Abnormal Psych Midterm

Fear

A state of immediate alarm in response to a recognized threat.

Anxiety

A vague sense of danger

Similarities and differences of Fear and Anxiety

Similarities: Same kind of sympathetic autonomic arousal

DIfferences: Immediacy and specificity of the stimulus

Generalized Anxiety Disorder (“The Worriers”) Symptoms

Excessive ongoing worry / anxiety for at least six months

Difficulty controlling worry

Significant Distress or impairment

Generalized Anxiety PHYSICAL SYMPTOMS

Restlessness

Easy Fatiguability

Difficulty Concentrating

Irritability

Muscle Tension

Sleep Disturbance

Treatments for Generalized Anxiety Disorder

Sedative-Hypnotic drugs

Antidepressants

Relaxation Training

Biofeedback

Phobia Symptoms

Marked, persistent fear lasting at least six months

Immediate anxiety to most exposures

Actively avoid or endured with intense fear or anxiety

Fear / Anxiety is out of proportion to actual danger

Persistent, lasting six months or more

Significant distress or impairment

Treatment of Phobias

Systematic Desensitization

Flooding 

Modeling and Participant Modeling

Virtual Reality

Agoraphobia Symptoms

Anxiety about being in places or situations from which escape might be difficult (or embarrassing), or in which help may be unavailable in the case of a panic attack

Situations are avoided or else endured with marked distress or anxiety about having a panic attack, or require a companion

Treatment for Agoraphobia

Exposure (with significant encouragement, support and reasoning)

Support Groups

Medical Treatment of associated panic attack

Social Anxiety Disorder (Previously Social Phobia) Symptoms

Marked fear or anxiety about one or more social situations during which the subject is exposed to the scrutiny of others

Individual fears they will act in a way or show anxiety symptoms that will be negatively evaluated

Almost always provokes fear or anxiety

Out of proportion to threat 

Last six months or more

Clinically significant distress

Treatment for Social Anxiety Disorder

Exposure Therapy

Cognitive Therapies

Medications (Benzodiazepines / Antidepressants)

Social Skills Training

Panic Attack Symptoms

Four of Thirteen appear suddenly and PEAK within ten minutes:

Palpitations

Sweating

Trembling

Shortness of Breath

Choking Sensation

Tightness of Chest / Chest Pain

Nausea / Abdominal Distress

DIzziness / Faintness / Lightheadedness

Hot and Cold flashes

Parethesias

Derealization / Depersonalization

Fear of Losing Control or Going crazy

Fear of Dying

One or more of the following for at least one month:

Persistent concern about having more panic attacks

Worry about the implications or consequences of the attacks

Treatment for Panic Disorders

SSRI’s (80 % effective)

Benzodiazepines

Obsessive-Compulsive Disorder and Related Disorders Symptoms

OBSESSION:

Persistent thoughts, ideas, impulses or images that are experienced repeatedly, feel intrusive and unwanted, and cause anxiety

Attempts to ignore or suppress such thoughts, urges or images, or neutralize them with some other thought or action.

COMPULSIONS:

Repetitive behaviors or mental acts that the individual feels driven to perform in response to an obsession or according to rules that must be adopted rigidly

Actions are aimed at reducing / preventing Anxiet

In general, Obsessions lead to Compulsions

True

Common Themes of Obsessions

Contamination (50%)

Pathological Doubt (42%)

Somatic (33%)

Orderliness (32%)

Violence (31%)

Sex (24%)

Multiple (72%)

Treatments for Obsessive-Compulsion Disorder

Short-term Psychodynamic Techniques (LITTLE SUPPORT)

Exposure and Response (ritual) prevention (NOT FOR OBSESSIONS)

Psychoeducation

Habituation Training

Combination Cognitive / Behavioral Treatments

SSRI’s

Psychosurgery (Cingulotomy)

Deep Brain Stimulation

Disorders RELATED to Obsessive-Compulsive Disorder

Body Dysmorphic Disorder

Hoarding Disorder

Hair-Pulling Disorder (Trichotillomania)

Skin-Picking Disorder (Excoriation Disorder)

Stressors

An event or condition that demands adaptation

Three Stages of Stress Response

Alarm Stage

Resistance Stage

Exhaustion Stage

Physical, Emotional and Cognitive Responses to Stressors

Physical:

Sympathetic Nervous System

HPA Axis Stimulation

Emotional:

Anxiety: State Anxiety (Acute) vs. Trait Anxiety (Chronic)

Cognitive:

Exaggerated assessment of threats

Distorted memories

Psychological Stress Disorder Symptoms

Trauma (Experiencing, Witnessing or Hearing from someone close)

Re-experiencing Symptoms

Avoidance symptoms

Negative Alteration in Cognition or Mood

Alterations in arousal and reactivity

Acute Stress Disorder Symptoms

Nine or more of Fourteen Symptoms across FIVE categories:

   Intrusion

   Negative Mood

   Dissociation

   Avoidance

   Arousal

(for AT LEAST two days but no more than four weeks)

Post-Traumatic Stress Disorder Symptoms / Categories

Re-Experiencing (One)

Avoidance (One)

Negative Alterations to Cognition and Mood (Two)

Marked Alterations in Arousal and Reactivity (Two)

(For AT LEAST four weeks)

Post-Traumatic Stress Disorder Symptoms (Re-Experiencing)

Recurrent, involuntary and distressing memories

Nightmares

Flashbacks

Psychological Arousal to reminders

Physiological distress to reminders

(ONE symptom)

Post-Traumatic Stress Disorder Symptoms (Avoidance)

Avoidance of memories, thoughts, or feelings

Avoidance of external reminders

(ONE symptom)

Post-Traumatic Stress Disorder Symptoms (Cognitive Change)

Dissociative Amnesia

Persistent and exaggerated beliefs of world, others, or self

Persistent, distorted cognitions about the cause and consequences of traumatic event

Post-Traumatic Stress Disorder Symptoms (Alteration in Arousal / Reactivity)

Irritability

Recklessness / Self-Destructive Behavior

Hypervigilance

Exaggerated Startle Response

Poor Concentration / Sleep

Treatments for Post-Traumatic Stress Disorder

Medication

Exposure Techniques

Insight Therapy

Family Therapy

Group Therapy

Psychological Debriefing* (Only IMMEDIATELY after trauma is experienced)

What is Identity?

The continuity of memory, and consistency of actions, values and goals integrated into personality

What is Dissociation?

The loss of integration of personality / The disruption of the experience of memory, identity, or consciousness

Dissociative Amnesia with Dissociative Fugue Symptoms

Forgetting personalities and memories of precious lives; May also include traveling for hours, days, or even year, and ends suddenly

Dissociative Identity Disorder (Multiple Personality) Symptoms

The development of Two or more personalities, each with unique thoughts, memories, behaviors and emotion.

What are the different relationship personalities of DID can have?

One-way Amnestic

Mutually Amnestic 

Mutually Cognizant 

Treatment of Dissociative Amnesia and Fugue

Psychodynamic Therapy

Hypnotic Therapy

Drug Therapy

Treatment of Dissociative Identity Disorder

Recognize the Disorder

Recover memories

Integrate the subpersonalities

Depersonalization-Derealization Disorder Symptoms

Persistent or recurring instances in which one’s mental functioning or body feels unreal or foreign.

What is doubling in Depersonalization-Derealization Disorder?

A sense of the mind floating above the body that may cause experiences of distortion or sensations

Unipolar Depression Symptoms

Patients only have depressive episodes

Bipolar Disorder Symptoms

Patients have BOTH manic and depressive episodes

Depressive Episode Symptoms

At least FIVE of the following over a two week period:

Depressive mood most of the day everyday

Markedly diminished interest or pleasure in almost all activities most of the day nearly everyday

Significant weight loss / gain, or decrease / increase in appetite everyday

Insomnia or Hypersomnia nearly everyday

Psychomotor agitation or retardation nearly everyday

Fatigue or loss of energy nearly everyday

Feelings of worthlessness or excessive guilt nearly everyday

Reduced ability to think or concentrate, or indecisiveness nearly everyday

Recurrent thoughts of death or suicide, a suicide attempt, or a specific plan to commit suicide

D-SIGECAPS meaning for Depressive Disorders

D - (Depression)

S - (Sleep)

I - (Interest)

G - (Guilt)

E - (Energy)

C - (Concentration)

A - (Apetite)

P - (Psychomotor)

S - (Suicide)

Depressive Disorder Symptoms

A depressive episode without any previous manic or hypomanic episodes

May be:

Recurrent

Seasonal

Postpartum

Melancholic

Typical

Atypical

“Double Depression”

Psychotic

Persistent Depressive Disorder Symptoms

Chronic Major Depressive Disorders

Dysthymia

Symptoms are present for TWO years, with no absence for more than TWO months at a time

Premenstrual Dysphoric Disorder

Significant Symptoms for the week prior to menses

Potential impacts to Emotions, Motivation, Behavior, Cognition and Physical Wellbeing

Manic Episodes DSM-V symptoms

Period of Abnormally or persistently elevated, expansive or irritable mood lasting AT LEAST one week

Persistent of at least THREE of the following:

Inflated Self-Esteem

Decreased Need for Sleep

More Talkative than usual or pressured speech

Flight of ideas or racing thoughts

Distractibility

Excessive involvement in pleasurable activities that have a high potential for painful consequences

Bipolar Disorder I Symptoms

May be rapid cycling

May be seasonal 

May be psychotic

Bipolar Disorder II Symptoms

Hypomania and Depression

Cyclomania Symptoms

Hypomania and Dysthymia

Last Two years or more