Psych disorder exam 2

Somatic Symptom Disorders (genre)

Preoccupation with health and/or body appearance and functioning, no identifiable medical condition causing the physical complaints

Somatic symptom Disorder

Presence of one or more medically unexplained symptoms, substantial impairment in social or occupational functioning, concern about the symptoms, in severe cases symptoms become the person’s identity. Relatively rare condition, onset in adolescence, more likely to affect unmarried, low SES women, runs a chronic course

Somatic symptom disorders causes

little is known: familial history of illness, stressful life events, sensitivity to physical sensations, experience suggesting that there are benefits to illness

Somatic symptom disorder treatment

CBT is the best treatment, reduce the tendency to visit numerous medical specialists “doctor shopping”, assign “gatekeeper” physician, reduce supportive consequences of talk about physical symptoms

Illness Anxiety Disorder Clinical description

physical complaints without a clear cause, severe anxiety about the possibility of having a serious disease, strong disease conviction, medical reassurance does not seem to help. 1%-5% prevalence, onset at any age, sex ratio equal, runs a chronic course.

Illness anxiety disorder causes

cognitive perceptual distortions, familial history of illness

Illness anxiety disorder treatment

Challenge illness-related misinterpretations, provide more substantial and sensitive reassurance and education, stress management and coping strategies, CBT is generally effective, antidepressants offer some help

Dissociation

Involve severe alterations or detachments from reality, affect identity, memory, or consciousness.

Depersonalization

distortion in perception of one’s own body experience (ex feeling like you own body isn’t ready)

Derealization

losing a sense of the external world (sense of living in a dream)

Depersonalization/Derealization Disorder overview

Recurrent episodes in which a person has sensations of unreality of one’s own body or surroundings, feelings dominate and interfere with life functioning, Only diagnosed if primary problem involves depersonalization and derealization (similar symptoms may occur in the context of other disorders, including panic disorder and PTSD)

Depersonalization/ Derealization Disorder Facts and statistics

High comorbidity with anxiety and mood disorders, 1-2% of the population, onset is typically in adolescence, usually runs a lifelong chronic course, having a history of trauma makes this disorder more likely to manifest

Depersonalization/ Derealization Disorder Causes and Treatment

Risk factors: cognitive deficits in attention, short-term memory, spatial reasoning; deficits related to tunnel vision and mind emptiness; such persons are easily distracted. Treatment: little is known due to limited research

Dissociative Amnesia Overview

Includes several forms of psychogenic memory loss, generalized vs localized or selective type, may involve dissociative fugue. During the episode, person travels or wanders, unable to remember how or why one has ended up in a new place. Statistics: usually begin in adulthood, show rapid onset and dissipation

Dissociative Amnesia and Fugue Causes and Treatment

Little is known, trauma and stress can serve as triggers. Treatment: most get better without treatment, most remember what they have forgotten

Dissociative Trance Disorder Overview

Symptoms resemble other dissociative disorders, dissociative symptoms and sudden changes in personality, changes often attributed to possession by a spirit, Only considered a disorder if leads to distress or impairment

Dissociative Trance Disorder Causes and treatment

Often attributable to a life stressor or trauma. Treatment : little is known, May need to address stressor/trauma

Dissociative Identity Disorder (DID) Overview

Defining feature is dissociation of personality, adoption of several new identities (as many as 100; may be just a few; average is 15), identities display unique behaviors, voice, and postures

DID statistics

Ratio of females to males is high (9:1), onset is almost always in childhood or adolescence, high comorbidity rates & lifelong, chronic course, more common that previously thought: 3%-6%

DID causes

typically linked to a history of severe, chronic trauma, often abuse in childhood; closely related to PTSD, possibly an extreme subtype; mechanism to escape from the impact of trauma; biological vulnerability possible

DID treatment

Focus is on reintegration of identities, identify and neutralize cues/triggers that provoke memories of trauma/dissociation, patient may have to relive and confront the early trauma

Major depressive episode

Extremely depressed mood and/or loss of pleasure: lasts most of the day, nearly every day for at least two weeks; At least 4 additional physical or cognitive symptoms (ex indecisiveness, feelings of worthlessness, fatigue, appetite change, restlessness or feeling slowed down, sleep disturbance)

Manic episode

Elevated, expansive mood for at least one week; inflated self-esteem, decreased need for sleep, excessive talkativeness, flight of ideas or sense that thoughts are racing, easy distractibility, increase in goal-directed activity or psychomotor agitation, excessive involvement in pleasurable but risky behaviors; impairment in normal functioning

Hypomanic episode

Shorter, less severe version of manic episodes; last at least four days; have fewer and milder symptoms; associated with less impairment than a manic episode (ex less risky behavior); may not be problematic in and of itself, but usually occurs in the context of a more problematic mood disorder

Bipolar 1 Disorder

Alternations between full manic episodes and major depressive episodes. Statistics: average age of onset is 15-18 years, can begin in childhood, tends to be chronic, suicide is a common consequence

Bipolar 2 disorder

Alternations between major depressive and hypomanic episodes. Statistics: average age of onset is 19-22, can begin in childhood, 10%-25% of cases progress to full bipolar 1 disorder, tends to be chronic

Cyclothymic disorder

Chronic version of bipolar disorder, alternating between periods of mild depressive symptoms and mild hypomanic symptoms (episodes do not meet criteria for full major depressive episode, full hypomanic episode or full manic episode); hypomanic or depressive mood states may persist for long periods; must last for at least two years (one year for children and adolescents)

Sleep Disturbance

hallmark of most mood disorders, depressed patients have quicker and more intense REM sleep, sleep deprivation may temporarily improve depressive symptoms in bipolar patients

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Arbitrary inference

cognitive error of depression, overemphasize the negative aspects of a mixed situation. Ex: Professor sees several students asleep during class during class and infers “I must be a bad teacher”

Overgeneralization

cognitive error of depression: negatives apply to all situations. Ex: Professor makes one critical remark on your paper, and you assume you will fail the course

Depressive cognitive triad

Think negatively about oneself, think negatively about the world, think negatively about the future

Cortisol

stress hormones decrease neurogenesis in the hippocampus > less able to make new neurons

Operant conditioning in pain

Social reinforcement for pain behaviors

General Adaptation Syndrome (GAS)

Phase 1: alarm response (sympathetic arousal)

Phase 2: resistance (mobilized coping and action)

Phase 3: exhaustion (chronic stress, permanent damage)

Behavioral medicine

application of behavioral science to preventing, diagnosing and treating medical problems

Lifestyle practices

Core of many health problems; Injury and injury prevention, AIDS prevention (highly preventable by changing behaviors); diet, exercise, promotion of health and wellness

Obesity

considered a symptom of some eating disorders but not a disorder in and of itself; considered BMI of 30+; increasing more rabidly in children/teens; also growing rapidly in developing countries

Obesity causes

is related to technological advancement; genetics account for about 30% of cases; biological and psychosocial factors contribute as well

Cognitive-behavioral therapy in health psychology

identifying maladaptive thinking patterns and behavioral habits, then gradual practice of new habits

Gate control theory

impulses from painful experience travel up spine and through the dorsal horns of the spinal column (“gate”); regulated by nerve fibers opening/closing the gate; explains why we rub our head/elbow after hitting it

Health psychology

one part of behavioral medicine. Studies psychological factors that promote and maintain good health

Type A personality and increased risk

High blood pressure, anger and negative affect, impatience, accelerated speech and motor activity

Alcohol and Sleep

 help fall asleep, not restful sleep, does not improve sleep it worsens it

Major Depressive Disorder overview

One or more major depressive episodes separated by periods of remission; single episode - highly unusual; recurrent episodes- more common

Binge Eating Disorder overview

New disorder in DSM-5; binge eating without associated compensatory behaviors; associated with distress and/or functional impairment; 

Binge Eating Disorder Treatment

Previously used medications for obesity are now not recommended; psychological treatment: CBT , interpersonal psychotherapy, self-help techniques

Bulimia Overview

Binge eating: hallmark of this; eating excess amounts of food in a discrete period of time; eating is perceived as uncontrollable; may be associated with guilt, shame or regret; may hide behavior from family members; food consumed are often high in sugar, fat or carbs

Compensatory behaviors: designed to “make up for” binge eating ; most common: purging (vomiting, diuretics, laxatives), excessive exercise, fasting or food restriction 

Overly concerned with body shape

Bulimia Causes

Media and cultural: media portrayals: thinness linked to success, happiness; cultural emphasis on dieting; standards of ideal body size

Biological: partial genetic component; deficits in serotonin may contribute to bingeing 

Psych and behavior: low sense of personal control, perfectionistic attitudes, distorted body image, preoccupation with food, mood i

Bulimia Treatment

Psychosocial treatments: CBT

Medical and drug:

Antidepressants (can help reduce binging and purging), usually not efficacious in the long term

Insomnia overview

Most common sleep disorder; microsleeps: after being awake for 40 hours, people tend to sleep for a few seconds at a time; problems initiating/maintaining sleep (trouble falling asleep, waking during night) 35% of adults report daytime sleepiness, only diagnosed if not better explained by something different

Insomnia treatment

Benzodiazepines and over-the-counter sleep medicines; prolonged use: can cause dependence and rebound insomnia; best short-term solution 

Psych: CBT for insomnia: psychoeducation about sleep, changing beliefs about sleep, extensive monitoring using sleep diary, practicing better sleep-related habits

Sleep Apnea overview

Stop breathing at night, wake up without realizing their awake. Report daytime sleepiness, headache in morning (from not getting enough oxygen)  

-People are not aware of problem, often snore, sweat during sleep, wake frequently

-morning headaches, may experience episodes of falling asleep during the day

Sleep Apnea causes

Breathing issues are caused by obstruction (tonsils, excess skin from being overweight) 

Could also be nervous system stops breathing (rare) 

Parasomnias

abnormal behavioral and physiological events during sleep

Recurrent episodes of: 

Sleep terrors: recurrent episodes of panic-like symptoms during non-REM sleep

Sleepwalking 

Individual has no memory of the episodes