Test 3

Question 1

____ – mania was described as “bestial madness”

Answer 1

1025

Question 2

1854 – _____ described bipolar disorder as “dual form insanity”

Answer 2

Jules Baillarger

Question 3

1913 – _______ termed “manic-depressive”

Answer 3

Emil Kraepelin

Question 4

_____ – bipolar disorder added to the DSM III

Answer 4

1980

Question 5

Biogenic Amine Hypothesis
Chronobiologic Theories
Sensitization and Kindling theory
Genetic Factors
Immunology

Answer 5

Etiology of Bipolar

Question 6

Bipolar I Disorder
Bipolar II Disorder
Cyclothymic Disorder
Substance/Medication-Induced Bipolar and Related Disorder
Bipolar and Related Disorder Due Another Medical Condition
Other Specified Bipolar and Related Disorder
Unspecified Bipolar and Related Disorder

Answer 6

DSM 5 Diagnoses

Question 7

Manic Episode
Hypomanic Episode
Major Depressive Episode

These are not ________
They are abnormal mood conditions which make up the bipolar and depressive disorders mood disorders

Answer 7

disorders

Question 8

Criteria A: Distinct period of abnormally & persistently elevated, expansive or irritable mood and abnormal and persistent increase in goal directed activity (energy) lasting for at least one week (unless it is severe enough to cause hospitalization).
Criteria B: During the episode at least 3 of following symptoms have persisted & are significant
1. inflated self-esteem or grandiosity
2. decreased need for sleep
3. more talkative, pressured speech
4. flight of ideas, racing thoughts
5. distractibility
6. increase in goal directed activity or psychomotor agitation
7. excessive involvement in high risk, pleasurable activities

Answer 8

Manic EPISODE

Question 9

Decreased need for sleep
Labile or irritable
Pressured speech (unable to interrupt)
Heightened senses (colours/smells) – can progress to hallucinations
Inflated sense of self capacity – can progress to grandiose delusions
Flamboyant or histrionic dress/make-up
Heightened sensuality & sexuality
High risk behaviours – driving fast, gambling, & drinking
Spending large sums of money
Disregard for usual ethical standards
Lack of insight, at least initially
Lack of distress with symptoms

Answer 9

Mania features

Question 10

Criteria A: Same as for Manic Episode criteria A except the word “goal-directed” is left out and duration criteria is only 4 days.
Criteria B: Same as Mania criteria B
Criteria C: A change in functioning from normal
Criteria D: Change in mood and function is noticeable to others
Criteria E: Does not cause marked impairment, hospitalization or psychotic features

Answer 10

Hypomanic Episode

Question 11

uncritical self-confidence
taking on numerous and/or ambitious projects
may manifest as irritability
unbounded enthusiasm
markedly increased energy levels
less need for sleep
louder, more talkative but can be interrupted

Answer 11

Hypomania associated features

Question 12

Criteria A: 5 or more of the following present for 2 weeks
1. Depressed mood
2. Loss on interest or pleasure
3. Weight loss or weight gain
4. Insomnia or hypersomnia
5. Psychomotor agitation or retardation
6. Fatigue or loss of energy
7. Feelings of worthless or guilt
8. Poor concentration or indecisiveness
9. Recurrent thoughts about death
Criteria B: Causes significant distress or impairment to important areas of functioning

Answer 12

Depressive Episode

Question 13

Criteria A
Occurrence of at least one manic episode

Criteria B
Manic or depressive episode not better explained by schizoaffective disorder, or other schizophrenia spectrum or psychotic disorders

Code for type of current or most recent episode.
Ex Bipolar I Disorder Manic Episode

Answer 13

Bipolar I Disorder

Question 14

Onset, Development, Course
Equal gender representation
Controversy about childhood onset
Average young adulthood
Possible onset into 60’s and 70’s
New onset mania in mid or late life may suggest other medical condition
Increase risk of suicide

Answer 14

Bipolar I

Question 15

Criteria A: Meet criteria for at least one hypomanic episode and one major depressive episode at some point.
Criteria B: Has never experienced a manic episode
Criteria C: Not better explained by schizophrenia spectrum disorder or other psychotic disorder
Criteria D: Depression or alternating between depression and hypomania causing distress and dysfunction in important areas of life

Answer 15

Bipolar II

Question 16

At least one major depressive episode of at least 2 weeks
At least one hypomanic episode of at least 4 days
Alternating mood states
Typically presents during depressive phrase as it is painful compared to positively evaluated hypomania
Unpredictability of mood states (unstable moods) can cause problems and concerns

Average age of onset mid-20’s
Suicide risk

Answer 16

Bipolar II

Question 17

Criteria A: For at least 2 years (or 1 year in children and youth), the presence of numerous periods with hypomanic symptoms & numerous periods of depressive symptoms
Criteria B: During that time, has symptoms of hypomania or depression at least half the time, and symptom free for no more than 2 months at a time
Criteria C:
No major depressive, manic, or hypomanic episodes.

Criteria D
Not better accounted for by schizoaffective disorder, schizophreniform disorder, delusional disorder or psychotic disorder NOS
Criteria E
Not due to general medical condition or substance use
Criteria F
Symptoms cause clinically significant distress or impairment

Answer 17

Cyclothymic Disorder

Question 18

Specifiers:
With anxious distress
With mixed features
With rapid cycling
With mood-congruent psychotic features
With mood-incongruent psychotic features
With catatonia
With peripartum onset
With seasonal pattern

Answer 18

Bipolar I

Question 19

Specify if :
Depressed
Hypomanic
Anxious distress
Mixed features
Rapid Cycling

Answer 19

Bipolar II

Question 20

Presence of at least 2 of following during mania, hypomania, or depressive episode
1. Feeling tense
2. Feeling usually restless
3. Difficulty concentrating because of worry
4. Fear something awful may happen
5. Feeling may lose control of self

Answer 20

With Anxious Distress

Question 21

Full criteria for mania or hypomania plus at least 3 of following:
1. Prominent dysphoria or depressed mood
2. Diminished or pleasure in all or almost all activities
3. Psychomotor retardation
4. Fatigue, loss of energy
5. Feelings of worthlessness or excessive guilt
6. Recurrent thoughts of death, suicide ideation

Answer 21

Manic or Hypomanic episode with Mixed Features

Question 22

Full criteria for depression plus at least 3 of following
1. Elevated, expansive mood
2. Inflated self-esteem
3. More talkative than usual or pressure to keep talking
4. Flight of ideas or racing thoughts
5. Increase in energy or goal directed activities
6. Increased high risk behaviours
7. Decreased need for sleep

Answer 22

Depressive episode with Mixed Features

Question 23

Can be applied to Bipolar I or II disorder
Presence of at least four mood episodes in one year
1. Elevated, expansive mood
2. Inflated self-esteem
3. More talkative than usual or pressure to keep talking
4. Flight of ideas or racing thoughts
5. Increase in energy or goal directed activities
6. Increased high risk behaviours
7. Decreased need for sleep

Answer 23

With Rapid Cycling

Question 24

Delusions or hallucinations are present at any time in the episode
the episode the delusions and/or hallucinations experienced are consistent with typical manic themes of grandiosity, invulnerability ect.
May also include paranoia especially if others doubt the individuals accomplishments

Answer 24

With Mood - Congruent Psychotic Features

Question 25

Delusions or hallucinations are present at any time in the episode
Content to the delusion and/or hallucination does not match the themes described above (can also be a combination)

Answer 25

With Mood – Incongruent Psychotic Features

Question 26

Mania, hypomania, depression
Can be present with or without psychotic features
Onset during pregnancy or 4 weeks post-partum
3 to 6% experience major depressive episode with pregnancy or post-partum

Answer 26

With Peri-partum Onset

Question 27

Lifetime pattern of at least one type of mood episode occurring predictably with a certain time of the year.
Full remission predictably occurs at another time of the year

Can be mania, hypomania, or depression

Answer 27

With seasonal pattern

Question 28

The personality emerges from a complicated interaction of biologic dispositions, psychological experiences, and environmental situations

“personality is an enduring pattern of inner experience and behaviour” (American Psychological Association, 2013, p. 646)

“enduring patterns of perceiving, relating to, and thinking about the environment and oneself that are exhibited in a wide range of social and personal contexts” (American Psychological Association, 2013, p.647).

Answer 28

Personality

Question 29

Openness to new experiences
Conscientiousness – self-directed, perseverating
Extraversion – social interaction
Agreeableness – helpfulness
Neuroticism – emotional instability to flat affect

Answer 29

OCEAN

Question 30

Lack of knowledge about ____ leads to stigma
Contested areas- DSM-5 personality and personality disorder working group wanted to shift to more of a dimensional approach

Answer 30

Personality Disorders

Question 31

“Enduring pattern of inner experience and behaviour that deviates markedly from the expectations of the individual’s culture” (American Psychological Association, p. 645)

Answer 31

Personality Disorders

Question 32

early onset & persists

Answer 32

Enduring

Question 33

fixed pattern, not adaptable

Answer 33

Inflexible

Question 34

persists across aspects of person’s life

Answer 34

Pervasive

Question 35

Personality traits may impair function & cause distress within a given context & a given time frame.

Personality traits do not cause significant, ongoing distress and/or dysfunction.

Answer 35

Personality Traits vs. Disorders

Question 36

The question arises as to whether personality traits are _______. We all have personality traits—relatively consistent patterns in how we perceive and interact with the world.

Answer 36

pathological

Question 37

Largely unknown
Many types are associated with trauma
Traits are often observed in childhood
Appears to be a correlation between temperament and environmental experiences

Answer 37

Eitology of Personality Disorders

Question 38

Criteria A
Effects at least two areas of functioning:

1. cognition
2. affectivity
3. interpersonal relations
4. impulse control

Answer 38

Personality Disorders

Question 39

Criteria B
Enduring, inflexible, pervasive across broad range of personal and social situations
Criteria C
Enduring pattern leading to clinically significant distress or impairment
Criteria D
Stable, long duration, onset traced to at least adolescence or early adulthood
Criteria E
Not better explained by another mental disorder
Criteria F
Not attributable to substance, medication or medical condition

Answer 39

Personality Disorders

Question 40

Paranoid Personality Disorder
Schizoid Personality Disorder
Schizotypal Personality Disorder

Answer 40

Cluster A

Question 41

Antisocial Personality Disorder
Borderline Personality Disorder
Histrionic Personality Disorder
Narcissistic Personality Disorder

Answer 41

Cluster B

Question 42

Avoidant Personality Disorder
Dependent Personality Disorder
Obsessive Compulsive Personality Disorder

Answer 42

Cluster C

Question 43

A pervasive distrust and suspiciousness of others such that their motives are interpreted as malevolent, beginning by early adulthood and present in a variety of contexts, as indicated by 4 (or more) of the following:
1. Suspects, without sufficient basis, that others are exploiting, harming, or deceiving them.
2. Is preoccupied with unjustified doubts about the loyalty or trustworthiness of friends or associates.
3. Is reluctant to confide in others because of unwarranted fear that the information will be used maliciously against them.
4. Reads hidden demeaning or threatening meanings into benign remarks or events.
5. Persistently bears grudges
6. Perceives attacks on their character or reputation that are not apparent to others and is quick to react angrily or to counterattack.
7. Has recurrent suspicions, without justification, regarding fidelity of spouse or sexual partner.
Criteria B – Does not occur during course of schizophrenia, bipolar disorder, or depression with psychotic features

Answer 43

Paranoid Personality Disorder

Question 44

Increased prevalence with relatives diagnosed with schizophrenia or delusional disorders (persecutory)
Associated with low income populations, stress, trauma, and neglect in childhood
A predictor of aggressive behaviours in forensic settings
May co-occur anxiety and mood disorders and schizophrenia
No medications have been found helpful at treating this disorder

Answer 44

Paranoid Personality Disorder

Question 45

A pervasive pattern of detachment from social relationships and a restricted range of expression of emotions in interpersonal settings, beginning by early adulthood and present in a variety of contexts, as indicated by 4 (or more) of the following:
1. Neither desires nor enjoys close relationships, including being part of a family.
2. Almost always chooses solitary activities.
3. Has little, if any, interest in having sexual experiences with another person.
4. Takes pleasure in few, if any, activities.
5. Lacks close friends or confidants other than first-degree relatives.
6. Appears indifferent to the praise or criticism of others.
7. Shows emotional coldness, detachment, or flattened affectivity.

Answer 45

Schizoid Personality Disorder

Question 46

Uncommon to see in clinical settings
Increased prevalence with first degree relatives experiencing a diagnosis of schizophrenia or schizotypal personality disorder
More common in males
Minimal ability to practice introspection
May be associated with cold parenting styles

Answer 46

Schizoid Personality Disorder

Question 47

A pervasive pattern of social/ interpersonal deficits marked by acute discomfort with/reduced capacity for, close relationships as well as by cognitive or perceptual distortions and eccentricities of behavior, beginning by early adulthood and present in a variety of contexts, as indicated by 5+:
1. Ideas of reference (excluding delusions of reference).
2. Odd beliefs or magical thinking that influences behavior and is inconsistent with subcultural norms
3. Unusual perceptual experiences, including bodily illusions.
4. Odd thinking and speech (e.g., vague, circumstantial, metaphorical, overelaborate, or stereotyped).
5. Suspiciousness or paranoid ideation.
6. Inappropriate or constricted affect.
7. Behavior or appearance that is odd, eccentric, or peculiar.
8. Lack of close friends or confidants other than first-degree relatives.
9. Excessive social anxiety that does not diminish with familiarity and tends to be associated with paranoid fears

Answer 47

Schizotypal Personality Disorder

Question 48

More likely to seek treatment for depression or anxiety
Increased prevalence with first degree relatives with a diagnosis of schizophrenia
More common in males
Considered to be part of the schizophrenia spectrum

*Know cultural norms before making diagnosis

Answer 48

Schizotypal Personality Disorder

Question 49

International classification of disease: ICD-11 not a PD but considered a form of schizophrenia

Answer 49

Schizotypal

Question 50

A pervasive pattern of disregard for and violation of the rights of others, occurring since age 15 years, as indicated by 3+ of the following:
1. Failure to conform to social norms with respect to lawful behaviors, as indicated by repeatedly performing acts that are grounds for arrest.
2. Deceitfulness, as indicated by repeated lying, use of aliases, or conning others for personal profit or pleasure.
3. Impulsivity or failure to plan ahead.
4. Irritability and aggressiveness, as indicated by repeated physical fights or assaults.
5. Reckless disregard for safety of self or others.
6. Consistent irresponsibility, as indicated by repeated failure to sustain consistent work behavior or honor financial obligations.
7. Lack of remorse, as indicated by being indifferent to or rationalizing having hurt, mistreated, or stolen from another.
B. The individual is at least age 18 years.
C. There is evidence of conduct disorder with onset before age 15 years.
D. The occurrence of antisocial behavior is not exclusively during the course of schizophrenia or bipolar disorder.

This disorder has been labeled as “psychopathy” “sociopathy” – most extreme form (uncommon)

Answer 50

Antisocial Personality Disorder

Question 51

Associated with anxiety, depression, substance use, gambling, uncontrolled anger, poor impulse control
Associated with a history of childhood abuse, neglect or erratic parenting styles and a poverty
More common in males
More prevalent in forensic settings
Symptoms likely to remit in 40’s
Found decreased activity in the amygdala

Answer 51

Antisocial Personality Disorder

Question 52

A pervasive pattern of instability of interpersonal relationships, self-image, and affect, and marked impulsivity, beginning in early adulthood and present in a variety of contexts, as indicated by 5+:
1. Frantic attempts to prevent abandonment, whether real or imagined
2. Unstable relationships that alternate between idealization and devaluation
3. Identity disturbance (severely distorted or unstable self-image/sense of self)
4. Potentially self-damaging impulsiveness in at least 2 areas such as binge eating, reckless driving, sex, spending, substance abuse
5. Self-mutilation or suicide thoughts, threats or other behavior
6. Severe reactivity of mood creates marked instability (mood swings of intense anxiety, depression, irritability last a few hours to a few days)
7. Chronic feelings of boredom or emptiness
8. Anger that is out of control or inappropriate and intense
9. Brief paranoid ideas or severe dissociative symptoms related to stress

Austin and Boyd suggest 11 to 70% of clinical population with median of 31%.
Outpatient = 8 to 27%
Inpatient = 15 to 51%

Answer 52

Borderline Personality Disorder

Question 53

Twice as common in females
Associated with childhood trauma
Structural & functional brain changes as result of abuse and trauma: (in animal models)
Often associated with major depression
Pronounced startle response
Increased activation of stress hormones
Structural changes to limbic system (e.g., hippocampus and amygdala)

Answer 53

Borderline Personality Disorder

Question 54

Innate emotional vulnerability (emotional dysregulation)
+
Invalidating environments
=
___________

Current hypothesis: BPD occurs when people with “sensitive” brains are exposed to abuse, trauma and neglect in developing years.
-Marsha Linehan

Answer 54

Borderline Personality Disorder

Question 55

Depression and anxiety
Intolerably painful inner states
Self-harming behaviour such as self-injurious behaviors and/or suicidal attempts
Disorganized behaviour
Substance abuse
High risk of suicide

Service Provider Stigma

Answer 55

BPD

Question 56

A pervasive pattern of excessive emotionality and attention seeking, beginning by early adulthood and present in a variety of contexts, as indicated by 5+:
1. Is uncomfortable in situations in which they are not the center of attention.
2. Interaction with others is often characterized by inappropriate sexually seductive or provocative behavior.
3. Displays rapidly shifting and shallow expression of emotions.
4. Consistently uses physical appearance to draw attention to self.
5. Has a style of speech that is excessively impressionistic and lacking in detail.
6. Shows self-dramatization, theatricality, and exaggerated expression of emotion.
7. Is suggestible (i.e., easily influenced by others or circumstances).
8. Considers relationships to be more intimate than they actually are.

Answer 56

Histrionic Personality Disorder

Question 57

More often diagnosed in female populations although some studies have found no gender differences
It may be that females are more likely to seek treatment
May co-occur with other personality disorders (borderline personality disorder or dependent personality disorder), anxiety disorders, substance use, and mood disorders
Cause unknown

Answer 57

Histrionic Personality Disorder

Question 58

A pervasive pattern of grandiosity (in fantasy or behavior), need for admiration, and lack of empathy, beginning by early adulthood and present in a variety of contexts, as indicated by 5 (or more) of the following:
1. Has a grandiose sense of self-importance (e.g., exaggerates achievements and talents, expects to be recognized as superior).
2. Is preoccupied with fantasies of success, power, brilliance, beauty, etc.
3. Believes that they are “special” and unique and can only be understood by, or should associate with, other special or high-status people (or institutions).
4. Requires excessive admiration.
5. Has an unrealistic sense of entitlement.
6. Is interpersonally exploitative (i.e., takes advantage of others to achieve their own ends).
7. Lacks empathy
8. Is often envious of others or believes that others are envious of them.
9. Shows arrogant, haughty behaviors or attitudes.

Answer 58

Narcissistic Personality Disorder

Question 59

Associated with depressive disorders, anorexia nervosa, substance use disorders
50-75% male
May be associated with neglect, sudden loss of a significant relationship, trauma

May result from parenting styles that are overly indulging or excessively criticising

Answer 59

Narcissistic Personality Disorder

Question 60

A pervasive pattern of social inhibition, feelings of inadequacy, and hypersensitivity to evaluation, beginning by early adulthood and present in a variety of contexts, as indicated by 4+:
1. Avoids occupational activities that involve significant interpersonal contact because of fears of criticism, disapproval, or rejection.
2. Is unwilling to get involved with people unless certain of being liked.
3. Shows restraint within intimate relationships because of the fear of being shamed or ridiculed.
4. Is preoccupied with being criticized or rejected in social situations.
5. Is inhibited in new interpersonal situations because of feelings of inadequacy.
6. Views self as socially inept, personally unappealing, or inferior to others.
7. Is unusually reluctant to take personal risks or to engage in any new activities because they may prove embarrassing.

Answer 60

Avoidant Personality Disorder

Question 61

No clear cause
Associated with avoidant temperament as an infant
May be related to neglect as a child

Associated with dependent personality disorder
No gender differences in prevalence

Answer 61

Avoidant Personality Disorder

Question 62

A pervasive and excessive need to be taken care of that leads to submissive and clinging behavior and fears of separation, beginning by early adulthood and present in a variety of contexts, as indicated by 5+:
1. Has difficulty making everyday decisions without an excessive amount of advice and reassurance from others.
2. Needs others to assume responsibility for most major areas of their life.
3. Has difficulty expressing disagreement with others because of fear of loss of support or approval.
4. Has difficulty initiating projects or doing things on their own.
5. Goes to excessive lengths to obtain nurturance and support from others, to the point of volunteering to do things that are unpleasant.
6. Feels uncomfortable or helpless when alone because of exaggerated fears of being unable to care for themselves.
7. Urgently seeks another relationship as a source of care and support when a close relationship ends.
8. Is unrealistically preoccupied with fears of being left to take care of themselves

Answer 62

Dependent Personality Disorder

Question 63

May co-occur with other personality disorders such as avoidant personality disorder or borderline personality disorder
More commonly diagnosed with women but some studies show no gender differences
As an infant have a dependent temperament
Associated with an overprotective parenting style

Answer 63

Dependent Personality Disorder

Question 64

A pervasive pattern of preoccupation with orderliness, perfectionism, and mental and interpersonal control, at the expense of flexibility, openness, and efficiency, beginning by early adulthood and present in a variety of contexts, as indicated by 4 + of the following:
1. Is preoccupied with details, rules, lists, order, organization, or schedules to the extent that the major point of the activity is lost.
2. Shows perfectionism that interferes with task completion.
3. Is excessively devoted to work and productivity to the exclusion of leisure activities and friendships (not accounted for by obvious economic necessity).
4. Is over conscientious, scrupulous, and inflexible about matters of morality, ethics, or values
5. Is unable to discard worn-out or worthless objects even when they have no sentimental value.
6. Is reluctant to delegate tasks or to work with others unless they submit to exactly his or her way of doing things.
7. Adopts a miserly spending style toward both self and others; money is viewed as something to be hoarded for future catastrophes.
8. Shows rigidity and stubbornness.

Answer 64

Obsessive Compulsive Personality Disorder

Question 65

Considered to be the most prevalent personality disorder ranging from 2-8% of general population
Twice as common in males
Associated with anxiety, depression, bipolar and eating disorders
May be linked to myocardial infarctions
Associated with parenting styles that focus on punishment and lack praise

Answer 65

Obsessive Compulsive Personality Disorder