Psychopathology Exam 2 - Herman Rutgers

Mood disorders

-involve severe alterations in mood which are intense and persistent enough to be clearly maladaptive and often lead to serious problems

-must be clinically significant and significantly deviate from the individual's base line or ordinary emotional state

The two key moods involved in mood disorders are...

Euphoria and Dysphoria

Euphoric mood (mania)

characterized by intense and unrealistic feelings of excitement and euphoria

Dysphoria (depression)

feelings of extraordinary sadness and dejection

Mixed features (mixed episode)

characterized by symptoms of both mania or hypomania with depressive features

Depressive disorder

-involves periods of symptoms in which an individual experiences an unusually intense sad mood

-the disorder's essential element is an unusually elevated sad mood, known as dysphoria

Major depressive disorder

a disorder in which the individual experiences intense but time limited episodes of depressive symptoms

Major depressive episodes

-a period in which the individual experiences intense psychological and physical symptoms accompanying feelings of overwhelming sadness

-recurrent major depressive disorder with two or more episodes within an interval of at least 2 consecutive months

An affected person with major depressive episodes must experience the following...

-dysphoria for most of the day, nearly every day for at least 2 consecutive weeks

-symptoms include sleep and appetite disturbances, low energy/fatigue, low self-esteem, difficulty concentrating or making decisions, poor hygiene, feelings of hopelessness

-if untreated, a major depressive episode usually lasts 6 to 9 months and often recur as some future point

Persistent depressive disorder (dysthymia)

-chronic but less severe mood disturbance in which the individual does not experience a major depressive episode but a blue mood for a minimum of two years (1 year for children and adolescents)

-average duration is 4 to 5 years but can last for 20 or more

As compared to major depressive disorder, symptoms of persistent depressive disorder are...

-mild to moderate but last much longer (are chronic)

-periods of normal moods occur briefly but only last for a few days to a few weeks with a maximum of 2 months

-these intermittent normal mood swings are the most important characteristic distinguishing PDD from major depressive disorder

Unspecified Mood Disorder

applies to symptoms characteristic of a depressive disorder and cause clinically significant distress or impairment in social, occupational, or other important areas of functioning, however, symptoms do not meet the criteria for a depressive or bipolar disorder diagnosis

Disruptive mood dysregulation disorder

-a depressive disorder in children who exhibit chronic and severe irritability and have frequent temper outbursts

-occur on average 3 or more times/week over at least 1 year and in at least 2 settings

-diagnosis for children between ages 6 to 18

-onset must be before age 10

Premenstrual dysphoric disorder (PMDD)

-disorder that involves depressed mood or changes in mood, irritability, dysphoria and anxiety during the premenstrual phase that subside after the menstrual period begins for most of the cycles of the preceding year

-causal factors are biological (genetic influences are prevalent)

Psychological causes to depression include...

-stressful life events (ex: loss of a loved one, serious threats to important close relationships or to one's occupation, economic or health problems)

-chronic stress

-early adversity (ex: family turmoil, abuse, harsh or intrusive parenting)

-neuroticism

-learned helplessness

What the primary personality variable that serves as a vulnerability factor for depression (and anxiety)?

Neuroticism - involves temperamental sensitivity to negative stimuli and are prone to experiencing a broad range of negative moods

The learned helplessness model of depression

-when perceived lack of control is present, helplessness may result in depression

-result is that people make attributions that are central to whether they become depressed

-3 critical dimensions include internal/external, global/specific, stable/unstable

-those with a pessimistic attributional style have a vulnerability for depression

Bipolar disorder

mood disorder involving euphoric episodes, intense and very disruptive experiences of heightened mood referred to as a euphoric mood, possibly alternating with a major depressive episode

Bipolar I

-distinguished from major depressive disorder by at least one or more euphoric episodes or mixed features for at least 1 week

-onset in adolescence or young adulthood

Bipolar II

-person had one or major depressive episodes and at least one mixed with clear-cut hypomanic episodes

-onset on average 5 years later then young adulthood

Hypomanic episodes

-involves milder versions of euphoria but must last at least 4 days

-same symptoms but less impairment and never need hospitalization

Cyclothymic disorder

-defined as more chronic but less severe version of bipolar disorder

-lacks certain extreme symptoms and psychotic features

-in the depressed phase, similar to persistent depressive disorder (dysthymia)

-in the hypomanic phase, involves creative and productive physical and mental energy

-must be at least 2 years of numerous periods with hypomanic and depressed symptoms (1 for children and adolescents) and symptoms must cause significant distress or impairment in functioning

-never symptom free for more than 2 months

Is bipolar equal in men and women?

yes

You cannot be diagnosed with bipolar disorder unless...

exhibited at least one manic or mixed episode

Rapid cycling

experience at least 4 episodes in a year

Of all the psychological disorders, bipolar disorder is the most likely to occur in people who...

-also have problems with substance abuse

-with both there is earlier onset, more frequent episodes, greater chance for anxiety and stress related disorders, aggressive behavior, problems with the law, risk of suicide

Biological causal factors of bipolar

genetic influences

Neurochemical factors of bipolar

excesses of norepinephrine during manic episodes, less serotonin in both depressive and manic phases

Abnormalities of hormonal regulatory systems of bipolar

some evidence of abnormalities of thyroid function are frequently accompanied by changes in mood

Psychological factors of bipolar

stressful life events as in depressive disorders

Depressive Disorder Due to Another Medical Condition

mood disorder diagnosis where there is a prominent and persistent period of depressed mood or markedly diminished interest/pleasure thought to be related to the direct physiological effects of another medical condition

Some well-known illnesses that can lead to a diagnosis of mood disorder caused by a general medical condition can include...

neurological disorders (Huntington's disease, Parkinson's disease, Alzheimer's disease), multiple sclerosis, hypothyroidism, traumatic brain injury, strokes, and heart attacks

Criterion for Depressive Disorder Due to Another Medical Condition

a prominent and persistent period of depressed mood or markedly diminished interest or pleasure in all, or almost all, activities that predominates in the clinical picture, the disturbance is not better explained by another mental disorder (e.g. - adjustment disorder with depressed mood, in which the stressor is a serious medical condition) and the disturbance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning

Substance-induced mood disorder

-symptoms of depression that are due to the effects of medicine, drug abuse, alcoholism, exposure to toxins, or other forms of treatment

-substance induced mood disorder is a change in the way you think, feel, or act, caused by taking or stopping a drug

-these changes in your mood can last days or weeks

-the brain makes chemicals that affect thoughts, emotions, and actions

-without the right balance of these chemicals, there may be problems with the way you think, feel, or act

-many drugs change the amounts of these chemicals

-some drugs can cause mood problems while you are taking them while other drugs can cause mood problems for several weeks after you stop taking them

Drugs and medicines that can cause mood problems include...

-alcohol, marijuana, and illegal drugs such as cocaine and LSD

-nonprescription medicines such as some decongestants

-prescription medicines such as those to treat heart problems, high blood pressure, anti anxiety medicines, antidepressants, pain medicines, and others

Treatment for substance induced mood disorder

-can be treated with either group or individual therapy (therapy in a group with other people who have substance abuse problems is often very helpful) and in some cases, medicines for depression or anxiety may help you to stop substance abuse

-self help groups such as Narcotics Anonymous, support groups, and therapy may be helpful

-learning ways to relax may help like yoga and meditation

-claims have been made that certain herbal and dietary products help control cravings or withdrawal symptoms

-supplements are not tested or standardized and may vary in strengths and effects and may have side effects and are not always safe so before you take any supplement, talk with your healthcare provider

Depression symptoms include...

feeling sad and uninterested in things you usually enjoy, have trouble falling asleep (wake up very early or sleep too much), have changes in your appetite and weight (either up or down), have low energy, lose sexual desire, feel worthless and guilty, not be able to concentrate or remember things, feel hopeless or just not care about anything, have physical symptoms, such as headaches and joint pain, think often about death or suicide

Euphoria symptoms include...

having a very high sense of self-worth and a feeling of being "on top of the world", be very talkative and talk so fast that others have trouble following what you are saying, have racing thoughts and trouble concentrating, be very restless, have more feelings of anxiety and panic, go for days with little or no sleep and not feel tired, be very irritable and get into fights with others, be extremely active and act recklessly, such as going on spending sprees or having unsafe sex

Suicide

"fatal self-inflicted destructive act with explicit or inferred intent to die"

Suicidal continuum

1 - suicidal ideation (thinking about ending one's life)

2 - developing a plan

3 - suicide attempt (nonfatal suicidal behavior)

4 - suicide (the actual ending of one's life)

Self-harm without the Presence of Suicidality

-the DSM 5 TR has added self harm without the presence of suicidality to its list of diagnoses

-because not everyone who has engaged in self-harm may do so with the intent of ending their life, lumping it into suicidality could blur assessments made by clinicians

-the intent of the injury is the focus, which makes it easier to track harmful behaviors and assess risk

-in addition, diagnostic codes for suicidal behavior without the presence of other mental health disorders have been included in the new updates

Positive psychology

-resilience (risk for suicide but unlikely when high in resilience)

-resilience is a psychological construct since it is a belief you can overcome diversity, good coping skills

Pharmacotherapy for mood disorders include...

-antidepressant drugs include monoamine oxidase inhibitors (MAOIs) (1950's, intense side effects lethal, interactions with certain foods, significant withdrawal effects), tricyclic antidepressants (intense side effects, increase suicidal thoughts particularly in children and adolescents) Elavil, Anafranil, -selective serotonin reuptake inhibitors (SSRIs) (3 to 5 weeks to take effect)

-mood stabilizing drugs for both depressive and euphoric episodes of bipolar disorder and the most common is Lithium

Alternative biological treatments for mood disorders include...

-electroconvulsive therapy (ECT)

-transcranial magnetic stimulation (TMS)

-deep brain stimulation (DBS)

Electroconvulsive therapy (ECT)

treatments induce seizures, used with severely depressed patients who may present serious suicidal risk

Transcranial Magnetic Stimulation (TMS)

-focal stimulation of the brain

-stimulates nerve cells in the brain to improve symptoms of major depression (OCD, anxiety, and PTSD) and is noninvasive as there is no surgery involved

Deep Brain Stimulation (DBS) (neuromodulation)

-implanting an electrode in the brain (via tiny holes) and stimulating that area with electric current

-controlled by a pacemaker type device placed under the skin in the upper chest

-a wire travels under the skin connecting the device with the electrodes

Psychotherapy for mood disorders include...

-cognitive behavioral therapy (CBT)

-behavioral Activation Treatment which focuses intently on getting patients to become more active and engaged with their environment and with interpersonal relationships

-interpersonal Therapy (IPT) which focuses on current relationship issues and understanding and change of maladaptive interaction patterns

-family and Marital therapy

Dissociative disorders

conditions that involve disruptions or breakdowns of memory, awareness, identity, or perceptions

Dissociative Identity Disorder

-a dissociative disorder, formerly called MPD, in which an individual develops more than one-self or personality

-must have 2 distinct identities and when inhabiting identity one, are not aware that they also inhabit the other identity

-as a result, will have large gaps in memory

-individuals with dissociative identity disorder have learned to cope with extremely stressful life circumstances by creating "alter" personalities that unconsciously control their thinking and behavior when they are experiencing stress

-often, Dissociative disorders involve mood, anxiety, and PTSD

Dissociative Amnesia

-inability to remember important personal details and experiences, usually associated with traumatic or very stressful events

-fugue state is when someone may travel or wander without knowing their identity

-dissociative amnesia with dissociative fugue

Depersonalization

condition in which people feel they are detached from their own body

Derealization

condition in which people feel a sense of unreality or detachment from their surroundings

Depersonalization/derealization disorder

condition in which the individual experiences recurrent and persistent episodes of depersonalization/derealization

Somatic symptoms

symptoms involving physical problems and/or concerns about medical symptoms → "somatic" comes from the Greek word "soma" meaning body

Somatic symptom disorder

-somatic disorder involving actual physical symptoms that may or may not be accountable by a medical condition, accompanied by maladaptive thoughts, feelings, and behaviors

-manifests as physical symptoms that suggest illness or injury but cannot be explained fully by a general medical condition or by the direct effect of a substance and are not attributable to another mental disorder

-medical test results are either normal or do not explain the person's symptoms, and do not indicate the presence of a known medical condition

-for a diagnosis, there must also be excessive worry about their symptoms, and this worry must be judged to be out of proportion to the severity of the physical complaints

-must have recurring somatic complaints for at least six months

-not the result of conscious malingering (fabricating or exaggerating symptoms for secondary motives) or factitious disorders (deliberately producing, feigning, or exaggerating symptoms)

-difficult to diagnose and treat

What do symptoms of somatic symptom disorder involve?

-similar in various illnesses and may last for years

-usually, the symptoms begin appearing during adolescence, and patients are diagnosed before the age of 30 years → may occur across cultures and gender

-anxiety and depression, but since anxiety and depression are also common in those with confirmed medical illnesses, it remains possible that such symptoms are a consequence of the physical impairment, rather than a cause

Illness anxiety disorder

-a somatic symptom disorder characterized by the misinterpretation of normal bodily functions as signs of serious illness and does not involve actual physical symptoms (hypochondriasis)

-individuals do not experience any specific physical ailment, but instead, they are preoccupied with concern about developing a severe medical condition

-easily alarmed about their health and seek unnecessary medical tests and procedures to rule out or treat exaggerated or imagined illnesses

-they remain unsatisfied with the reassurance of the physicians and can cause a huge burden on the resources of health care facilities and on health care providers

Functional Neurological Symptom Disorder (Conversion disorder)

-a somatic symptom disorder involving the translation of unacceptable drives or troubling conflicts into physical symptoms (once known as "hysteria")

-"conversion" refers to the presumed transformation of psychological conflict to physical symptoms

-physical ailments include "pseudoseizures", disorders of movement, paralysis, weakness, disturbances of speech, blindness, and other sensory disorders and cognitive impairment

Malingering

-involves deliberately fabricating physical or psychological symptoms for some ulterior motive → want direct benefit or reward

-primary gain is the relief from anxiety or responsibility due to the development of physical or psychological symptoms

-direct benefits occupying the sick role include disability, lawsuit, insurance benefits, time off from work, etc

Fictitious disorder imposed on self

fake symptoms or disorders not for the purpose of any particular gain, but because of an inner need to maintain a sick role (Munchausen's syndrome)

Fictitious disorder imposed on another

inducing physical symptoms in another person who is under their care (Munchausen's syndrome by proxy)

Factitious disorder

-faking or exaggerating symptoms for secondary gains

-secondary gain is sympathy and attention that a sick person receives from other people → motives are internally driven, not externally

Theories and treatment for Somatic Symptom Disorder

-Dissociative and Conversion disorders are nearly always precipitated by some prior trauma

-Cognitive Behavioral Therapy (CBT) which aims to help clients identify and change their thoughts linked to their physical symptoms and change their maladaptive behavior that accompanies those irrational thoughts and the focus is on the unusually high level of health anxiety - worry about physical symptoms and illness

-Hypnotherapy and Medication

Psychological factors affecting other medical conditions

-disorder in which clients have a medical disease or symptom that appears to be exacerbated by psychological or behavioral factor

-psychological factors affecting medical conditions include mental disorders, stress, emotional states, personality traits, and poor coping skills

-all interact with physiological conditions

Stress

the unpleasant emotional reaction that a person has when an event is perceived as threatening

Stressful life event

an event that disrupts the individual's life

Coping

the process through which people reduce stress in a healthy manner

Problem focused coping

coping in which the individual takes action to reduce stress by changing whatever it is about the situation that makes it stressful

Emotion focused coping

coping in which a person does not change anything about the situation itself, but instead tries to improve feelings about the situation

Daily Hassles

relatively minor events that can add up and cause significant stress that can impair mental health

Type A behavior pattern

a pattern of behaviors that include being hard-driving, competitive, impatient, cynical and suspicious, easily irritated, and hostile toward others

Type D Personality

people who experience emotions that include anxiety, irritation, and depressed mood

Both type A and type D are considered to what?

alter one's mental health

The DSM-5 includes several changes to what?

-better represent the symptoms and behaviors of patients feeding and eating disorders and among the most substantial changes are recognition of binge eating disorder, revisions to the diagnostic criteria for anorexia nervosa and bulimia nervosa, and inclusion of pica, rumination, and avoidant/restrictive food intake disorder

-listed the latter three among Disorders Usually First Diagnosed in Infancy, Childhood, or Adolescence, a chapter that does not exist in DSM-5

The Eating Disorders Work Group intended for DSM-5 changes to minimize what?

-use of the catch-all diagnoses of Other Specified Feeding and Eating Disorder and Unspecified Feeding and Eating Disorder

-a primary goal was for more people experiencing eating disorders to have a diagnosis that accurately describes their symptoms and behaviors

-determining an accurate diagnosis is a first step for clinicians and patients in defining a treatment plan

Eating Disorders

-persistent disturbances of eating or eating related behavior that result in changes in consumption or absorption of food

-eating behavior significantly impair the individual's physical and psychosocial functioning

Feeding Disorders

-characterized by extreme food selectivity (beyond pickiness)

-while eating disorders are not really about issues with the food, but rather a coping mechanism gone wrong, feeding disorders actually are more often the direct result of food preferences or perceived intolerances

Body dysmorphia and related behaviors, such as negative body talk, body-checking, or frequent weighing, are common with eating disorders even though they are not assocoated with what?

-not associated with feeding disorders since the use of compensatory behaviors, including self-induced vomiting or laxative abuse, is also only found in cases of eating disorders

-despite the distinct differences between the two, feeding and eating disorders can co-occur

Anorexia Nervosa (NA)

-an eating disorder characterized by an inability to maintain normal weight, an intense fear of gaining weight, and distorted body perception

-results in serious health changes

-weak and brittle bones, muscles, hair and nails, low blood pressure, slowed breathing and pulse, lethargic, sluggish, and fatigued

-eventually organ failure

Bulimia Nervosa

-eating disorder involving alternation between the extremes of eating large amounts of food in a short time and then compensating for the added calories either by vomiting or other extreme actions to avoid gaining weight

-must binge and purge once per week

Binge eating

eat an excessive amount of food during a short period

Purging

inappropriate methods of compensating for added calories such as vomiting, laxatives, diuretics, or other medications, fasting or excessive exercise

Binge Eating Disorder

-the ingestion of large amounts of food during a short period of time, even when full and a lack of control over what or how much is eaten

-must engage in binges at least twice a week for 6 months

-must involve large food intake, past the point of full, eating while alone, feeling guilt or self-disgust after

-usually significantly overweight

-no purging

According to the DSM-5, the category of other specified feeding or eating disorder (OSFED) is applicable to who?

individuals who are experiencing significant distress due to symptoms that are similar to disorders such as anorexia, bulimia, and binge-eating disorder, but who do not meet the full criteria for a diagnosis

Perspectives of eating disorders include...

-biopsychosocial perspective believed to be a genetic vulnerability combined with experiences with eating, body image, and exposure to sociocultural influences

-biological was studying the role of dopamine

-psychological says binge eaters feel relief from depression and anxiety

-social says social activities usually paired with food

Avoidant/restrictive food intake disorder

-a disorder in which individuals avoid eating out of concern about aversive consequences or restrict intake of food with specific sensory characteristics

-a new diagnosis in the DSM-5, previously referred to as "Selective Eating Disorder"

-show an apparent lack of interest or concern in eating or food and as a result, lose a significant amount of weight, nutritional deficiency, and may become dependent on feeding tubes or oral nutritional supplements

-this disorder is unique from AN and BN because there is no concern about physical appearance

Pica

a condition in which a person eats inedible substances such as dirt or feces, commonly associated with developmental disabilities

Rumination disorder

eating disorder in which the infant or child regurgitates food after it has been swallowed and then either spits it out or re-swallows it

Other Specified Feeding or Eating Disorder (OSFED)

-applicable to individuals who are experiencing significant distress due to symptoms that are similar to disorders such as anorexia, bulimia, and binge-eating disorder, but who do not meet the full criteria for a diagnosis

-purging disorder - the individual engages in purging behaviors such as self-induced vomiting or laxative misuse, but they do not experience eating binges

-night eating syndrome the individual experiences recurring episodes of eating after awakening at night, or of eating excessively after their evening meal → these episodes cause significant distress or impaired functioning

Elimination Disorders

characterized by age-inappropriate incontinence beginning in childhood

Enuresis

elimination disorder in which the individual is incontinent of urine and urinates on clothes or in bed after the age of 5

Encopresis

elimination disorder where the individual is incontinent of feces and has bowel movements in clothes or in other inappropriate places at age 4 or above

Insomnia

-a common sleep disorder

-you may have trouble falling asleep, staying asleep, or getting good quality sleep

-this happens even if you have the time and the right environment to sleep well

-types of insomnia include onset insomnia (trouble falling asleep), maintenance insomnia (trouble staying asleep), and behavioral insomnia of childhood

-the insomnia may be acute or chronic

The fifth edition of the APA's DSM-5 included a new chapter, not in the previous chapters, on what?

-disruptive, impulse control, and conduct disorders covering disorders "characterized by problems in emotional and behavioral self-control"

-these are a group of disorders that are linked by varying difficulties in controlling aggressive behaviors, self-control, and impulses

-typically, the resulting behaviors or actions are considered a threat primarily to others' safety and/or to societal norms

Impulse-control disorders

-repeatedly engage in behaviors that are harmful and feel they cannot control

-experience tension and anxiety until they follow their impulses and feel a sense of pleasure or gratification, although later may have regrets

-having a sudden impulse or desire to do something is a trait that most people share

-those with impulse control disorders find it extremely difficult or impossible to regulate their impulses or desires

Oppositional defiant disorder

-impulse control disorder characterized by angry or irritable mood, argumentative or defiant behavior, and vindictiveness that results in significant family or school problems

-symptoms begin between ages 5 and 10, usually evident between ages 8 and 12

-around 2-11% of children in the United States have this disorder, and it is more common in preadolescent males than females

-involves a long-lasting pattern of defiance, disobedience, and hostility toward parents, teachers, and other authority figures

Some of the most common signs and symptoms of oppositional defiant disorder are...

-frequent temper tantrums

-irritability, anger, argumentativeness, vindictiveness

-refusal to obey adults' rules or follow directions

-difficulty making and keeping friends

-frequently getting in trouble at school

Treatment for oppositional defiant disorder includes...

-behavioral, cognitive, and social learning approaches

-focus on reinforcement, behavioral contracting, modeling, and relaxation training

Conduct disorder

-impulse control disorder that involves repeated violations of the rights of others and society's norms and laws

-delinquent behaviors including aggressiveness to people and animals

-onset after adolescence

-around 2-10% of children and teens in the U.S. have this disorder

-people with this condition are also more likely to have attention deficit hyperactivity disorder (ADHD), mood disorders, and developmental disorders