Psychopathology Exam 2 - Dr. Herman Rutgers

mood disorders

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

The two key moods involved in mood disorders

Euphoria and Dysphoria.

what is 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.

major depressive disorder

A disorder in which the individual experiences intense but time limited episodes of depressive symptoms.
- an affected person must experience dysphoria for most of the day, nearly every day for at least 2 consecutive weeks.
- Recurrent major depressive disorder with two or more episodes within an interval of at least 2 consecutive months.

major depressive episodes

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

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.

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.

The learned helplessness model of depression

when perceived lack of control is present, helplessness may result in 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.
- Two main categories of Bipolar disorder: Bipolar I and Bipolar II
- 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.

Bipolar I

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

Bipolar II

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

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.

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.

Depression Symptoms

- Feel 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

- Have 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

suicidal continuum

1. Suicidal ideation: thinking about ending one's life
2. Developing a plan
3. Suicide attempt: nonfatal suicidal behavior
4. Suicide: actual ending of one's life

Positive psychology: Resilience

- Risk for suicide but unlikely when high in resilience.
- Resilience is a psychological construct: a belief you can overcome diversity, good coping skills.

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.

Dissociative Amnesia

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

Fugue state

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 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.

Illness anxiety disorder

a somatic symptom disorder characterized by the misinterpretation of normal bodily functions as signs of serious illness. Does not involve actual physical symptoms.

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.

Conditions related to Somatic Symptom Disorder

- Malingering
- Fictitious disorder imposed on self
- fictitious disorder imposed on another

Malingering

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

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).

Malingering gain

- want direct benefit or reward.
- Primary gain: the relief from anxiety or responsibility due to the development of physical or psychological symptoms. Direct benefits occupying the sick role. (disability, lawsuit, insurance benefits, time off from work)

Factititous disorder gain

- faking or exaggerating symptoms for secondary gains.
- Secondary gain: sympathy and attention that a sick person receives from other people. Motives are internally driven, not externally.

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

- Stress: the unpleasant emotional reaction that a person has when an event is perceived as threatening.
- Research says 80% of "stressors" are not actually stress.

stressful life event

an event that disrupts the individual's life.

Coping

the process through which people reduce stress in a healthy manner.

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.

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.
- Body dysmorphia and related behaviors, such as negative body talk, body-checking, or frequent weighing, are common with eating disorders, though not associated with feeding disorders.

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.

Anorexia Nervosa (NA)

- An eating disorder characterized by an inability to maintain normal weight, an intense fear of gaining weight and distorted body perception.
- Distorted body perception commonly comes from magazines and parents.
- 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.

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.

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: Purging disorder

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

Other Specified Feeding or Eating Disorder: 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.

Sleep-Wake Disorders

- Insomnia is a common sleep disorder. With insomnia, 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.

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.

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 &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.

Conduct disorder

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

Intermittent explosive disorder

an impulse control disorder involving an inability to hold back urges to express strong angry feelings and associated violent behaviors.

Kleptomania

an impulse-control disorder that involves the persistent urge to steal. The condition can present at any age.

Pyromania

an impulse-control disorder involving the persistent and compelling urge to start fires. (Not Arson) More common in teenagers and adult males.