Psychopathology Flashcards
Separation Anxiety Disorder
Inappropriate or excessive fear or anxiety 4 weeks children and adolescents 6 months adults
Treatment Separation Anxiety
CBT plus parent training child needs to return to school as soon as possible
Specific Phobia definition
and also Mowers 2 factor theory
- avoid the situation or endure with intense stress 6 months (persistent) and out of proportion of danger
- must cause significant distress or impaired functioning
- Mowers 2 factor theory combination of classical and operant conditioning
Treatment for Specific Phobia
In vivo with exposure is the best CBT with exposure and response to prevention Therapist led exposure more effective than self led
Specific Phobia Blood Injury Type Treatment
combined applied tension and relaxing bodys large muscles to increase blood pressure and prevent fainting
Social Anxiety Disorder
and treatment
- fear in at least one social situation where people may evaluate or judge them.
- Significant distress 6 months or impaired functioning
- Treatment-CBT with exposure or response prevention and
- SSRI, SNRI or beta blocker
Treatment of Panic Disorder
Treatment: antidepressants (e.g., imipramine) and benzo’s (but benzo’s ↑ relapse if used alone), CBT + interoceptive exposure (e.g., spin in a circle, breathe through a straw to replicate panic symptoms)
Agoraphobia
marked fear in at least 2/5 situations public trans, open spaces, in line/crowd, out home alone persistent 6 months and significant distress or impaired functions
Agoraphobia treatment
First combining vivo w/exposure (flooding) and response prevention Graded Exposure also common (intense non graded exposer is longer lasting though CBT NOT as effective
Generalized anxiety disorder
Excessive worry more days than not persistent 6 months 3 symptoms for adults, 1 symptom for children restlessness, fatigued, difficulty concentration, irritability, muscle tension sleep disturbance reduced activity in prefrontal cortex and amygdala
Generalized Anxiety Treament
CBT and relaxation with drugs most effective SSRI’s, SNRI, if nonresponsive to antidepressants try anxiolytic buspirone (Buspar) or benzodiazepine
Obessive-Compulsive OCD
time consuming ( more than one hour per day) Obsessions-recurrent persistent thoughts or urges Compulsions-repetitive behaviors or mental acts, goal is to reduce anxiety and prevent situation from happening
Treatment OCD
Exposure and response prevention (flooding) (ritual) treatment of choice Elevated caudate nucleas, orbitofrontal cortex cingulate, gyrus, and thalamus
Body Dysmorphic Disorder
- Preoccupation with perceived defect or flaw in physical appearance to be minor to others.
- May seek medical treatment to correct defect or flaw.
- Must have performed repetitive behaviors or mental acts due to flaw
Sexual Dysfunction
Disturbance in ones ability to respond or experience sexual pleasure
Erectile Disorder
1/3 of symptoms on 75% to 100% of occassions difficulty obtaining, difficulty maintaining erection decreased in erectile rididity 6 months and cause significant distress
Erectile Disorder treatment
Sensate focus- reduce sexual anxiety by promoting intimacy and reduce performance anxiety Nonsexual touch, sexual touch, sexual intercourse Sidenafil citrate (Viagra) tadalafil (Cialis) Vardenafil (Levitra)
Premature Ejaculation
Persistent or Recurrent parten of ejaculation 1 minute or before person desires 6 months 75% to 100% Low levels of serotonin
Premature Ejaculation Treatment
Sensate focus, (aka counter conditioning) start-stop technique or pause-squeeze SSRI taken daily Paroxetine may help delay ejaculation for some
Genito-Pelvic Pain/Penetration
Persistent with at least one Vaginal Penetration Vulvo/vaginal pain anxiety regarding pain tensing of pelvic floor 6 months or longer
Genito Pelvic Pain/Penetration Treatment
Relaxation training Sensate focus topical anestehtic vaginal dialators Kegal exercises
Gender Dysphoria
children vs adults
incongreunce w/assigned gender and experienced gender children 6 of 8 symptoms for 6 months Adolescents and Adults 2 of 6 symptoms 6 months
Gender Dysphoria Treatment
Gender-affirmative Model watchful waiting to support children from families at 16 child can begin hormones if desired any child at any age may be aware of their authentic identity as being different
Paraphilic Disorder
causing distress to the person or personal harm or risk of harm to others
Paraphilic disorder treatment
CBT with group therapy, marital therapy or pharmacotherapy Cover sentization and orgasmic (masturbatory) conditioning
Frotteuristic Disorder
touching or rubbing someone that does not want this this can be acted on or by impairment due to fantasies or urges 6 months
Transvestic Disorder
cross dressing for sexual arousal 6 months
Pedophilic Disorder
recurrent sexual urges and must have acted on them or experienced significant distress not to act on it with a child under age of 13. Person must be great than 16 years of age
Fetishistic Disorder
recurrent and intense sex arrousal 6 months to a nonliving object or nongenital body part
Brief Psychotic Disorder
1 or more for one day less than one month at least one delusions, hallucinations, or disorg speech 4 symptoms above and grossly disorganized or catatonic behavior
Schizophrenia
2/5 in active phase 1 month with at least 1 being delusions, hallucinations or disorganized speech 5 symptoms above and grossly disorganized or catatonic behavior and negative symptoms Must also be signs continuous for 6 months Prodromal and residual phase is 2 or more symptoms may be negative only
Schizophreniform Disorder
2/5 for one month to less than six months at least one being delusions, hallucinations, disorganized speech 5 symptoms above and grossly disorganized or catatonic behavior and negative symptoms
Schizophrenia Etiology
Parent 6% Bio Sib 9% Child of 1 parent w/schz 13% Dizygotic twin 17% Child w/2 parents 46% Monzygotic twin 48% Dopamine, glutame and serotonin
Dopamine Hypotheses
- Schizophrenia is high due to high levels of dopamine or hyperactivity of dopamine receptors
- Positive symptoms due to dopamine hyperactivity subcortical regions (striatal area)
- Negative symptoms due to hypo activity in cortical regions (prefrontal cortex)
Hypofrontaility
lower than normal activity in prefrontal cortex contributes to negative symptoms
Cormorbidity Schzophrenia
anxiety, ocd, 70-85% tobacco users
Onset, Course Prognosis Schzophrenia
teens to early 30 peak early to mid 20 for female Psychotic symptoms decrease, neg&cog symptoms remain same Better prognosis for female acute, late onset and comorbid mood disorders
Expressed emotion
Familes response to member with schzophrenia or other mental disorder High expressed emotion-high criticism, hostility and over involvement with patient
Treatment Schizophrenia
- psychosocial interventions
- antipsychotic drug
- adjunctive medications
- evidence-based include-community treatment
- cbt for psychosis
- cognitive remediation for schizophrenia, family psychoeducation, social skills training, supported employment and acceptance commitment
Delusional disorder
list the 3 different types
- 1 or more delusions for 1 month and overall functioning is not significantly impaired
- erotomanic-believes another person is in love w/them
- grandiose-believes they’re great (unrecognized talent)
- jealous-believes spouse or partner is unfaithful persecutory-being spied on, poisoned, conspired against
Disruptive, Impulsive Control, and Conduct
Oppositional Defiant Disorder
- MOOD–6 months
- mild form of acting out
- less severe than Conduct disorder
- 3 symptoms AVA has ODD
- Angry/irritable mood
- Vindictiveness
- Argumentative
- 30% more likely to become CD w/early onset
- equal among boys and girls
- higher with adolescent boys
- parent management/family therapy, cognitive problem solving
Disruptive, Impulsive Control, and Conduct
Conduct disorder
- 12 months 3 symptoms 1 sympt for 6 months
- behavior violates the rights/social norms of others
- 3 symptoms
- Conduct D/O makes me SADD
- serious violation of rules
- aggression with animals/people
- destruction of property
- deceitful or stealing
- Cannot be given over age 18
- emerges middle childhood to middle adolesence
- *
*
- *
Disruptive Impulse Control
Conduct disorders specifiers
- childhood onset at least 1sx (symptom) before 10
- adolescent onset no symptoms before 10
- Unspecified onset Unknown
- mild, moderate and severe is based on the # of conduct problems
Disruptive Impulsive Disorder
Conduct Disorder Etiology
NT
Life-course
Adolescent
- heriditary, ↓ serotonin, prenatal exposure to opiates, inadequate parenting
- Life-Course persistent type- combo bio deficits, parenting and temperament
- adolescent limited type-temporary and maturity gap between biological/sexual and social maturity
Disruptive Mood Conduct
Conduct Disorder treatment
- family intervention
- PMTO Parent mangaement training Oregon Model
- parenting modifications, effective disciplinary strategies
- Multisystemic treatment MST
- mulitdetermined-get child w/family, school & combine cognitive, behavioral, family systems and case management
*
- mulitdetermined-get child w/family, school & combine cognitive, behavioral, family systems and case management
Disruptive mood
Intermittent Explosive D/O
- behavioral or verbal outburst unable to control aggressive behaviors/impulses
- must be 6 years of age
- not violent no damage to property or people
- 2x weekly for 3 months
- or with 3 outburst within/12 months
- not premeditated or looking for tangible outcome
- 6 YEARS OLD at least
Substance and Additions Disorders
10 classes of substances
- caffenine
- cannabis
- phencyclidine
- inhalants
- opioids
- sedatives
- hypnotics
- anxiolytics
- stimulants
- tobacco
- unknown
Substance and Additions Disorders
Substance use disorder
- 2 or more w/in 12 months except caffeine
- cognitive, behavioral, physiological…person uses w/o reason
- 4 sx (symptoms
- lack of control, social challenges, risky use, pharmacological (tolerance/withdrawal)
- # of sx indicates severity
Substance and Additions Disorders
Substance disorder treatment
- psychosocial intervention, group/family therapy, 12 step program and/or medication
- alcohol-disulfiram or naltrexone
- opioid-methadone, naltrexone
- nicotine-replacement therapy
- tobacco-antidepression, bupropion
-
cocaine-no fda medication approved for treatment
- treatment is CBT, recovery based therapy, or psych social intervention
Substance and Additions Disorders
RPT relapse prevention therapy Marlatt & Gordon
- addiction is a learned habit
- relapse is after absence in high risk situation
- relapse is worse when person does not have coping skills, self efficacy & ↑expectations
- *** goal is to help client deal with ↑risk situations
Substance induced disorders
Alcohol Intoxication
- behaviors and psychological changes
- WITH 1/6
- slurred speech
- incoordination
- unsteady gait
- nystagmus (uncontrolled eye moment)
- Δ memory/cognition stop coma
Alcohol induced major neuro cognitive disorder
- ↓ 1> cognitive domains interferes everyday activities
- specifier Nonamnestic -confabulatory or amnestic-confabulatory AKA Korsafoff syndrome-thiamine deficiency & retrograde amnesia confabulation
Alcohol withdrawal
2/8 w/in hours to days
- autonomic hyperactivity
- hand tremor
- insomnia
- nausea or vomiting
- hallucinations, or illusions
- anxiety
- motor agitation (pacing, toe tapping)
- genrelized tonic seizueres
Opiod Intoxication
- behavioral changes-initially euphoric followed by apathy or dysphoria and impaired judgment with
PUPIL CONSTRICTION
- 1/3 sx
- drowsiness/coma
- slurred speech
- problems w/attention/memory
Opiod Withdrawal
- 3/9 including dysphoric mood , nausea or vomiting
- muscle aches, diarrhea, yawning
- fever and insomnia
Sedative, Hypnotic, Anxiolytic Intoxication
1/6 hypnotic or anxiolytic-slurred speech, incoordination, unsteady gait, nystagmus, impaired cognition, stupor or coma
Sedative, Hypnotic, Anxiolytic Withdrawal
2/8 hours to days after stopping the drug
- ↓ of sedative, hypnotic, or anxiolytic use
- autonomic hyperactivity, hand tremor, insomnia, nausea or vomiting, transient hallucinations or illusions, psychomotor agitations, anxiety,
- GRAND MAL seizures
Stimulant Intoxication
2/9
- ↑ tachycardic or bradycardic, pupil dilation
- ↑↓decrease blood pressure, perspiration or chills, nausea or vomiting, weight loss, psychomotor agitation or retardation, respiratory depression or cardiac arrhythmia, seizures or coma
- Stimulant drugs amphetamines, methamphetamines and cocaine
Stimulant Withdrawal
dysphoric mood and psychological
2/5
fatigue, vivid and unpleasant dreams, insomnia
hypersomnia (excessive daytime sleeping), increased appetite, psychomotor agitation, retardation
tobacco withdrawal
- 4/7 within 24 hours of stopping/quitting
- irritability, anger, anxiety, impaired concentration, ↑ increased appetite, restlessness, depressed mood, insomnia
Bipolar and Depressive DO
Manic
- persistent, elevated/irritable mood, ↑ goal directed activity/energy for 1 week
- includes 3 or more sx
- ↑ self esteem-grandiosity
- ↓need for sleep
- flight of ideas
- marked impairment in functoning
- a need of hospitalization to avoid harm to self/or others
- or psychotic features
Bipolar and Depressive Disorders
Hypomanic
- same as manic for at least 4 days, BUT the person has never met the criteria for a manic episode
- ↑ expansive or irritable mood
- increased activity or energy
- 3 or more sx of mania 4 DAYS
- NOT severe enough for marked hospitalization or marked impairment, do not have psychotic features
Bipolar and Depressive Disorders
Major Depressive
- 5 or more sx w/1 sx depressed mood or loss of pleasure
- sx last 2 weeks & cause distress and/or significant impaired functioning
Bipolar 1 diagnosis
- requires at least 1 manic episode
- cannot have been preseeded or followed by a major depressive or hypomanic episode
Bipolar II
1 manic & 1 major depressive episode
Cyclothymic Disorder
requires hypomanic symptoms that have NEVER met criteria for mania and symptoms of depression that have NEVER met criteria for a MDD
o can’t have more than 2 months without symptoms
o Symptoms required for at least 2 years in adults and 1 year for kids
Bipolar Etiology
- heridity, NT and & brain abnormalities & circadian rhythm irregularities
- Strong genetic component .67 to 1 mono twins, .2 di twins
- Neurotransmitters- NE, Serotonin, Dopamine and Glutamate
- brain-prefrontal, amygdala, hippocampus, basal ganglia
- circadian rhythms-sleep-wake cycle, the release of hormones, appetite and core body temperature
Bipolar Treatment
- psychosocial and medication
- psychosocial therapy + Rx is best, family therapy, psychoeducation, IPT, CBT, Interpersonal Social Rhythm Therapy (which is all about creating routines and circadian rhythms and resolving interpersonal problems),
- Classic bipolarRx: lithium, atypical antipsychotics and antidepressants, valproate/carbamazepine
Atypical Bipolar sx and tx
- Atypical Bipolar between ages 10-15
- -mixed mood states, rapid cycling, a lack of full recovery between episodes
- at least 2 of the following ↑weight gain, ↑appetite, hypersomnia (excessive sleeping during day), leaden paralysis, interpersonal relationships sensitivity
Major Depressive Disorder
- 5 or more sx for 2 weeks with at least 1sx being depressed mood or loss of interest in everything
- ↓ REM latency (amount of time it takes to fall asleep) and ↑ REM density (frequency of eye movements that occurs during REM sleep)
Persistent Depressive disorder
- depressed mood 2 or more sx (poor appetite, or overeating, insomnia or hypersomnia, feelings of hopelessness)
- 2 years for adults 1 year child & adolescents
Disruptive mood dysregulation
o SEVERE, recurrent temper outbursts outside of developmental age
o 3+ times a week
o chronic irritability/angry mood
o 12 months in 2 settings
o At least 6 years old but not over 18 years old o Treatment: CBT, parent training, family therapy
Peripartum onset depression vs post partum
- Peripartum-means symptoms occur during pregnancy or 4 weeks after delivery - symptoms include: anxiety (e.g. preoccupied with infant’s well-being), irritability, not being interested in the baby, guilt, suicidal ideation, sad mood and last for a short while
- Post partum-lasts longer and symptoms includes sadness, difficulty with sleep, irritability, changes in appetite
Seasonal Pattern aka seasonal affective disorder and tx
- linked to ↓ serotonin↑ melatonin, crave carbs, irritability, hypersomnia, ↑ appetite, weight gain
- tx-responds well to light therapy and exposure to bright light
Rates of depression
- highest for 12-17 then 18-25 then 26-49 and then 50+
Etiology of Depression
NT
Catecholamine Hyp
Social Reinforcement
Cognitive Theory
Learned Helplessness
- HPA Axis involved, cortisol, ↓ epinephrine/serotonin,
- catecholamine hypothesis = low norepinephrine, Lewinsohn’s -operant conditioning-reinforcement, b/c the person is on an “extinction schedule” for a really long time and not getting any reinforcement,
- Social reinforcement theory-low rate of response due to lack of social reinforcement
- depression schemas/cognitive theory (Beck) = negative beliefs about self/others/world,
- Seligman’s Learned Helplessness – repeat negative life events that lead to hopelessness
Major depression
age and culture
- younger-genetic, life stress, cognitive limitations
- more affective symptoms
- older-chronic medical illness, medical illness ↓physical function and ↑ social loneliness more somatic symptoms
- Americans and euro-Canadian express more psychological symptoms (depressed mood, loneliness, helplessness
- other members non western, Chinese, latin, middle eastern and asian report somatic symptoms appetite, sleep disturbance, headaches, heart palpitations
*
Depression C0morbidity
- 57% substance (alcohol most common)
- 37% anxiety (generalized most common)
- 31 % personality disorder (borderline most common)
*
Depression Treatment
therapy and medication best
antidepressants TCA
SSRIS
SNRI
CBT
IPT,
Behavorial action therapy
Problem solving
acceptance and commitment therapy
emotion focused therapy
Similar in-person and telehealth results
*biblotherapy-effectiveness best established with major depressive patients
Suicide in US
- 10th leading cause of death 1999-2017
- ↑ males ↓females
- ↑ females aged 45-64
- ↑males over 75
- In order American Indians, whites, asian/pacific islanders, blacks, hispanic
- American indians ↑ 15-24 years
- Whites ↑ 45-64 & over 65-74
*
Goal of compulsions
Goal of compulsions is to ↓ anxiety or distress is an attempt to prevent the undesirable event from happening
Flooding
immediate exposure to most feared object or situation until the anxiety subsides (extinguished)
Graded (Graduated Exposure)
List of about 10 situations that cause anxiety from least to greatest. The client approaches the situation until the anxiety subsides
Prevalence of OCD
↑ males vs females in childhood
↑ females vs males in adulthood
↑ males comorbidity w/tic disorders
OCD impact on brain
↓serotonin
↑ brain activity in the caudate nucleus, orbitofrontal cortex, cingulate gyrus, and thalamus.
Neurocognitive Disorders
Delirium diagnosis
- must have problem w/attention & awareness over short time hours and days
- Δ’s in severity
- and 1 disturbance in cognition (memory or language impairment)
- not due to a medical condition and psychological issues are specifically due to that impairment
Neurocognitive Disorder
Delirium causes
- high fever, lack of food or electrolytes, renal or heptic failure, head injury and certain group medications
- most common in elderly
Delirium treatment
- adequate lighting, noise reduction, minimize visitors,
- Haloperidol, or other antipsychotics ↓agitations & symptoms
Neurocognitive disorders
Major and mild neurocognitive disorder (NCD)
previous known as Dementia
↓ in cognition acquired rather than developmental
↓1 or more cog domain (executive functioning, learning, memory, and social cognition) w/delivery & daily functioning
Mild neurocognitive disorder (previously cog disorder not otherwise specified)
- modest ↓ in previously learned functioning
- does not impact daily functioning
Neurocognitive disorder due to Alzheimers
- 60 to 70 percent of all cases
- meet mild or major (NCD)
- insidious onset and gradual progression of impairment 1 or more cog domains
- or 2 or more cog domain that interfere with daily functioning
- meet criteria
- not better explained
Major vs Mild NCD due to Alzheimers
- Major NCD probable causative genetic mutations, family history, or testing if criteria not met the diagnosis of “possible Alzheimers
- Mild NCD probable Alzheimers has evidence of causative genetic mutations, testing, or family history
- Possible Alzheimers disease has NO EVIDENCE of genetic mutations but EVIDENCE of ↓ memory&learning, gradual ↓ cognition, no evidence of mixed etiology
Pseudodentia
Depression with cognitive symptoms
Pseudodentitia vs Alzheimer
Pseudodementia VS Alzheimer
- dont know wrong answers
- abrupt onset insidious onset
- responds well2 treatment minimus ordeals/cognitive problems
Alzheimers Etiology
- ApoE4 variant chromosome 19
- ↓ACH & ↑Glutamate (both involved in learning and memory)
- amyloid plaques neurofibrillary tangles first in the temporal lobe (cortex, amygdala & hippocampus) as it progress moves to frontal and parietal lobes
- locus ceruleus (part of brainstem) is affected first before signs are shown
Stage of Alzheimer’s
- 3 stages
- gradual onset
- slow decline in cognitive functioning
- Early- 2-4 years anomia (hard time recalling names & objects), short term memory loss,
- Middle-2-10 years (longest stage) ↑ anterograde &/or ↑retrograde amnesia, disorientation, anxiety, depression, delusions, wandering, repetitive behaviors, impaired speech, disruption of sleep patterns and daily activities
- Late-1-3 years ↓IQ, disoriented. severe speech impairment, agitation, & aggression, incontinence, ↓ motor skills, cannot perform daily activiites
Alzheimers Treatment
- cholinesterase & Memontine to ↓ reduce&stabilize memory loss and confusion
- Cholinesterase inhibitors include DONEPEZIL & RIVASTIGMINE delay ACH breakdown
- Memantine (NMDA receptor antagonist) regulates glutamate
- antidepressants-depression & irritability
- anxiolytic-anxiety, restlessness
- antipsychotics-mania, psychosis
Neurocognitive Disorder
Lewy bodies
- person meets Major or Mild NCD criteria
- abnormal protein
- INSIDIOUS onset & GRADUAL progression
- cognitive-attention, visuospatial & Executive F
- cognition proceeds (before) motor issues
- note in Parkinson’s motor proceeds cognitive
Vascular Neurcognitive Disorder
- meets major or mild/minor NCD
- symptoms include stroke, heart attack , ↓ attention & EF
- acute onset, STEPWISE ↓ (significant plateaus)
Vascular Neurocognitive Disorder
Prevention and Intervention
- look at risk factors like hypertension
- heart disease
- diabetics
- obesity
- ↑ cholesterol
- heavy cigarettes use
Neurocognitive Due
HIV
- mild or major NCD
- damage to subcortical areas
- forgetfulness, impaired attention, concentration
- psychomotor retardation, clumsiness, dreamers, apathy, and social withdrawal
Neurocognitive disorder due to
Prion Disease
- think Creutzfeldt Jacob
- INSIDIOUS onset and VERY RAPID
- meets criteria for NCD w/n 6 months
- confusion, disorientation, impaired memory & judgement, ataxia (impaired coordination), myoclonus (muscle jerk), chorea (involuntary movement, jerk) apathy, anxiety, mood swings
- Sporadic CJD-most common, unknown etiology
- Familial CJD-inherited
- Acquired CJD-consuming infected meat-mad cow or blood transfusion
Personality Disorders
DSM definition
- symptoms 1 year
- deviation of expectations, pervasive, inflexible
- onset adolescence & early adulthood
- stable over time,
- leads to distress or impairment
Personality disorders
3 Clusters
- odd or eccentric behaviors
- paranoid, schizoid, schizotypal
- dramatic, emotional, erratic
- antisocial, borderline, histrionic and narcissistic
- anxiety & fearful
- avoidant, dependent, and OCD
Personality disorder
↓18 and ↑ 18
↓ personality disorder can be diagnosed ↓18
↑ 18 years of age or older for an antisocial personality
Paranoid Personality Disorder
- distruss and suspiciousness 4 out of 7 4/7
- believes others are harming, exploiting, deceiving
- doubts of loyalty and trustworthiness
- will not take to others
- misinterprets remarks or events
- believes being attacked & quick to attack
- suspicious of partners fidelity
- bears grudge
SchizoiD Personality D/O
- D is for DETACHED from social relationships and DESIRES no sex/praise/pleasure/people, restricted emotions, flat affect, indifferent
- 4/7
SchizotoPal Personality D/0
- P is for PECULIAR behavior/appearance
- social/interpersonal deficits
- odd interests and behavior
- eccentric/odd/magical beliefs or thinking
- if mom has schizophrenia more likely child will develop schizotypal
- they want to have PALS, but hesitate to get close to people out of concern of being taken advantage of
- may actually be okay being alone
- ideas of reference
- ↓closer friends or relatives of 1 degree
- body illusion and/or unusual perception
- 5/9
Antisocial Personality Disorder
- disregard for & violation of others rights since BEFORE 15 years old
- fail social norms regarding law
- decitful
- impulsive
- disregard to safety or self or others
- irresponsible
- lack remorse
- irritable and aggressive
- ****must be 18 but have history before 15***
- want money or power
Antisocial Personality Interventions
- cognitive behavioral group therapy may help to ↓ reoffense
- contingency mangement
Borderline Personality D/O
- instability of interpersonal relationships, self image, affection
- 5/9
- avoid abandonment
- unstable relationships (idealization to devaluation)
- identity disturbance
- impulsive and self-damaging
- recurrent attempts of suicide
- or self mutilization
- effective instability
- feelings of emptyness
- intense anger
- paranoid ideation or dissociate symptoms
Borderline Personality Disorder Onset
- late adolescence w/most severe early adulthood
- 75% no longer meet criteria by 40 years old
Borderline Personality Disorder
Treatment
Linehans dialect behavioral therapy (DBT)
- group skills training-emotional dysregulation, disastrous tolerance, relationship difference
- individual therapy, maintain DBT skills
- phone coaching for between therapy
Histrionic Personality Disorder
emotional and attention-seeking
- 5/8
- has to be center of attention
- inappropriate sexual seduction or provation
- the rapid shift in moods
- uses looks to get attention
- speech impressionistic and lacks details
- exaggerated emotion
- easily influenced
- thinks relationships is more that it is
Histrionic vs Antisocial
Histrionic-
- exaggerated emotions & manipalitive
- gain nurturance
Antisocial-
- antisocial & manipulative
- gain power or material gratification
Narcissistic Personality Disorder
grandiosity, admiration, & lack empathy
- 5/9
- grandiose self
- fantasizes unlimited success power, beauty & love
- unique & only important people n world understand them
- entitlement
- lack of empathy
- envious of self or others
- arrogant
- admiration
- interpersonally exploitative
*
Avoidant Personality Disorder
social inhibition, feelings of inadequacy, hypersensitive to (-) evaluation
- 4/7
- avoids occupation activities
- will not interact w/others unless knows will b liked
- restraint in intimate relationships due to fear ridicule
- worried about social rejection
- feels inadequate
- socially inept
- reluctant to new activities fear of embarrassment
Dependent Personality Disorder
need to be taken care of very clingy
- 5/8
- difficult make everyday decisions
- needs others to assume reponsibilities
- avoids dissagrements for fear of disapproval
- does not like to do things alone
- seeks nurturance & guidance & support seek new relationships quick
- ↑ fears of being alone
Obsessive-Compulsive Disorder
order, perfection mental interpersonal
- 4/8
- details and rues
- devoted to work
- inflexible moral and ethics or values
- spends self and others
- ridged and stubborn
- perfection in tasks and task completion
Neurodevelopmental disorders
Intellectual disability
- 2 SD below mean
- deficits in intellectual, conceptional (reading, writing, math) social, and practical (adaptive)
- vInelanD-assess adaptive functioning (also used in ASD, ADHD, TBI and dementia)
- 25-50% cause is known of these 85% are due to prenatal factors (chromosome or genetic issues)
Intellectual Disability Etiology
- most common cause Down Syndrome, followed by fragile X syndrome, most common preventable prenatal is Fetal alcohol syndrome
Autism Spectrum D/O
- deficits in social communication/interaction, restricted repetitive patterns/behaviors/interests/movement/use of objects/speech (e.g., pronoun reversal – say “me” instead of “I”, echolalia)/not good with routine changes
- begins in early development (as early as 2 years old)
Autism Spectrum Disorder ASD
Specifier symptom severity
- Level 1-requiring support
- Level 2-requiring substantial support
- Level 3-requiring very substantial support
Autism Etiology
- abnormal cerebellum/amygdala/hippocampus, genetic and
- ↑ serotonin, norepinephrine and dopamine
- risk factors include
- male gender
- certain medical conditions fragile & Angelman
- born before 2 weeks
- advanced maternal age
- exposure to certain environmental development
Autism Treatment
- Early Intensive Behavior Interventions (EIBI),
- shaping and
- discrimination training help with speech
Autism Prognosis
- good prognosis 😊: if communicating by age 5, IQ > 70 and symptoms happen later in development
ADHD
6 symptoms of inattention, and/or hyperactivity/impulsivity for 6 months
o before age 12 in 2 settings
o 17 years and older only need 5 symptoms from one of the categories
o Females present more with symptoms of inattention
ADHD comorbidity in order
- oppositional defiant
- conduct disorder
- anxiety
- depressive disorder
ADHD Brain abrmornialities
- brain parts involved: Prefrontal cortex, Globus pallidus, Corpus callosum, Cerebellum, Caudate nucleus *think Person Gotta Concentrate Concentrate Concentrate (PGCCC)*
- basal ganglia also involved, smoking during pregnancy, low birth weight, TBI,
- abnormal levels of dopamine, serotonin and norepinephrine, genetic
ADHD deficit in behavioral inhibition
4 executive neurocognitive functions
- working memory
- internalization of speech
- self-regulation of affect
- motivation and arousal
- reconstitution-behavioral analysis and synthesis
ADHD Treatment
- neurofeedback (EEG) more effective with inattention than hyperactivity,
- parent/teacher intervention,
- Rx (methylphenidate),
- anamoxetine may be prescribed if people cannot tolerate the stimulant Rx,
- BEST outcomes for therapy combined with Rx
Tics Disorders
- motor tics (i.e., eye blinking) between 4-7 years old and
- vocal (i.e., echolalia) around 11 highly co-morbid with ADHD
- peaks at 11-12 years age
tourettes disorder (Tic disorder)
- multiple motor + 1 vocal tic
- at least 1 year before age of 18
- highly co-morbid with ADHD and OCD, Major Depressive D/o, Substance Use
- usually begins around ages 5-7
Tourettes etiology
- ↑ dopamine
- ↓ caudate nucleus ( smaller)
tourettes treatment
- Haloperidol, behavior therapy,
- CBIT (Cognitive Behavior Therapy for Tics) which includes psychoeducation, relaxation training and habit reversal, competing response
- SSRIs, antihypertensive drugs (e.g., clonidine and guanfacine are the Rx of choice)
Communication disorder
- deficits in language, speech communication
- 1 or more of 7 1/7 symptoms
- anxious about speaking due to abnormal fluency /timing speech
- good predictor of recovery is severity of symptoms at age 8
Communication disorder treatment
- Habit reversal training – incorporates competing response with breathing – consists of awareness training,
- social support
Specific Learning disability
reading, writing, math: performance is typically 1.5 standard deviations below the mean
- for at least 6 months
- tend to have above average IQ’s and comorbid ADHD (20-30%)
- delayed motor skills
- ↑ unemployment/drop out of school/antisocial behavior
Specific learning disability
Etiology
- genetic,
- otitis media,
- toxins
Types of tic disorders
- Tourettes-multiple motor plus 1 vocal
- persistent (chronic) motor or vocal tic- 1 motor or vocal for more than 1 year before age 18
- provisional tic disorder- 1 or more motor and/or vocal present for less than 1 year begins before 18
Trauma and Stressor-Related Disorders
Reactive Attachment Disorders
- no REactions, more REserved, withdrawn
- opposite of disinhibited social engagement D/O
- lack of seeking support or comfort
- sx before age 5 must have a development age of 9 months or more
- social and emotional disturbance at least 2
- limited social-emotional responsiveness
- limited positive affect
- unexplained irritability
- sadness
- or fearfulness
- all with caregiver
Reactive attachment and Disinhibited Social Engagement D/O etiology
poor care, neglect, frequent changes in caregiver (all of these examples are aka “pathogenic care” and lead to insecure attachment)
Disinhibited Social Engagement Disorder
- no reservations
- opposite of Reactie Attachment D/O
- inappropriate interactions with unfamiliar adults
- the developmental age of 9 months or greater
- diagnosis requires history of extreme insufficient care believe responsible for sx
- 2/4 sx
- reduced or absent reticence approaching strangers
- overly familiar behavior with strangers
- diminished or absent checking w/adult caregivers after being separated from them
- willingness to accompany a stranger with little or no hesitation
Posttraumatic Stress Disorder
5 symptoms clusters *DINAA, as in DINAAsaurs traumatize you* for at least a month
o Dissociative
o Intrusive (re-experiencing memories/dreams/flashbacks)
o Negative mood
o Avoidance
o Arousal (aggression, reckless behavior, sleep difficulty)
PTSD brain and NT
- ↓ medial prefrontal cortex and anterior cingulate cortex
- ↓ volume in hippocampus
- ↑ responsivity of amygdala to trauma stimuli
- ↑ dopamine, norepinephrine, glutamate
- ↓serotonin and GABA
PTSD Treatment
- CBT and/or CPT (cognitive processing therapy-combines negative cognitions w/writing and reading detailed description of trauma), cognitive therapy, brief eclectic psychotherapy, EMDR and narrative
- children and adolescence- trauma-focused cognitive behavioral therapy created for age 3-18 experience sex abuse and now used for a variety of trauma
- SSRI’s-fluoxetine, paroxetine, sertraline and SNRI venlafaxine
Dissociative Disorders
Depersonalization D/o
- detached, outside observer of thoughts/actions
- sense of unreality/detachment with surroundings
o may feel: dead, dream-like, lifeless, foggy
Acute stress disorder
- requires actual or threatened death, severe injury or sex violation
- must of 9 sx from any of 5 categories (intrusion, - mood, dissociative symptoms, avoidance, arousal)
- must lasted 3 days to 1 month
- cause significant distress or impairment
Dissociative Disorder
Dissociative Amnesia
- inability to recall important personal information beyond forgetfulness
- dissociative fugue-purposeful travel or purposeful wandering due to loss of memory
- localized amnesia-most common inability to recall events during a certain time in life
- selective-cannot recall some events that happened during a certain time in life
- generalized-complete loss of memory for ones entire life
- systematized-a loss of memory for specific category of information
- continuous-inabiity to remember new events
Somatic Symptom Disorder
- think soooooo many aches and pains)
- excessive thoughts/emotions/behaviors related to symptoms or associated health concerns constantly worry about their health
- may or may not have an actual health diagnosis
- 6 months, have at least 1 somatic symptom concerned about
- predominant pain can be used as a specifier if applicable (i.e., chronic pain dx)
Illness anxiety Disorder
aka hypochondriac
- may or may not have mild somatic symptoms
- preoccupied with having or developing a serious illness
- excessive anxiety about health – tend to be preoccupied with acquiring a disease
- often hyperaware of normal body signs and interpret as signs of a serious illness (e.g., I can feel my heart pounding in my chest = I must be dying
- for at least 6 months
Somatic Symptom Disorder Treatment
- ACT
- CBT for chronic pain
- Biofeedback
Factitious D/o
Functional neurological symptom disorder AKA Munchousens
- FAKing for attention
- must be distinguished from malingering
- the factitious disorder requires the absence of obvious rewards
- Imposed on self – induce physical/psychological symptoms to present to others as sick (e.g., ingesting raw meat to make you sick for attention; not for an external incentive)
- Imposed on another (aka Factitious D/o by Proxy)– usually mother to child (Ex. mom makes the kid sick like Gypsy Rose Blanchard and the mom to her daughters in the show/book Sharp Objects)
Factitious Disorder Treatment
- establish a strong rapport and provide supportive therapy to help manage symptoms,
- family therapy can be helpful but not as effective
Malingering
- think Money
- malingering is differentiated from factitious disorder by the intentional reporting of symptoms for personal gain
- intentionally create symptoms for an external reward (money, reduced sentence)
- related to Antisocial Personality D/o
- use forced-choice method to detect (using True/False items and malingerers will answer INCORRECTLY more than 50% of the time) -called Test of Memory and Malingering (TOMM)
Factitious Disorder
Feigned memory loss vs genuine memory loss
-
feigned memory loss onset and termination are sudden
- people do not recall any events during this time
- believe hints or clues will help them recall lost memories
-
genuine memory loss-beginning & end time are gradual and hazy
- people will recall fragments of some events
*
- people will recall fragments of some events
Conversion Disorder
- Functional Neurological Symptom Disorder
- 1 or more symptoms that involve a disturbance involuntary motor or sensory functioning that suggest serious neurological or other medical condition (paralysis, blindness, seizures, fainting)
- Specifiers- symptom type acute or persistent and presence or absence of a psych stressor
Food and eating disorders
a persistent problem with eating or eating-related behavior that alters consumption/absorption of food and impairs physical health or psychological function
Pica
eating nonnutritive/nonfood substance for at least
1 month
Anorexia Nervorsa
- restrict energy which leads to low body weight
- must have
- intense fear to gain weight or engage in behavior that interferes with weight gain
- and
- altered view of how one experiences their weight, self-evaluation, influenced by weight
Anorexia Nervosa
restricting
binge-eating/purging
-
restricting type-3 months no binging or purging
- person is restricting intake by diet/exercise
- binge-eating/purging- 3 months person has engaged in binging/purging behaviors
Anorexia Nervosa
Etiology
Co-morbidity
Prognosis
- ↑ Serotonin, perfectionism, genetic
- co-morbidity w
- depression and or anxiety (OCD)
- it is shown anxiety precedes anorexia
- one of the most difficult disorders to treat
- poorer prognosis than bulimia
- recovery at 9 year follow up 31 percent compared to bulimia 68%
Anorexia Nervosa Treatment
- goal is to restore person to healthy weight
- ↑ motivation to participate in treatment
- provide nutritional counseling
- help person identify and ∆ beliefs/emotions
- treat psychological conditions
- enlist family support
- help person identify strategies
- CBT/IPT, Family Behavioral Therapy (FBT) and SSRI’s to maintain weight gain
Bulimia Nervosa
- least 1x (time) a week for 3 months
- many people within normal weight range
- recurrent binge eating with lack of control
- inappropriate compensatory behavior to prevent weight gain (e.g., self-induced vomiting, excessive exercise, laxatives)
Bulimia Nervosa
comorbitity
etiology
- depression or anxiety preceeds disorder
- severity is based on the average # binge episodes
- most people are normal weight or overweight
- ↓serotonin
Bulimia Nervosa
Treatment
- Nutritional rehabiiltation + CBT preferred
- IPT-takes longer to produce results
- nutritional counseling,
- CBT/IPT,
- SSRIs, imipramine and fluoxetine
*
Bulimia Nervosa
Enhanced Cognitive Behavioral Therapy (CBT-E)
- most effective for people with bulima
- Stage 1- engage patient in treatment/identify problem, establish self-monitoring, estab eating pattern
- Step 2-brief transitional stage-involves review patients progress, identify problems & barriers
- Stage 3-addressing patients’ overall evaluation of shape and weight, explore origin.
- Stage 4-help patient find other ways to keep progress and reduce stress
Bulimia vs Anorexia
- Bulimia compared to Anorexia, bulimics are more stressed about having the disorder and are motivated to change
- Autonomous (intrinsic) and Controlled (extrinsic) motivation it is found that ↑levels of autonomous motivation (but not controlled motivation) predicted greater reduction of overall symptoms and ↓risk of dropping treatment
Enuresis
o wet bed/clothes 2 or more times a week for 3 months
o can be intentional/unintentional
o must be at least 5 years old w=developmental level
- specifier nocturnal (night) or diurnal (day)
Enuresis Treatment
- bell and pad (moisture alarm → this is the BEST Tx),
- Rx = desmopressin – think of something heavy pressin’ on your bladder → when used by itself – but ↑ relapse in behavior when medication is discontinued
Insomnia disorder
- sx’s 3x’s per week for 3 months
- 1/3
- difficulty initiating sleep (sleep-onset) (2nd common)
- difficulty maintaining sleep (sleep maintenance) middle ***most common**
- early morning waking or unable to return 2 sleep (late insomnia)
Insomnia Treatment
- CBT-I- with stimulus control,
- sleep restriction,
- sleep hygiene education,
- relaxation training
Narcolepsy
- sx’s 3 times per week for 3 months
- attacks of irrepressible need to sleep that causes daytime naps at least 3 times per week for 3 months
- requires
- cataplexy is required=loss of muscle tone, triggered by strong emotion
- hypocretin deficiency–etiology
- or a rapid eye movement 15 minutes or less
2 types of Narcolepsy
- 2 types
- hypoGOgic hallucinations- going to sleep
- hypnoPOMpic hallucinations-cheerleaders using pom-poms to Pump wake you up
Narcolepsy treatment
- combination medication and behavior strategies
- meds are used to improve alertness & ↓cataplexy
- modafinil (armodafinil) ↑dopamine levels
- amphetamines (methylphidate) ↑dopamine, increase serotonine, and NE a little
- med cataplexy-antidepressant venlafaxine, fluoxetine, clomipramine.
- sodium oxybate is useful for people who do not respond to other drugs (natural brain chemical taken to improve sleep)
Non-Rapid Eye Movement (N-REM)
Sleep arousal disorders
- tends to occur in stages 3 and 4 of sleep in the 1st/3 (third) of sleep cycle
- sleep walking-getting out of bed during sleep and may include sleep related eating, sexual behavior
-
sleep terror no-remembrance of what happened during a sleep terror
osleep terror abrupt arousal from sleep
o starts with screaming, intense fear, increased heart rate, unresponsive to attempts to be awakened
Nigthmare disorder
- think Nightmare on Elm Street + REM sleep
o REMember what happened during nightmares b/c they occur in REM sleep
- when awakened person may be oriented and alert
Schizoaffective Disorder
- Concurrent sx of schizophrenia & major depressive or manic episode
- Happening in and out of the illness
- Presence of hallucinations for 2 or more weeks without mood symptoms
Immigrant Paradox
- immigrant adjust better to with a disorder than both us native-born same ethinicity and acculturated immigrants
Marlott and Gordan
Relapse Prevention
Absence Violation Effect (3 things)
- negative emotions
- guilt
- sense of personal failure
Substance and Addition
Apathy
dysphoric
Euphoria
Hypervigilance
- apathy-does not care (opposite empathy)
- dysphoria-unease or dissatisfaction w/life
- euphoria-intense excitement
- hypervigilance-constantly assessing threats (trauma)
Substance and Addition
4 categories of substance addiction
- risky use
- social impairment
- pharmalogical (tolerance and withdrawal)
- impaired control
Antipsychotics
First-generation
effects + or - symptoms
address which NT
- impacts positive sx more than -
- blocking D2 or dopamaine receptors
Antipsychotic
First gen major side effects
3 types
- Anticholinergic-cant pee, cant see, cant poop, dry mouth and tachycardia
- extrapyramidal- high potency (haloperidol & fluphenazine) parkinsonism resting tremor or rigidity, dystonia cant control muscles, akathisia (restless leg-aka cant be still), and tardive dyskinesia ( life-threatening)
- neuroleptic malignant syndrome-rare but life-threatening, mind altering, autonmic dysfunction, high fever, combative
