MCAT Behavioral Science - Psychological Disorders

505

maladaptive

some aspect of the individual’s behavior negatively impacts others or leads to self-defeating outcomes

biomedical approach

assumes that any disorder has roots in biomedical disturbances, and emphasizes interventions that rally around symptom reduction of psychological disorders

biopsychosocial approach

assumes that there are biological (e.g. genetic), psychological (e.g. thoughts, emotions, behaviors), and social (e.g. surroundings, SES, social interactions, discrimination) components to an individual’s disorder

direct therapy

treatment that acts directly on the individual, such as medication or periodic meetings with a psychologist

indirect therapy

aims to increase social support by educating and empowering family and friends of the affected individual

Diagnostic and Statistical Manual of Mental Disorders (DSM)

manual written to collect statistical data on mental disorders in the United States; now used as a diagnostic tool based on descriptions of symptoms; currently in its fifth edition, which was published in May 2013 (DSM-5)

psychotic disorder

one or more of the following symptoms:

• delusions

• hallucinations

• disorganized thought

• disorganized behavior

• catatonia

  • negative symptoms

Positive symptoms

behaviors, thoughts, or feelings added to normal behavior; not present in the general population

ex. delusions and hallucinations, disorganized thought, disorganized or catatonic behavior.

psychotic dimension

delusions and hallucinations

disorganized dimension

disorganized thought and behavior

Negative symptoms

the absence of normal or desired behavior

ex. disturbance of affect and avolition

Delusions

false beliefs discordant with reality and not shared by others in the individual’s culture; maintained often in spite of strong evidence to the contrary

ex. reference, persecution, and grandeur

Delusions of reference

belief that common elements in the environment are directed toward the individual

ex. characters in a TV show are talking to them directly

Delusions of persecution

the belief that the person is being deliberately interfered with, discriminated against, plotted against, or threatened

ex. gangstalking

Delusions of grandeur

the belief that the person is remarkable in some significant way; also common in bipolar I

ex. inventor, historical figure, or religious icon

thought broadcasting

belief that one’s thoughts are broadcast directly from one’s head to the external world

thought withdrawal

belief that thoughts are being removed from one’s head

thought insertion

belief that thoughts are being placed in one’s head

Hallucinations

perceptions that are not due to external stimuli but which nevertheless seem real to the person perceiving them

ex. most commonly auditory, including voices; visual and tactile may be seen in drug use/withdrawal

Disorganized thought

characterized by loosening of associations; may be exhibited as speech in which ideas shift from one subject to another in such a way that a listener would be unable to follow the train of thought

word salad

speech may be so disorganized that it seems to have no structure as though it were just words thrown together incomprehensibly

neologisms

new imvented words in disorganized speech; symptom of schizophrenia

Disorganized behavior

inability to carry out activities of daily living, such as paying bills, maintaining hygiene, and keeping appointments

Catatonia

certain motor behaviors characteristic of schizophrenia

ex. reduced spontaneous movement and activity, rigid posture, useless and bizarre movements not caused by any external stimuli

echolalia

repeating another’s words

echopraxia

imitating another’s actions

Affect

experience and display of emotion

blunting

severe reduction in the intensity of affect expression

emotional flattening (flat affect)

virtually no signs of emotional expression

inappropriate affect

affect is clearly discordant with the content of the individual’s speech

ex. laugh hysterically while describing a parent’s death

avolition

marked by decreased engagement in purposeful, goal-directed actions

Schizophrenia

characterized by a break between an individual and reality; diagnosed by continuous signs of the disturbance for at least six months, which must include at least one month of positive symptoms (delusions, hallucinations, or disorganized speech)

somewhat genetic - first degree relatives increases risk 10x; related to hypoxemia at birth and marijuana use during adolescence

associated with excess dopamine

downward drift hypothesis

schizophrenia causes a decline in socioeconomic status, leading to worsening symptoms, which sets up a negative spiral for the patient toward poverty and psychosis; explains why rates of schizophrenia are much, much higher among homeless and indigent people

prodromal phase.

a phase characterized by poor adjustment before schizophrenia diagnosis; exemplified by clear evidence of deterioration, social withdrawal, role functioning impairment, peculiar behavior, inappropriate affect, and unusual experiences

active phase

a phase in schizophrenia development in which pronounced psychotic symptoms are displayed

residual/recovery phase

phase of schizophrenia that occurs after an active episode and is characterized by mental clarity often resulting in concern or depression as the individual becomes aware of previous behavior

Delusion Disorder

Psychotic symptoms are limited to delusions and are present for at least a month

Brief Psychotic Disorder

Positive psychotic symptoms are present for at least a day, but less than a month

Schizophreniform Disorder

Same diagnostic criteria as schizophrenia except the required duration for this diagnosis is only 1 month

Schizoaffective Disorder

Major mood episodes (major depressive episodes and manic episodes) while also presenting psychotic symptoms

Depressive disorders

conditions characterized by feelings of sadness that are severe enough, in both magnitude and duration, to meet specific diagnostic criteria

Abnormally high glucose metabolism in the amygdala, Hippocampal atrophy after a long duration of illness, Abnormally high levels of glucocorticoids (cortisol), Decreased norepinephrine, serotonin, and dopamine

depressive symptoms

• Depressed mood, feelings of sadness and emptiness

• Insomnia or hypersomnia

• Anhedonia

• Inappropriate feeelings of guilt or worthlessness

• Lower levels of energy throughout the day

• Decrease in ability to concentrate (self described, or observed by others)

• Pronounced change in appetite (increase or decrease) resulting in a significant change (5%+) in weight.

• Psychomotor retardation (slowed thoughts and physical movements) and psychomotor agitation (restlessness resulting in undesired movement)

  • Recurrent suicidal thoughts

anhedonia

Loss of interest and pleasure in activities that previously sparked joy

major depressive disorder (MDD)

presence of major depressive episodes, can be codiagnosed with PDD

major depressive episode

a 2-week (or longer) period in which 5 of the 9 defined depressive symptoms are encountered, which must include either depressed mood or anhedonia

persistent depressive disorder (PDD)/dysthymia

when an individual experiences a period, lasting at least 2 years, in which they experience a depressed mood on the majority of days; can be codiagnosed with MDD

selective serotonin reuptake inhibitors (SSRIs)

most common first-line treatment for depression; block the reuptake of serotonin by the presynaptic neuron, resulting in higher levels of serotonin in the synapse and relief of symptoms

disruptive mood dysregulation disorder

diagnosed between the ages of 6 and 10, and has the key diagnostic feature of persistent and recurrent emotional irritability in multiple environments, beyond what is considered normal for children

Premenstrual dysphoric disorder

characterized by mood changes, often depressed mood, occurring a few days before menses and resolving after menses onset

seasonal affective disorder (SAD)

dark winter months are believed to be the source of depressive symptoms; best categorized as major depressive disorder with seasonal onset; symptoms are present only in the winter months; may be related to abnormal melatonin metabolism

postpartum depression

the rapid change in hormone levels just after giving birth is the cause of the depressive symptoms

bright light therapy

treatment for SAD where the patient is exposed to a bright light for a specified amount of time each day

Manic symptoms

associated with an exaggerated elevation in mood, accompanied by an increase in goal-directed activity and energy; prolonged and exaggerated emotion of happiness or joy

• Distractibility: Inability to remain focused on an activity

• Irresponsibility: Engaging in risky activities without considering future consequences

• Grandiosity: Exaggerated and unrealistic increase in self-esteem

• Flight of thoughts: Racing thoughts, self-reported or revealed through rapid speech

• Activity or agitation: Increase in goal-oriented work or social activities

• Sleep: Decreased need for sleep, e.g. sleeping for only a couple hours but feeling rested

• Talkative: Exaggerated desire to speak

hypomanic episode

manic symptoms are present for at least 4 days and include at least 3 or more of the 7 defined manic symptoms, yet the symptoms are not severe enough to impair the person’s social or work activities

manic episode

manic symptoms, 3 or more of the defined 7, are severe enough to impair a person’s social or work activities and persist for at least 7 days

bipolar I disorder

key diagnostic feature of this disorder is the presence of manic episodes; do not require depressive symptoms

Increased norepinephrine and serotonin (monoamine theory); Higher risk if parent has bipolar disorder; Higher risk for persons with multiple sclerosis

bipolar II disorder

presence of both a major depressive episode and an accompanying hypomanic episode, but not a manic episode

Increased norepinephrine and serotonin (monoamine theory); Higher risk if parent has bipolar disorder; Higher risk for persons with multiple sclerosis

cyclothymic disorder

numerous periods of manic and depressive symptoms for the majority of time over a 2-year (or longer) period; yet never experienced 3 or more of the 7 manic symptoms in a 4 day period (diagnostic criteria for hypomanic episode) and has never experienced 5 or more of the 9 depressive symptoms in a 2-week period (diagnostic criteria for a major depressive episode).

monoamine/catecholamine theory of depression

too much norepinephrine and serotonin in the synapse leads to mania, while too little leads to depression; oversimplification

anxiety

fear of an upcoming or future event

anxiety disorder

irrational and excessive fear or anxiety affects an individual’s daily functioning

clinicians must rule out hyperthyroidism because increasing the whole body’s metabolic rate will create anxiety-like symptoms

phobia

irrational fear of something that results in a compelling desire to avoid it

specific phobia

fear and anxiety are produced by a specific object or situation; lack a specific ideation or thought pattern and instead present as an immediate and irrational fear response to the specific object or situation

claustrophobia

irrational fear of closed places

acrophobia

irrational fear of heights

arachnophobia

irrational fear of spiders

separation anxiety disorder

excessive fear of being separated from one’s caregivers or home environment, persisting beyond the age where it is deemed developmentally appropriate; accompanied by the ideation that when separated, the caregiver or the individual themselves will be harmed; may result in avoidant behaviors such as refusal to leave the home, shadowing the caregiver, etc.

social anxiety disorder

fear or anxiety towards social situations with the belief that the individual will be exposed, embarrassed, or simply negatively perceived by others; avoidant behaviors to the point of social or occupational impairment as broad as avoiding social situations entirely or as narrow as avoiding handshakes out of fear of sweaty palms

selective mutism

characterized by the consistent inability to speak in situations where speaking is expected; heavily associated with social anxiety disorder

panic disorder

recurrence of unexpected panic attacks; may become anxious at the thought of having an unexpected panic attack; impairs one’s daily functions and persists for at least a month

panic attack

sudden surge of fear in which individuals feel that they are losing control of their body and/or that they are dying; misfiring of the sympathetic nervous system resulting in an unwanted fight-or-flight response (autonomic overdrive); includes the associated emotions that accompany the sympathetic response, such as intense fear and a sense of impending doom/danger; not considered a psychological disorder alone

expected panic attacks

the occurrence of an individual’s attacks may be associated with specific triggers

unexpected panic attacks

no clear trigger and the panic attacks are seemingly random

Agoraphobia

anxiety disorder characterized by a fear of being in places or situations where it might be difficult for an individual to escape; tend to be uncomfortable leaving their homes, using public transport, being in open spaces, waiting in lines, or simply being in crowds

Generalized anxiety disorder (GAD)

disproportionate and persistent worry about many different things for at least six months; worrying is difficult to control, even in cases where the individual knows that their worrying and fear is irrational; physical symptoms like fatigue, muscle tension, and sleep problems; approximately 3% of the population experiencing symptoms in a 12-month period; 1 in 10 chance of meeting the diagnostic criteria in a lifetime

Obsessive–compulsive disorder (OCD)

characterized by obsessions, which produce tension, and compulsions that relieve tension but cause significant impairment in a person’s life; ego-dystonic; rituals or sets of rules are developed for how their compulsions must be performed

obsessions

persistent, intrusive thoughts and impulses; perceived needs with the accompanying ideation that if a particular need is not met, then disastrous events will follow

compulsions

repetitive tasks and actions paired with obsessions

ego-dystonic

the individual knows that their behavior is irrational, but the anxiety that arises when compulsions are not performed cannot be ignored

body dysmorphic disorder

unrealistic negative evaluation of personal appearance and attractiveness, usually directed toward a certain body part they see as ugly or even horrific when actually ordinary in appearance; disrupts day-to-day life, and the sufferer may seek multiple plastic surgeries or other extreme interventions

preoccupation

type of worry which lacks the disastrous ideation that accompanies obsessions

muscle dysmorphia

individuals believe that their body is too small or unmuscular and respond through working out

Hoarding Disorder

presents as a need to save or keep items and is often paired with excessive acquisition of objects; often fill their homes with seemingly useless items even past the point where the accumulation of belongings impairs daily life

trichotillomania

body-focused compulsion; individuals are compelled to pull out their hair; diagnosis requires previous attempts to stop their body-focused compulsions that have so far failed

excoriation disorder

body-focused compulsion; individuals are compelled to ppick at their skin; diagnosis requires previous attempts to stop their body-focused compulsions that have so far failed

posttraumatic stress disorder (PTSD)

occurs after experiencing or witnessing a traumatic event; consists of intrusion symptoms, arousal symptoms, avoidance symptoms, and negative cognitive symptoms; symptoms must be present for at least one month

Intrusion symptoms

include recurrent reliving of the event, flashbacks, nightmares, and prolonged distress

Arousal symptoms

include an increased startle response, irritability, anxiety, self-destructive or reckless behavior, and sleep disturbances

Avoidance symptoms

include deliberate attempts to avoid the memories, people, places, activities, and objects associated with the trauma

Negative cognitive symptoms

include an inability to recall key features of the event, negative mood or emotions, feeling distanced from others, and a persistent negative view of the world.

acute stress disorder

PTSD symptoms for less than one month (but more than three days)

dissociative disorders

avoid stress by escaping from parts of their identity, but otherwise still have an intact sense of reality

Dissociative amnesia

characterized by an inability to recall past experiences; not due to a neurological disorder; often linked to trauma

dissociative fugue

a sudden, unexpected move or purposeless wandering away from one’s home or location of usual daily activities; confused about their identity and can even assume a new identity, with a complete backstory

dissociative identity disorder (DID)

formerly multiple personality disorder; two or more personalities that recurrently take control of the patient’s behavior; patients often suffered severe physical or sexual abuse as young children

depersonalization/derealization disorder

patients experience depersonalization and derealization; presents as a feeling of automation and can include symptoms like a failure to recognize one’s reflection; significant impairment of regular activities

depersonalization

feeling detached from one’s own mind and body

ex. out-of-body experience

derealization

feeling detached from one’s surroundings; giving the world a dreamlike or insubstantial quality

somatic symptom disorder

at least one somatic symptom, which may or may not be linked to an underlying medical condition accompanied by disproportionate concerns about its seriousness, devotion of an excessive amount of time and energy to it, or elevated levels of anxiety; previously hypochondriasis with somatic symptoms

Illness anxiety disorder

characterized by being consumed with thoughts about having or developing a serious medical condition; quick to become alarmed about their health, and either excessively check themselves for signs of illness or avoid medical appointments altogether; previously hypochondriasis without somatic symptoms