Unit 3 Flashcards
illness anxiety disorder (FRM: hypochondriasis)
unrealistically interpret bodily symptoms as signs of a serious illness- chronic anxiety/ preocupation- symptoms change as body changes
DC: - physical symptoms due to mild condition disproportionate to anxity
-can experience almost panic state
-repeated medical visits/ checking body
-worry despite assurances
-often aware that fear is exaggerated, not delusional
-1-5%
-treatments= antidepressants, tricyclic and SSRI- CBT and ERP used
conversion disorder (aka. functional neurological symptom disorder)
people experiencing a physical symptom without cause- neurological symptoms
-symptoms are REAL- not delusional, usually start suddenly in time of stress
-at least 1/3 of primary care visits involve unexplained symptoms
-historically, it was believed that psych trouble was CONVERTED Into physical illness (freud)
DC= 1+ symptom involving altered motor or sensory function, inconsistent with real physical disorder, symptoms are inexplicable by medicine, distress/ dysfunct
la belle indifference
patient sometimes dismisses the symptoms as minor, though they are incapacitated, NOT part of the DC
somatic symptom disorder
disproportionate and persistent concern about seriousness of one’s physical symptom- NOT neuro symptoms; often has history of large number of medical appts. (predominant pain and somatization subtypes)
-anxiety about illness, but symptoms are real and severe and physical with SSD> IAD
malingering
NOT an actual disorder- motivated by external incentives
factitious disorder (munchausens)
DC: intentionally produced physical or psych symptoms, person is motivated by internal incentives, may undergo multiple procedures, may have history of travel and different hospitals, person creates additional symptoms when test yields negatives
-can be imposed on self or another
psych factors affecting medical
coping, maladapt health behavior, stress etc can increase chance of MI
psychosis
severe disturbance in one’s experience of reality- difficult to discern what is real
positive symptoms
distortions or excess of normal behavior
-delusions, hallucinations, disorganized speech, abnormal motor behavior
negative symptoms
functioning below normal level
-avolition, affect flattening, alogia, anhedonia, sociality
delusion
deeply held, false belief (grandeur, persecution, somatic…)
disorganized speech
loose association, tangentiality, incoherence, neologisms
abnormal motor behavior (positive symptoms)
catatonic, agitation, staring, tick, bizarre/ purposeless movements
avolition
lack of self motivation
affect flattening
decreased emotional expression
alogia
poverty of speech- decreased speaking/ mute
anhedonia
decreased pleasure
schizophrenia
DC: 2+ active phase symptoms, at least one must be hall or delusion and present for significant portion of one month
- symptoms must last at least 6 months with one month active phase
- not due to subs use
schiz stats
10-25 year reduction in life expectancy due to suboptimal lifestyles and antipsychotic drug side effects
- affect less than 1% pop (equal males and females)
1/3 homeless pop has severe mental illness
DA hypothesis
overactive DA in schiz leads to positive symptoms
brain abnormalities
increased synaptic pruning increased ventricle size decreased white matter shrinkage of frontal and temporal lobe --flu exposure during second trimester
expressed emotion
extent to which close family members express negative attitudes towards the patient during private interview- hostile and critical
-4x more likely to relapse if in environment with EE
brief psychotic disorder
at least one psychotic symptom present for 1-30 days
-sudden onset (within 2 weeks)= reactive psychosis due to the nature of the disorder to be in response to something
(peripartum onset/ post partum response)
schizophreniform disorder
same symptoms as schiz, shorter duration (symptoms= 1-6 mo)… 2/3 will develop schiz
-those most likely to recove= no negative symptoms, sudden onset, and good functioning before the disorder presentation
schizoaffective disorder
combo of schiz and mood episodes at the same time (2-5 symptoms of schiz with a depressive or manic episode)
females>males
delusional disorder
just one symptom of psychosis= delusions for 1+ mo
- .2% prev
- common delusions= erotomanic, grandiose, paranoid, somatic
milieu therapy
humanistic approach- creating safe social environment with independence and responsibilities
-Maxwell jones
token economy
identify target behavior, token as reinforcer
**requires consistent application
antipsychotic drugs
1950s= 1st generation= neuroleptics (1954= thorazine/ chlorpromazine), work on positive symptoms- d2 receptors
-unwanted side effects= tardive dyskinesia
2nd gen= atypicals= clokaril/ dispersal- help reduce positive and negative symptoms with less side effects- metabolic Side effects= higher BP/ cholesterol and weight gain
** reduce symptoms in 65% people, but 75% stop taking meds within 18 mo
extrapyramidal syndrome
involuntary movement problems- may be reversible or irreversible
new wave CBT
mindfulness meditation to gain distance from symptoms
ACT
cost effective way to provide community based care- small case loads, assertive outreach- interdisciplinary team approach
-voluntary
AOT
court ordered and often time constrained
-40 to 60% schiz receive no treatment at all in a given year
paranoid PD
pervasive distrust and suspiciousness of others- not usually delusional- hypersensitive and hold grudges
4% pop
-attachment issues
schizoid PD
persistent avoidance of social relationships bc they don’t want them- socially isolated, loners, may be awkward
1% pop. men>women
schizotypal PD
schiz-like, but like prodromal stage and still in contact with reality- peculiar thought patterns, oddities of perception, difficulty with conversation
2-4% pop. men>women
antisocial PD
persistently violate other’s rights- lack of empathy
DC: must be 18yo, with history of conduct disorder as child and violation of rights behavior (3)
40-75% of prison pop meets criteria
males> females
2-3% pop
maturation hypothesis
suggests that people are better able to manage their behavior with age (reduced impulsivity)
borderline PD
great instability- prone to anger and aggression or directed at self harm
suicidal or self harm is a major symptom
dialectic behavioral therapy (DBT)
recognizes need for such clients to enhance emotional and behavioral self regulation- modified CBT for borderline PD
=intensive 1:1 and group therapy
histrionic PD
extremely emotional and seek to be center of attention- shifting and shallow emotions- engage in attn seeking behavior
narcissistic PD
extreme grandiosity, need for excessive admiration, entitlement, lack empathy
50-75% men, 1% adults
avoidant PD
avoid social relationships- sense of social inferiority and inadequacy
-get lonely and WANT relationships
dependent PD
excessive dependence on others- cannot make small decisions for themselves and difficulty with separation- feel lonely
-comorbid= eating disorders, suicide, and anxiety
obsessive compulsive PD
pattern of preoccupation with orderliness, perfectionistic, mental and interpersonal control
- may be inflexible about morals, excessively devoted to work
- cognitive therapy and SSRIs are best
ASD
refers to 4 previously different disorders
DC= deficits in communication, restricted and repetitive patterns of behavior, and symptoms must be present in early development period
80% boys, 1/68 of pop
genetics= strong connection
-tend NOT to learn via observation or modeling
treatment= applied behavior analysis (modeling training) or augmented communication symptoms
Aspergers from DSM IV
significant impairment in social interaction, but no demonstrated language deficiency as in ASD
intellectual disability
3% pop worldwide- higher rates in low income areas
DC= early dev onset, adaptive and intellect deficiency
mild= 85% Individuals with ID- able to learn up to 6th grade level (“concrete learners”)
VABS
assessing adaptive function when ASD or ID is suspected
ADHD
symptoms of inattention AND/ OR hyperactivity
- symptoms onset before age 12
- impairment seen in 2 settings
- 7% kids, 70% boys
- symptoms of hyperactivity are less obvious in adolescence/ adulthood (fidget)
type I vs II attention processes
I= involuntary control, focusing attn on unexpected occurrences in surroundings
II= voluntarily controlled, effortful focus of attention
-in ADHD, may have difficulty overriding the type I response
stimulants on ADHD
stimulants work for 70-80% ADHD kids, they help bc they increase the release of NTs, BUT slow the reuptake (increased ability to focus)
