chapter 7 psychological disorders

Maladaptive behavior

Behavior that negatively impacts others or leads to self-defeating outcomes

Biomedical therapy

Intervention focused on symptom reduction of psychological disorders (e.g., medication)

Biopsychosocial approach

Assumes biological, psychological, AND social components all contribute to a disorder

Direct therapy (biopsychosocial)

Treatment that acts directly on the individual — medication, psychotherapy

Indirect therapy (biopsychosocial)

Increasing social support by educating and empowering family and friends of the individual

Positive symptoms (psychosis)

Behaviors, thoughts, or feelings ADDED to normal behavior (e.g., hallucinations, delusions)

Negative symptoms (psychosis)

ABSENCE of normal or desired behavior (e.g., flat affect, avolition)

Delusion

A false belief discordant with reality and not shared by others in the individual's culture

Delusion of reference

Belief that common environmental elements are directed at the individual (e.g., TV characters are speaking to them)

Delusion of persecution

Belief that one is being deliberately plotted against, discriminated against, or threatened

Delusion of grandeur

Belief that one is remarkably important — an inventor, historical figure, or religious icon

Thought broadcasting

Belief that one's thoughts are being transmitted to the world

Thought withdrawal

Belief that thoughts are being removed from one's mind

Thought insertion

Belief that thoughts are being placed into one's head by an outside force

Hallucination

A perception that feels real but is not caused by external stimuli

Disorganized thought

Loosening of associations; examples include word salad and neologisms (made-up words)

Disorganized behavior

Inability to carry out activities of daily living (hygiene, bills, appointments)

Catatonia

Abnormal motor behaviors; includes echolalia (repeating others' words) and echopraxia (imitating others' actions)

Avolition

Decreased engagement in purposeful, goal-directed activities (negative symptom)

Blunting vs. emotional flattening

Blunting = severe reduction in emotional expression intensity; Flattening = NO sign of emotional expression

Inappropriate affect

Emotional expression that is discordant with the situation (e.g., laughing at a parent's death)

Schizophrenia phases

'PAR' → Prodromal (deterioration), Active (psychosis), Residual (recovery)

Schizophrenia — prodromal phase

Social withdrawal, role dysfunction, peculiar behavior, inappropriate affect, unusual experiences — clear deterioration before active psychosis

Schizophrenia — active phase

Pronounced psychotic symptoms are present; slow onset = harder to diagnose and worse prognosis

Schizophrenia — residual/recovery phase

After active episode; mental clarity returns, often accompanied by depression as individual becomes aware of prior behavior

Schizophrenia neurobiology

Associated with high dopaminergic transmission; also linked to genetic factors, birth trauma, adolescent marijuana use

Schizotypal personality disorder

Personality disorder WITH psychotic-like symptoms (ideas of reference, magical thinking, eccentricity)

Delusional disorder

Psychotic symptoms LIMITED to delusions, present for at least 1 month

Brief psychotic disorder

Positive psychotic symptoms present for at least 1 DAY but less than 1 MONTH

Schizophreniform disorder

Same criteria as schizophrenia but duration of only 1–6 MONTHS (not the full 6+ months required for schizophrenia)

Schizoaffective disorder

Major mood episodes (depression or mania) occurring alongside psychotic symptoms

9 depressive symptoms

Sadness + SIG E CAPS → Sleep, Interest (anhedonia), Guilt, Energy, Concentration, Appetite, Psychomotor changes, Suicidal thoughts

Major depressive disorder (MDD)

5 of 9 depressive symptoms for at least 2 weeks; must include depressed mood OR anhedonia

Persistent depressive disorder (PDD)

Depressed mood on the majority of days for at least 2 YEARS

Disruptive mood dysregulation disorder

Diagnosed ages 6–10; persistent, recurrent irritability across multiple environments

Premenstrual dysphoric disorder

Mood changes and depressed mood occurring days before menses, resolving after menses begins

Postpartum depression

Depression triggered by rapid hormonal changes following childbirth

Neurobiology of depression

Low norepinephrine, serotonin, and dopamine; HIGH glucocorticoids

7 manic symptoms

DIG FAST → Distractibility, Irresponsibility, Grandiosity, Flight of thoughts, Activity/agitation, Sleep (decreased need), Talkative

Bipolar I disorder

Defined by the presence of at least one MANIC episode (may also have depressive episodes)

Bipolar II disorder

Presence of BOTH a major depressive episode AND a hypomanic episode (never full mania)

Cyclothymic disorder

Numerous periods of manic AND depressive symptoms for the majority of a 2-YEAR period (below threshold for full episodes)

Monoamine theory of bipolar/depression

Too much norepinephrine and serotonin → mania; too little → depression

Neurobiology of bipolar disorder

High norepinephrine and serotonin; highly heritable

Anxiety

Fear of an upcoming or future event

Anxiety disorder

Irrational or excessive fear/anxiety that impairs daily functioning

Selective mutism

Consistent inability to speak in situations where speaking is expected

Panic disorder

Recurrent, intense panic attacks with overwhelming fear and sympathetic activation — no clear trigger

Agoraphobia

Fear of places or situations where escape is difficult

Generalized anxiety disorder (GAD)

Disproportionate, persistent worry about many things for at least 6 months

Obsessive-compulsive disorder (OCD)

Obsessions (intrusive, persistent thoughts) AND compulsions (repetitive behaviors that relieve tension but impair functioning)

Body dysmorphic disorder

Unrealistic negative evaluation of one's appearance or a specific body part

PTSD — 4 symptom clusters

1. Intrusion (flashbacks, nightmares) 2. Avoidance (avoiding trauma reminders) 3. Negative cognition (amnesia, negative mood) 4. Arousal (startle response, irritability)

Dissociative amnesia

Inability to recall important autobiographical information, usually trauma-related

Dissociative identity disorder (DID)

Two or more distinct personalities that alternately take control of a person's behavior

Depersonalization/derealization disorder

Feelings of detachment from one's own mind/body OR from the surrounding environment

Somatic symptom disorder

At least one somatic symptom (linked or not to a medical condition) causing disproportionate concern

Illness anxiety disorder

Preoccupation with having or developing a serious medical illness, despite little or no symptoms

Conversion disorder

Unexplained neurological symptoms affecting motor or sensory function; associated with prior psychological trauma

Personality disorder (PD) — definition

Inflexible, maladaptive patterns of behavior causing distress or dysfunction in ≥2 of: cognition, emotion, interpersonal functioning, or impulse control

Cluster A PDs (memory trick)

'Weird' — Paranoid, Schizotypal, Schizoid. Think: 'A = Awkward/Odd/Eccentric'

Cluster B PDs

'Wild' — Antisocial, Borderline, Histrionic, Narcissistic. Think: 'B = Bad/Dramatic/Emotional'

Cluster C PDs

'Worried' — Avoidant, Dependent, Obsessive-compulsive PD. Think: 'C = Cautious/Anxious/Fearful'

Paranoid PD

Pervasive distrust and suspicion of others

Schizotypal PD

Ideas of reference, magical thinking, and eccentricity — but not full psychosis

Schizoid PD

Detachment from social relationships and very limited emotional expression

Antisocial PD

Persistent disregard for the rights of others; deceitfulness and lack of remorse

Borderline PD

Instability in relationships, mood, and self-image; characteristic splitting; recurrent suicidal behavior

Histrionic PD

Constant attention-seeking behavior; excessive emotionality

Narcissistic PD

Grandiose sense of self-importance and excessive need for admiration

Avoidant PD

Extreme shyness and intense fear of rejection — desires relationships but avoids them

Dependent PD

Continuous need for reassurance and submission to others

Obsessive-compulsive PD (OCPD)

Perfectionism, inflexibility, and preoccupation with rules and order — distinct from OCD (no true obsessions/compulsions)

Alzheimer's disease — pathology

Brain atrophy; decreased acetylcholine; senile plaques of β-amyloid; neurofibrillary tangles of hyperphosphorylated tau protein; genetic factors

Parkinson's disease — pathology

Loss of dopamine-producing cells in the substantia nigra → impaired basal ganglia function

Parkinson's disease — motor symptoms

Bradykinesia (slow movement), resting tremor, pill-rolling tremor, masklike facies, cogwheel rigidity, shuffling gait with stooped posture

Bradykinesia

Abnormally slow movement; cardinal feature of Parkinson's disease

Resting tremor

Tremor present when the muscle is NOT in use; hallmark of Parkinson's disease

Cogwheel rigidity

Muscle tension that suddenly gives way in a ratchet-like pattern; seen in Parkinson's disease