Psychopathology Flashcards
Schizophrenia
Two or more active phase symptoms for at least one month: at least one symptom is delusion hallucinations or disorganized speech
Signs of the disorder for at least 6 months
Activate symptoms
- delusions, hallucinations, disorganized speech, grossly disorganized or catatonic behavior, And negative symptoms
Negative symptoms
- take away
- diminished emotional expression
-anhedonia
Avolition-
Avolition
Decrease in motivated self-initiated activities
Anhedonia
- decreased ability to experience pleasure from positive experiences
Prodormal symptoms
- often proceed the active phase
- Non-Psychotic
social withdrawal, loss of interest in activities in people and decreased or inappropriate emotions
Residual symptoms
- follow active phase
Mild hallucinations, unusual or odd beliefs that are not of delusional, proportion, and or negative symptoms
Better prognosis of schizophrenia
- abrupt and later on set, precipitating stressor, female gender, insight into the illness, and no family history of schizophrenia
Elevated risk of reluctance for schizophrenia, mood, & eating dos
- high levels of expressed emotions are family members towards the client
- hostility and criticism or emotional over involvement family members Express towards client
Etiology of schizophrenia
- heredity, neurotransmitter abnormalities, in brain abnormalities
Heredity and schizophrenia
- The greater the degree of genetic similarity, the greater the concordance rate.
Concordance rate of Biological sibling and schizophrenia
9%
Concordance rate of fraternal twin and schizophrenia
17%
Concordance rate of identical twin in schizophrenia
48%
Concordance rate of one child with one parent with schizophrenia
13%
Concordance rate of child with two parents with schizophrenia
46%
Revised dopamine hypothesis of schizophrenia
- positive symptoms: due to dopamine hyperactivity and subcortical regions (mesolimbic system)
- negative symptoms and cognitive symptoms: dopamine hypoactivity in cortical regions (prefrontal cortex)
Neurotransmitters linked to schizophrenia
- ACH
- gaba- positive symptoms
- glutamate and serotonin: negative and cognitive symptoms
Brain abnormalities and schizophrenia
- enlarged ventricles and hypofontality (lower than normal activity in the prefrontal cortex)- negative and cognitive symptoms
Treatment of schizophrenia
- multiple evidence-based interventions: antipsychotic drug, family therapy, family education, CBT, social skills, training, and assertive community treatment
Assertive community treatment
- multidisciplinary team
- individualized treatment that’s available 24/7
- integrates medication management, rehabilitation, and social services
Primary goal is to prevent relapse and re-hospitalization
Schizophreniform
- two or more active phase symptoms
,- at least one symptom is delusion to hallucinations or disorganized speech
,- symptoms last one month to less than 6 months
Brief psychotic disorder
- one or more characteristic symptom with at least one symptom being delusions, hallucinations, or disorganized speech
- symptoms last one to one month
Schizoaffective disorder
- concurrent symptoms of schizophrenia and major depressive or manic episode
- 2 week period Without mood symptoms
Bipolar 1 disorder
- at least one manic episode for at least one week
- may or may not have been preceded or followed by a major depressive or hypomanic episode
Bipolar II disorder
- One hypomanic episode for at least 4 days
- at least one major depressive episode for at least 2 weeks
Cyclothymic disorder
- numerous periods of hypomanic and depressive symptoms
-at least 2 years in adults. One year and children are adolescents
- symptoms must be present for at least half the time and person can’t be without symptoms for 2 months at a time
Manic episode
- abnormally and persistent elevated, expansive, or irritable mood
- increase goal directed activity or energy for at least one week
- three or more characteristic symptoms: grandiosity/ inflated self-esteem, talkativeness, flight of ideas, decreased need for sleep
Duration is at least one week, and pairs functioning, and requires hospitalization and or psychotic features
Hypomanic episode
- lasts for at least 4 days
- abnormally and persistent elevated, expansive, or irritable mood and increased activity or energy
- at least three symptoms of mania
- symptoms are not severe enough to require hospitalization and don’t include psychotic features
Major depressive episode
- 2-week duration
- five symptoms: at least one symptom is depressed, mood or loss of interest and or pleasure
- decrease or increase in appetite nearly everyday, insomnia or hypersomnia, psychomotor agitation or retardation, diminished ability to concentrate, and recurrent suicidal ideation or suicide attempt, feelings of worthlessness or excessive guilt
Etiology of bipolar disorder
- heredity, neurotransmitter abnormalities, structural & functional brain abnormalities, And circadian rhythm abnormalities
Heredity and bipolar disorder
- bipolar disorder has a strong genetic contribution
CR
identical twins= 75%
Fraternal twins = 20%
Child with one parent= 25%
Child with both parents= 60%
Neurotransmitter, abnormalities and bipolar disorder
- normal levels of norepinephrine and serotonin
Structural and functional brain abnormalities and bipolar disorder
- pfc and amygdala
Possibly the hippocampus and Basal Ganglia
Circadian, rhythm, abnormalities and bipolar disorder
- sleep wake cycle
- release of hormones
-Regulation of appetite and body temperature
Circadian, rhythm, abnormalities and bipolar disorder
- sleep wake cycle
- release of hormones
-Regulation of appetite and body temperature
Treatment of bipolar disorder
- lithium for classic bipolar
Anticonvulsant drugs and atypical antipsychotics - Strong research support: family focused therapy And psychoeducation
- modest research support for interpersonal and social rhythm therapy and CBT
Treatment of bipolar disorder
- lithium for classic bipolar
Anticonvulsant drugs and atypical antipsychotics - Strong research support: family focused therapy And psychoeducation
- modest research support for interpersonal and social rhythm therapy and CBT
Major depressive disorder
- at least one major depressive episode for at least 2 weeks- most of the day or nearly everyday
- five or more characteristic symptoms, one symptom must be depressed, mood or loss of interest or pleasure
Major depressive disorder
- at least one major depressive episode for at least 2 weeks- most of the day or nearly everyday
- five or more characteristic symptoms, one symptom must be depressed, mood or loss of interest or pleasure
With peripartum onset
- onset of symptoms is during pregnancy or 4 weeks following delivery
- up to 80% experience baby blues
- To 6% experience a major depressive episode
- 50% of major depressive episodes begin prior to delivering
- sources other than DSM-5 site higher rates of mdd with peripartum onset
With seasonal pattern( seasonal affective disorder)
- relationship between moods, episodes and time of year( usually winter)
- hypersomnia, overeating, weight gain, and carbohydrate craving
- abnormal levels of serotonin and melatonin
- treated with bright light therapy
Persistent depressive disorder
- requires depressed mood for at least 2 years in adults and one year and kids are adolescents
Etiology of major depressive disorder
- biological and cognitive factors
Biological factors of MDD
- heredity, low levels of manorepinephrine and serotonin,, and increasedcortisol activity in the hypothalamic pituitary adrenal axis (HPA)
Seligman’s learned helplessness model
- og: depression is due to repeated exposure to repeated events that result in a sense of helplessness
- result of a pessimistic explanatory style (attribute negative events to a stable internal and global factors) and a sense of hopelessness was added as a proximal sufficient cause of depression
Beck’s cognitive triad
- negative self statements, about self-world and the future cause depression
Treatment of major depressive disorder
Evidence-based treatments: strong support antidepressant drugs , CBT, interpersonal therapy, behavioral activation therapy, and problem solving therapy
Lot of support: act and emotion-focused therapy
Panic disorder
- recurrent unexpected panic attacks
- one or more attacks followed by at least one month of persistent concern or worry about having additional attacks or their consequences and or a significant maladaptive change in behavior related to the attacks
Panic attack
- abrupt surge of intense fear or intense discomfort that reaches a peak within minutes
4 characteristic symptoms
Heart palpitations, pounding heart, or accelerated heart rate, trembling or shaking, chest pain or nausea, or feeling dizzy Light-Headed or unsteady
Panic attack
- abrupt surge of intense fear or intense discomfort that reaches a peak within minutes
4 characteristic symptoms
Heart palpitations, pounding heart, or accelerated heart rate, trembling or shaking, chest pain or nausea, or feeling dizzy Light-Headed or unsteady
Treatment of panic disorder
- CBT that includes exposure with response prevention
Panic control therapy
- brief type of CBT that includes cognitive restructuring, psycho-education, psychoeducation, relaxation techniques, and vivo exposure, and intorceptive exposure
Interoceptive exposure
- expose client to high levels of symptoms of a panic attack so that they learn that the symptoms aren’t dangerous or harmful
Specific phobia
- intense fear of or anxiety about specific objects or situations
- avoid the object or situation or endure it with marked distress
Subtypes: (animal, natural environment, situational, blood injection, injury, and other
Treatment of specific phobia
Evidence-based: exposure with response prevention and exposure combined with applied relaxation is most effective for all except blood injection injury type
- blood injection injury type: exposure with applied tension
Agoraphobia
- marked for anxiety and avoidance of at least two or five situations due to fear, escape may be difficult or help unavailable in case of panic like incapacitating or embarrassing symptoms
- using public transportation, being in open spaces, being an enclosed spaces, standing in line or being part of a crowd, and being outside the home alone
Treatment of agoraphobia
- in vivo exposure with response prevention
Generalized anxiety disorder
- excessive anxiety and worry about multiple events or activities for at least 6 months
Evidence-Based treatment of generalized anxiety disorder
- CBT- with cognitive restructuring and applied relaxationpharmacotherapy: ssri, snri, anziolytic, or benzo
Evidence-Based treatment of generalized anxiety disorder
- CBT- with cognitive restructuring and applied relaxationpharmacotherapy: ssri, snri, anziolytic, or benzo
Ocd
- recurrent obsessions and or compulsions that are time consuming or cause significant distress/ impaired functioning
Ocd
- recurrent obsessions and or compulsions that are time consuming or cause significant distress/ impaired functioning
Etiology of OCD
- heredity, lower than normal. Serotonin and elevated activity in caudate nucleus and orbital frontal cortex
Treatment of OCD
Evidence-based: cbt with exposure with response prevention and exposure which response prevention alone both have strong support
- therapy is often combined with tricyclic cloimipramine or an SSRI
- antidepressants were really used alone because of high relapse
Ptsd
- onset of symptoms after exposure to actual or threaten death, sexual violence, or serious injury
- symptoms last for over a month
- four categories:
- intrusion: distressing dreams or memories
- avoidance of stimuli associated with event
- negative alterations and cognition in mood: persistent fear, anger or guilt or feelings of detachment
- marked alterations in arousal and reactivity: reckless or self-destructive behavior, exaggerated startle response, or sleep disturbance
Treatment of PTSD
Adults: strong recommendation for CBT, cognitive processing therapy, cognitive therapy, and prolonged exposure
Conditional recommendation for brief eclectic psychotherapy, EDMR, and narrative exposure therapy
Trauma-Focused cognitive behavior therapy for kids and adolescents
Trauma focus CBT
- evidence-based treatment originally designed for kids and adolescents 3 to 18 years old who experience sexual abuse
+ Been applied to other types of trauma
Family therapy, parenting skills, training, and conjoined parent-child therapy
Acute stress disorder
- onset of symptoms after exposure to actual/threatened death, serious injury, or sexual violence
- symptoms last 3 days to a month
- represent five categories: intrusion, negative mood, disassociation, avoidance and arousal
Major neurocognitive disorder
- significant decline from previous functioning in at least one cognitive domain (complex attention, executive functioning, and learning and memory) that interferes with Independence and everyday activities
Mild neurocognitive disorder
- it’s going to be a modest decline from previous level of functioning in at least one cognitive domain that does not interfere with Independents and everyday activities but may require greater effort or use of compensatory strategies
Neurocognitive disorder due to Alzheimer’s
- insidious onset and slow, progressive decline in cognitive functioning that includes a decline in learning and memory
- most common: accounts for 60 to 80% of cases
For major: 2cog symptom
Mild: one cog symptom
Early stage of Alzheimer’s disease
- 2-4 years
Anterograde amnesia, irritability, or passivity, disorientation to day and time & anomia
Middle stage of Alzheimer’s
- 2 to 10 years
- increasing enterograde and retrograde amnesia, anxiety or depression, delusions, restlessness, pacing, compulsive and repetitive behaviors, rambling speech, disruption and sleep patterns, and problems with daily activities
Late stage of Alzheimer’s
- one to 3 years
- severely deteriorated intellectual functioning, severe disorientation, apathy, severely impaired speech, agitation and wandering, incontinence, loss of basic motor skills, and inability to perform basic activities of daily life
Etiology of ncd due to Alzheimer’s
- heredity: abnormal ApoE4 gene
- low ACH
- development of neurotic plaques and neurofibrillary tangles, especially in medial temporal structures (entorhinal cortex,hippocampus,& amygdala)
Treatment of NCD due to Alzheimer’s
- behavioral interventions and pharmacotherapy: these problematic behaviors
-cholinestarse inhibitors: Aricept, Razadyne, exelon) to improve cognitive functioning, reduce breakdown of ACH and reversing or slowing cognitive impairment in patients with early phases, only temporary
Vascular neurocognitive disorder
- symptoms consistent with vascular ideology plus evidence of cerebral vascular disease that accounts for symptoms
Of course, this depends on cause and may involve acute onset with partial recovery, a stepwise decline come our progressive course with fluctuations and symptom severity and plateaus that vary in duration
Risk factors of vascular NCD
– hypertension, hypotension, diabetes mellitus, heart disease, and heavy cigarette smoking & high cholesterol,
Ncd due to HIV
- infection with HIV
+ Symptoms have a subcortical pattern and include impaired functioning, difficulty learning new information, slowed process speed, impaired coordination, and other motor impairment, social withdrawal and severe anxiety and depression
Early sxs: forgetfulness, confusion impaired attention and slowed mental processes and clumsiness
Ncd with lewy bodies
- insidious, onset and gradual progression of symptoms
Must meet diagnosis of probable: 2 2 core symptoms or one core symptoms plus a suggestive symptom
Possible: at least one core symptom or one+ suggestive sxs
Core sxs: fluctuations in cognition with marked impairment and attention and alertness, recurrent/detailed visual hallucinations, symptoms of parkinsonisms that develop after cognitive decline
Suggestive sxs: rapid eye movement, sleep disorder, and severe neurocaleptic sensitivity
Ncd due to Parkinson’s
- motor other symptoms are present for at least one year before the onset of cognitive decline
Ncd due to disease
- insidious onset and rapid progressive of symptoms
- most common type is Creutzfeldt-jakob: neurocognitive deficits, prominent motor impairment, (ataxia, myoclonus, chorea, dystonia), and psychiatric symptoms (anxiety and mood changes)
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Ncd due to disease
- insidious onset and rapid progressive of symptoms
- most common type is Creutzfeldt-jakob: neurocognitive deficits, prominent motor impairment, (ataxia, myoclonus, chorea, dystonia), and psychiatric symptoms (anxiety and mood changes)
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Ataxia
- loss of muscle control & balance
Myoclonus
- sudden involuntary jerky movements involving muscle group or group of muscles
Chorea
- involuntary unpredictable movements, especially in face shoulders and hips
Dystonia
- involuntary contractions of one or more muscles that cause abnormal twisting and repetitive movements and postures
Schizoid personality disorder
- the pattern of detachment from interpersonal relationships and restricted rage of emotional expression in interpersonal settings
4 characteristic symptoms: prefer solitary activities, takes pleasure in a few activities, lacks close friends or confidence other than first-degree relatives, appears to be indifferent to praise or criticism and shows emotional coldness, detachment or flattened affectivity
Schizotypal personality disorder
- pervasive social and interpersonal deficits marked by discomfort with and reduce capacity for clothes, relationships, cognitive or perceptual distortions, and behavior eccentricities
5+ sxs: odd beliefs that influence behavior and are inconsistent with subcultural norms, unusual perceptual experiences, odd thinking & speech, inappropriate or constructed affect, odd or peculiar behavior and appearance, lack of close friends or confidence other than first degree relatives and excessive social anxiety
Antisocial personality disorder
- pervasive pattern of disregard for in violation of the rights of others since age 15 with history of conduct disorder before 15
- 3 or more characteristic symptoms: failure to conform to social norms for lawful behavior, a deceitfulness, impulsivity or failure to plan ahead, irritability and aggressiveness, reckless disregard the safety of self or others, consistent irresponsibility and lack of remorse
Common associated features of antisocial PD
- lack of empathy, inflated sense of self, And superficial charm
Borderline personality disorder
Pervasive pattern of instability and interpersonal relationships, self-image, and affect along with marked impulsivity
- five or more characteristic symptoms: frantic efforts to avoid real or imagined abandonment, pattern of unstable intense interpersonal relationships, recurrent suicidal behaviors, gestures or threats, affective instability, chronic feelings of emptiness and transient stress-related paranoid ideation or severe dissociative symptoms
Impairment of symptoms and risk for suicide with BPD
- greatest during young adulthood
Improvement in symptoms over time
Histrionic personality disorder
- pervasive pattern of emotionality and attention seeking
- 5+characteristic symptoms: discomfort when not the center of attention, inappropriate sexual seductiveness, rapidly shifting in shallow expression of emotion, consistent use of physical appearance to draw attention to oneself, exaggerate an expression of emotion, high degree of suggestibility, and use relationship is more intimate than they actually are.
Avoidant personality disorder
- pervasive pattern of social inhibition, feelings of inadequacy, and hypersensitivity to negative evaluation
- four or more? Characteristic symptoms: unwillingness to get involved with people unless certain of being liked, restrain an intimate relationships to the fear of being shamed or ridiculed, preoccupation with being criticized or rejected, inhibition in new interpersonal situations due to feelings of inadequacy and reluctance to take personal risks or engage in new activities because may be embarrassing
Dependent personality disorder
- pervasive and excessive need to be taken care of that leads to submissive, clinging behavior and fear of separation
- five or more characteristic symptoms: difficulty making everyday decisions without advice and reassurance from others, needs others to assume responsibility for most major areas of life, difficulty disagreeing with others because it might lead to loss of support, going to excessive lengths to get nurturing and support from others, and feels uncomfortable and helpless when alone
