: moderate distress, not getting some things accomplished
-Severe: severe distress, unable to function
-In Partial Remission
-In Full Remission
-Prior History
intellectual disability
Deficits in intellectual functions, confirmed by both
-Clinical assessment and
-Individualized, standardized intelligence testing
Deficits in at least 1 area of adaptive functioning across multiple environments
Onset during the developmental period
Associated features:
-Deficits in adaptive functioning (determined by age norms)
-communication, self care, home living, social, self direction, work, leisure, health, safety
IQ levels for ID
Mild: 50-55 - 70
Moderate: 35-40 to 50-55
Severe: 20-25 to 35-40
Profound: < 20-25
diseases and environmental factors that can contribute to ID
Disease
Prenatal: rubella, syphillis, toxoplasmosis, herpes, HIV
Postnatal: encephalitis, meningitis
Environment
Prenatal: High blood pressure, diabetes, drug and alcohol use
Postnatal: birth complications, heavy metals, malnutrition
specific learning disorder
Difficulties learning and using academic skills despite the provision of interventions
-At least 6 months
-At least 1 symptom
-Abilities substantially and quantifiably below expected for chronological age AND cause significant interference
-Confirmed by: clinical assessment OR individually administered standardized achievement measures
-For older than 17 years, documented history of impairing learning difficulties may be substituted for standardized assessment (!)
-Begins during school-age years
-May not be observed until demands exceed the individual’s limited capacity
three kinds of SLD
Reading: inaccurate or slow and effortful word reading, comprehension
Writing: spelling, written expression, grammer
Math: number sense, number facts, calculation, mathematical reasoning
achievement vs aptitude
achievement: knowledge or gained ability, sometimes represented as age or grade level, SAT, GRE, WIAT, Woodcock Johnson
aptitude: potential to learn or gain, IQ, GRE, WAIS, WISC, WIPSI
Autism spectrum disorder
Persistent deficits in social communication and social interaction across multiple contexts
-Social-emotional reciprocity
-Nonverbal communicative behaviors
-Developing, maintaining, and understanding relationships
At least 2 restricted, repetitive patterns of behavior, interests
-Stereotyped or repetitive motor movements, use of objects, or speech
-Insistence on sameness or routines
-Highly restricted, fixated interests abnormal in intensity or focus
-Hyper- or hyporeactivity to sensory input or unusual interest in sensory aspects
Begin in the early developmental period
-May not be observed until social demands exceed limited capacities
-May be masked by learned strategies in later life
Associated features:
-4 times more likely in boys; Girls when have Autism Spectrum Disorder more likely to also have Intellectual Disability
level 3 autism
Requiring very substantial support
social communication: Severe deficits in verbal & nonverbal social communication skills cause severe impairments in functioning, very limited initiation of social interactions, & minimal response to social overtures from others. For example, a person with few words of intelligible speech who rarely initiates interaction, and when they do, makes unusual approaches to meet needs only & responses to only very direct social approaches.
restricted, repetitive behaviors: Inflexibility of behavior, extreme difficulty coping with change, or other restricted/repetitive behaviors markedly interfere with functioning in all spheres. Great distress/difficulty changing focus or action.
level 2 autism
Requiring substantial support
social communication: Marked deficits in verbal & nonverbal social communication skills; social impairments apparent even with supports in place; limited initiation of social interactions; reduced or abnormal responses to social overtures from others. For example, a person who speaks simple sentences, whose interaction is limited to narrow special interests, & who has markedly odd nonverbal communication.
restricted, repetitive behaviors: Inflexibility of behavior, difficulty coping with change, or other restricted/repetitive behaviors occur frequently enough to be obvious to the casual observer & interfere with functioning in a variety of contexts. Distress/difficulty changing focus or action.
level 1 autism
Requiring support
social communication: Without supports in place, deficits in social communication cause noticeable impairments. Difficulty initiating social interactions, and clear examples of atypical or unsuccessful responses to social overtures of others. May appear to have decreased interest in social interactions. For example, a person who is able to speak in full sentences & engages in communication but whose to-and-fro conversation with others fails, and whose attempts to make friends are odd & typically unsuccessful.
restricted, repetitive behaviors: Inflexibility of behavior causes significant interference with functioning in one or more contexts. Difficulty switching b/w activities. Problems of organization & planning hamper independence.
attention deficit/ hyperactivity disorder
Inattention or Hyperactivity-Impulsivity
-At least 6 months
-Can have either/or
-Symptoms and impairment present before 12 years
-Impairment in at least 2 settings
-Clear evidence of clinically significant impairment in functioning
inattentive type (at least 6, if over 17 5): difficulty with attention or careless mistakes, difficulty sustaining attention, not listening when spoken to, poor follow through, difficulty organizing, avoids sustained mental effort, loses necessary objects, easily distracted, forgetful
hyperactivity (at least 6): fidgets, leaves seat, restless, difficulty playing quietly, difficulty organizing, on the go, excessive talking, blurts out answers, difficulty waiting turn, interrupts or intrudes
delirium
Disturbance of attention and awareness
-Inattention, somnolence
-Distractibility
-Requiring restatement of questions and directions
-Vague/unsatisfactory or bizarrely incorrect answers
-Inability to solve problems due to attention
Develops over a short period of time, represents a change from baseline, and tends to fluctuate during the day
-Develops within hours or days
-Changes during the day
-Often alert, normal in AM; symptomatic in PM
-Sundowning
-Sensory deprivation at nighttime
how delirium impacts other aspects of cognition
Memory
-Often for recent events
Orientation
-Time, place, person (x3)
Language (not just slurred)
-Difficulty naming objects
-Rambling or incoherent speech
Perception
-Misinterpretations, illusions, hallucinations
-Most often visual
-Sometimes accompanied by disorganized delusions
Emotion regulation
-Apathy, fearful, depressed, irritable, euphoric
evidence that delirium is physiological
infection/fever, metabolic disorder, electrolyte imbalance, anesthesia/postoperative state, cardiopulmonary disorders, vitamin deficiency, head trauma, brain lesion or stroke
how to code delirium
-Code medical condition first
Substance Intoxication Delirium
-In excess of effects of intoxication
-Prescribed medications
-Toxins
-Illicit drugs
Substance Withdrawal Delirium
1. Especially with rapid withdrawal from short-acting medications (e.g., alcohol, benzodiazepine)
2. Delirium tremens
-Tremor, agitation, disorientation, hallucination
-Toxin
-Multiple etiologies
Other:
3. Cultural factors may influence detection
4. Most common mental d/o
common causes of delirium across ages
children: fever, infection
young adults: drugs, accidents
adults: not common
older adults: metabolic problems, multiple health conditions, surgery conditions
other facts about delirium
-Male > Female
-Rapid onset
-Wax/waning symptoms
-Generally, resolves few hours to days
-Treat underlying condition
-Poorer prognosis (brain is not functioning)
neurocognitive disorder
Evidence of significant (modest) decline in one or more cognitive domains
-Memory impairment most common
-Widespread
-recognition
-Recall
Declarative
-Semantic and episodic, not procedural
Anterograde (new) or retrograde (previous)
-Cognitive deficits (do not) interfere with independence
-Even persons with mental retardation, delirium (if separate courses)
-Generally, diagnosis only given after 6 months
-Not exclusively in the context of a delirium
-Associated features: motor or gait disturbance; personality change; disinhibited behavior; mood changes and anxiety; sleep disturbance; delusions; poor insight into condition
-Cultural factors may influence detection: reverent treatment of elderly; less emphasis on cognitive demands; explanations for cognitive and behavioral changes
-More frequently observed in older and/or medically unwell individuals
aphasia
language disturbance (speech vague, circumstantial, extensive)
-Pronoun use, stereotyped phrases
-Cannot explain meaning of common phrases
apraxia
inability to coordinate motor movement (despite intact physical ability)
-Cannot perform simple actions on request
agnosia
inability to recognize objects (despite intact sensory ability)
-Cannot identify/name common objects
disturbance in executive function
problems planning, organizing, or abstracting information
-Cannot switch mental sets (serial 7’s)
-Cannot find similarities/differences
-Cannot generate novel information
neurocognitive disorder due to alzheimers disease
Insidious onset and gradual progression
-Typically unaware of cognitive deficits
-Onset to death typically 8-10 years
Evidence of Alzheimer’s disease
-Genetic mutation (rare)
-Decline in memory and learning and one other domain
-Steadily progressive, gradual decline, without plateaus
-No evidence of mixed etiology
problems for recent memory: forgetting, 50% first symptom, repeating things
further cognitive declines: three A’s, frontal release signs, personality changes, lose ability to live independently, delusions, hallucinations
final stages: lose vocabulary, lose self care, unable to coordinate movement, death
Associated features
-20% patients with Alzheimer’s show depressive symptoms
-20% will show pronounced delusions
vascular neurocognitive disease
Symptoms consistent with vascular etiology
-Temporally related to cerebrovascular events
-Decline is prominent in
-Complex attention
-Executive function
Presence of cerebrovascular disease
-Large vessel changes
-Ischemic
-Thrombosis, embolism, hypoperfusion
-Hemorrhagic
-Intra- or extraaxial (inside or outside the brain)
Small vessel changes
-Subcortical ischemic changes
-Also ischemic, but different symptoms, course
Evidence of TBI with one or more of
-Loss of consciousness
-Posttraumatic amnesia
-Disorientation and confusion
-Neurological signs
-Neuroimaging, seizures, change in functions
NCD presents immediately after and persists
Stepwise progression
substance induced neurocognitive disorder
Deficits persist beyond the usual duration of intoxication and withdrawal
-Substance, duration, and extent of use capable of producing neurocognitive impairment
-Temporal course consistent with use and abstinence
Associated features
-Previous substance dependence
-Consistent exposure to toxins
alcohol, cocaine, opioids, amphetamines, cannabis, inhalants, sedatives/anxiolytics, anticonvulsants, heavy metals, industrial chemicals, insecticides, carbon monoxide
mental disorders due to a general medical condition
-Presence of significant psychiatric symptoms
-Evidence of direct physiological consequence of GMC
-NBAFB other mental disorder
-Not exclusively during Delirium
short term, long term, and withdrawal effects of depressants
short term: Relief from anxiety
Euphoria
Lowered inhibition
Poor motor coordination
Impaired concentration/judgment
Slurred speech blurred vision
sedation
long term effects: Depression
Chronic fatigue
Respiratory impairments
Impaired sexual function
Decreased attention span
Poor memory/judgment
Chronic sleep problems
withdrawal: Tremors
Insomnia
Irritability/restlessness
Hallucinations
Convulsions
short term, long term, and withdrawal effects of stimulants
short term: Euphoria
Dilated pupils
Feeling of energy
Increased activity/speech
Decreased appetite
Wakefulness
long term: Chronic sleep problems
Poor appetite
Rapid/irregular heartbeat
Mood swings
withdrawal: Dysphoria
Extreme fatigue
Sleep disturbance
Increased appetite/weight gain
short term, long term, and withdrawal effects of perception distorting
short term: Bloodshot eyes (THC)
Increased appetite (THC)
Mood alterations
Disorientation
Hallucinations
Synesthesia
Impaired cognitive abilities
long term: Flashbacks (LSD)
Low motivation
Decreased cognitive abilities
withdrawal: Sleep disturbance
Loss of appetite
Irritability
Tremors
Depression
short term, long term, and withdrawal effects of opioids
short term: Euphoria
Drowsiness
Apathy
Impaired cognitive ability
Reduced pain sensitivity
long term: Mood instability
Constipation
Respiratory impairments
Physical deterioration
withdrawal: Dysphoria
Aches, pains
Diarrhea/nausea/vomiting
Pupil dilation
Fever
Insomnia
short term, long term, and withdrawal effects of steroids
short term: Euphoria
Muscle growth
long term: Reversal of 2°sex characteristics
Irritability
Reduced energy
Liver/heart disease
withdrawal: Mood swings
Depression
Weakness/fatigue
Weight loss
substance use disorders
Problematic pattern of substance use leading to clinically significant impairment or distress
At least 2 symptoms in a 12-month period
-Limit setting and breaking (impaired control) – using more than intended or over longer period of time; unsuccessful attempts to cut down; great deal of time spent using; craving
-Social impairment – failure to fulfill obligations; use despite interpersonal problems; activities given up
-Consequences (risky use) – use in physically dangerous situations; use despite knowledge of physical or psychological problem
-Physiological dependence (pharmacological) – tolerance; withdrawal
Not a prescribed substance used correctly
Specify if:
-Mild: 2-3 substances present
-Moderate: 4-5 substances present
-Severe: 6+ substances present
-In early remission: 3 consecutive months with no symptoms, but not more than 12 consecutive months; cravings can be present
-In full remission: 12 consecutive months with no symptoms; cravings can be present
substance intoxication vs. withdrawal
Substance Intoxication
-Development of a reversible syndrome due to substance use/exposure
-Problematic behavioral or psychological changes due to the effects on the CNS
-Symptoms should stop with no more usage
Substance Withdrawal
-Cessation of heavy or prolonged substance use
-Development of substance-specific syndrome
-Clinically significant impairment or distress
-Short-acting substances more likely to have prominent withdrawal symptoms
gambling disorder
Grouped with substance disorders due to similar reward pathways, behaviors
Problematic patterns of gambling
-Clinically significant distress or impairment
Four or more symptoms in a 12-month period
-Gambles with more in order to achieve excitement (tolerance)
-Restless or irritable when attempting to cut down (withdrawal)
-Repeated unsuccessful attempts to cut back
-Preoccupied with gambling
-Gambles when distressed
-After losing, returns to get even
-Lies to conceal gambling
-Jeopardized or lost relationship or opportunity
-Relies on other to relieve finances
Specify if:
-Episodic: symptoms subside for several months
-Persistent: continuous symptoms over years
-In early remission; in full remission
-Mild (4-5 symptoms); Moderate (6-7); Severe (8-9)
3x higher among Asian individuals
schizophrenia
Two or more following symptoms
-Delusions
-Hallucinations
-Disorganized speech
-Disorganized behavior
-Negative symptoms: lack of emotional expression, decreased speech, decreased social contact, decreased motivation, decreased self care, slow movement, low sex drive
Present for significant proportion of 1-month period
-Less time if treated
One or more major areas of functioning markedly below normal
Continuous signs of disturbance at least 6 months
Earliest point at which can give diagnosis of Schizophrenia
-5 months DEFINITE prodromal symptoms
-1-month active symptoms
-Can also give Schizophrenia 5 months after active symptoms if some residual symptoms present (and uncertain if prodromal symptoms present)
-Must give Schizophrenia if multiple episodes (without exclusionary diagnoses)
Culture
-Influences belief systems, experiences
-Higher prevalence among African-Americans
-vs. Bipolar in European Americans
-Higher prevalence in developed countries
-Not different urban vs. rural
Age
-Onset late adolescence to early 30s
-Men onset = 18-25
-Women onset = 25-30
schizoaffective disorder
Uninterrupted period of positive or negative symptoms with
-Major depressive episode - With depressed mood (not just anhedonia)
-Manic episode
-At least 2 weeks during lifetime when delusions or hallucinations without mood disturbance
-Mood episode present for the majority of active and residual period
schizophreniform disorder
At least 1 month of psychotic symptoms
-Defined same as Schizophrenia criteria
-Less than 6 months total duration
Impairment not necessary
Presumably better prognosis
-Not “locked in” to Schizophrenia
Diagnosing
-Can also give conservative diagnosis of Schizophreniform Disorder
- 1-month active symptoms
-UNCERTAIN 5 months prior
-6 months not past since break