CLP3144 UF EXAM 2

Somatic symptom disorders include:

somatic symptom disorder, conversion disorder, illness anxiety disorder, factitious disorder.

Individuals with a somatic symptom disorder experience

physical symptoms for which there is no biological apparent cause

DSM-V Criteria for Somatic Symptom Disorder

disruption of daily life, persistently high level of anxiety about symptoms, and excessive time and energy devoted to these concerns

Illness Anxiety Disorder

worry that one will develop or have a serious illness but does not experience severe physical symptoms

DSM-V Criteria for Illness Anxiety Disorder

preoccupation with having or acquiring an illness, mild or no somatic symptoms, high level of anxiety about health, excessive health related behaviors, illness preoccupation present for at least 6 mo.

Theories of Somatic Symptom Disorder and Illness Anxiety Disorder

Cognitive factors play a strong role, may be intertwined with PTSD

Treatment of Somatic Symptom Disorder and Illness Anxiety Disorder

psychodynamic- provide insight into emotions that link physical symptoms

behavioral- learn and eliminate reinforcements that contribute

cognitive- help to challenge maladaptive thoughts about illness

belief systems- help to engage in therapy to work on the symptoms

Conversion Disorder

dramatic type of somatic symptom disorder that causes patients to lose neurologic functioning in a certain part of the body with no medical cause

DSM-V Criteria for Conversion Disorder

one or more symptoms of altered motor or sensory function, clinical finding provide evidence of incompatibility between symptoms and loss, not better explained by another disorder, distress in important areas of life.

Theories of Conversion Disorder

Freudian- disorder is a result of the transfer of psychic energy, primary and secondary gain

Behavioral- alleviate stress by removing individual from the environment, Labelle indifference

Therapy for Conversion Disorder

psychoanalytic- helps express painful emotions or memories linked to symptoms

behavioral- focuses on reliving the anxiety and reducing any benefits received from the symptoms

Factitious Disorder

deliberate faking of an illness to gain medical attention, called Munchhausen's syndrome

Malingering

faking a symptom or a disorder in order to avoid an unwanted event

Dissociative Disorders

disconnection between a person's thoughts, memories, feelings, actions or sense of self.

Dissociative Identity Disorder

having more than one distinct identity or personality state taking control of the individuals behavior

DSM-V Criteria for DID

disruption of identity characterized by two or more distinct personalities, recurrent gaps in the recollection of events, distress in social or job events, not attributable to substance abuse.

Theories of DID

result of coping with trauma

integrate all alters into one coherent personality

help rebuild capacity to trust

DSM-V Criteria for Dissociative Amnesia

inability to recall important self events, symptoms causing distress, not aqrriutbale to another cause. with dissociative fugue (purposeful travel or wandering for identity)

Types of dissociative amnesia

organic- caused by brain injury (anterograde amnesia- inability to remember new information_

psychogenic- arises in the absence of brain injury

retrograde amnesia- inability to remember information from the past (both organic and psychogenic causes)

Depersonalization/Derealization Disorder

episodic feelings of detachment from one's own mental processes or body. caused by stressor or sleep deprivation. must occur frequently and interfere with ability to function

Symptoms of Depression

depressed mood out of proportion to any cause, changes in appetite and sleep, psychomotor retardation or agitation, losing touch with reality, experiencing delusions and hallucinations

Major Depressive Disorder

depressive symptoms lasting two weeks or more

Persistent depressive disorder

depressed mood for most of the day for at least two years or 1 year in children

Prevalence and Course of Depressive Disorders

high susceptibility in young adults,

difficult to diagnose in patients over 65,

less common among children,

women are more susceptible,

long lasting,

costly for both the individual and society,

people tend to recover with treatment.

Biological Theories of Depression

genetic theory- genes predispose people to depression

neurotransmitter theories- dysregulation of neurotransmitters

structural and functional brain abnormalities

neuroendocrine factors- hormonal dysregulation

Areas of brain implicated in major depression

anterior cingulate, prefrontal cortex, amygdala, hippocampus

Psychological theories of depression

cognitive theories

-negative cognitive triad (negative views ab self, world, and future)

-reformulated learned helplessness theory (people become helpless after a negative event)

-ruminative response style (focuses on content of thinking as source of depression)

interpersonal theories

-interpersonal difficulties and losses

-rejection sensitivity (easily perceiving rejection by others)

sociocultural thoeries

-cohort effects (changes in generations put higher risk for depression)

-gender/race differences

Symptoms of Mania

period of abnormally and persistently elevated mood and increased energy

-lasting at least one week

-inflated self esteem

-decreased need for sleep

-talkative

-flight of ideas

-involvement with potential for painful consequences

Bipolar I

characterized as mania

-elevated, expansive mood for more than one week and at least 3 additional symptoms

Bipolar II

severe depression and hypomania

Cyclothymia disorder

less severe but more chronic (at least 2 years) bipolar condition

Rapid cycling bipolar I or bipolar II disorder

four or more mood episodes that meet criteria for manic, hypomanic, or major depressive episode within one year

Disruptive mood dysregulation disorder

severe temper outburst that are out of proportion in intensity and duration to a situation and inconsistent with developmental level

-hard to diagnose from ADHD

Prevalence and Course of Bipolar Disorder

-less common than depressive disorders

-men and women equally susceptible

-no ethnic or cultural differences

-develops in late adolescent or early adulthood

-people suffering usually lose job and friendships

Biological theories of bipolar disorder

genetic factors (strong and consistent linkage)

structural and functional brain abnormalities (amygdala, white matter)

neurotransmitter factors (norepinephrine, serotonin, dopamine)

psychological contributions (sensitivity to rewards, increased stress)

Biological treatment of bipolar disorder

drug therapy

-SSRI

-SNRI

-norepinephrine-dopamine reuptake inhibitor

-tricyclic antidepressants

-monoamine oxidase inhibitors

mood stabilizers

-lithium, antipsychotic meds

Electroconvulsive therapy

Repetitive transcranial magnetic stimulation

-exposed to high intensity magnetic pulses

Vagus nerve stimulation

deep brain stimulation

light therapy

Psychological treatments for mood disorders

behavior therapy

-increasing positive reinforcers and decreasing aversive events

-new skills for relationships

CBT

-change the negative patterns of thinking

Suicide

death from self

leading cause of death in the world

-1 million die each year

many more unsuccessful attempts

Ethnic and Cultural differences in suicide

euro americans have higher suicide rates, followed by native Americans

rates among african american males have increased

rates are high in Europe, Russia, China

low in latin america and south america

suicide in children and adolescents

relatively rare in young children, increases into adolescents

girls more likely to attempt, boys more likely to complete

hispanic females have high rates

reasons include substance abuse and availability of firearms

decreased rate since antidepressants

nonsuicidal self injury

significantly injuring oneself without the intention to die

Perspectives on suicide

egoistic suicide- committed by people who feel alienated

anomic suicide- committed by those who experience severe disorientation from society

altruistic suicide- committed by people who believe taking their life will benefit society

Suicide cluster

suicides or attempted suicides are nonrandomly bunched together in space or time and likely to affect people who knew the person

suicide contagion

survivors who become suicidal may be modeling the behavior of the friend or admired celebrity who recently committed suicide

Factors regarding suicide

impulsivity, hopelessness, genetic component, low serotonin levels

Treatment of suicidal persons

hospitalization, intervention programs, drug therapy, psychological therapy

Psychosis

inability to differentiate between what is real and unreal

Schizophrenia

severe from of psychosis where individuals alternate between the following phases

-clear thinking and communication with an accurate view of reality

-active phase of illness- thinking and speech are disorganized, lose touch with reality.

Positive Symptoms of Schizophrenia

Overt expression of unusual perception, thought, or behavior

Delusions: ideas that individual believes to be true but is highly unlikely

Hallucinations: unreal perceptual experiences

Formal thought disorder: tendency to slip from topics with little coherent transition

Disorganized or catatonic behavior: display unpredictable and apparently untriggered agitation

Catatonia: disorganized behavior that reflects unresponsiveness to the environment

Types of Delusion

Persecutory delusion

Delusion of reference

Grandiose delusion

Delusion of being controlled

Thought Broadcasting

Thought insertion

Thought withdrawal

Delusion of guilt or in

Somatic delusion

Negative Symptoms of Schizophrenia

involves the loss of certain qualities of the person, rather than the behaviors expressed

Restricted affect: severe reduction in or absence of emotional expression

Avolition: inability to initiate or persist at common goal directed activities

DSM-V Criteria for Schizophrenia

must show two or more symptoms of psychosis one of which should be delusions, hallucinations, or disorganization speech.

must occur at least 6 months

continuous signs of disturbance

Prognosis of Schizophrenia

rehospitalization rates between 50-80%

gender and age factors

-women develop later, milder, and more favorable than men

-functioning improves with age

sociocultural factors

-developing countries have higher rates than developed

Schizoaffective disorder

mix of schizophrenia and a mood disorder

schizophreniform disorder

meets criteria for schizophrenia but symptoms only last 1 to 6 months

Delusion disorder

delusions lasting at least one month regarding situations that occur in real life

Schizotypal personality disorder

lifelong pattern of significant oddities to self concept, ways of relating to others, and thinking and behavior

ideas of reference

odd beliefs

lack of close friends

Theories of Schizophrenia

genetic transmission

-family studies

-adoption studies

-twin studies

structural and functional abnormalities in the brain

biological theories

-birth complications

-neurotransmitter theories(excess levels of dopamine)

-phrenothiazines or neuroleptics block the reuptake of dopamine

-mesolimbic pathway: subcortical part of the brain involved in processing reward

Structural and functional abnormalities of individuals with schizophrenia

reduced grey matter in cortex

enlarged ventricles

abnormal hippocampal activation and size

prefrontal cortex

Social drift

tendency to first downward in social class compared to the class of ones family of origin

Negative side effects of antipsychotics

tardive dyskinesia (involuntary movement of face)

Typical Antipsychotic Drugs

effective on positive symptoms:

-chlorpromazine

DSM-V Personality Disorder Classification

Cluster A: Odd-eccentric personality disorders

Cluster B: Dramatic-emotional personality disorders

Cluster C: Anxious-fearful personality disorders

Cluster A: Odd-Eccentric Personality Disorders

Paranoid Personality Disorder

Schizoid Personality Disorder

Schizotypal Personality Disorder

Paranoid Personality Disorder

a pattern of distrust and suspiciousness such that others motives are interpreted as malevolent

theories: some belief that others are deceptive, combined with lack of self confidence about being able to defend oneself

treatment: CBT

Schizotypal Personality Disorder

a pervasive pattern of deficits marked by acute discomfort with close relationships and other oddities of behavior

more common in men than women

FOUR ODDITIES:

1. Paranoia

2. Distorted ideas of reference

3. Odd beliefs and magical thinking

4. illusions that are just short of hallucinations

theories

-genetic, neurotransmitters

Treatment

-drug therapy

-CBT

Cluster B: Dramatic-Emotional Personality Disorder

Antisocial personality disorder

Borderline personality disorder

Histrionic personality disorder

Narcissistic personality disorder

Borderline Personality Disorder

out of control emotions

unstable relationships

concerns about abandonment

impulsive

self-damaging behavior

accompanied by anger, anxiety

theories: fundamental deficit in emotional regulation, hyper attentive to negative emotions, childhood abuse and neglect, smaller amygdala and hippocampus, genes

treatments: dialectical behavior therapy, CBT, transference focused therapy, mentalization based treatment, mood stablizers

Narcissistic Personality Disorder

self importance and arrogance

seeking constant admiration

relying on self evaluations

high rates of substance abuse, mood and anxiety disorders, aggression, homicidal behavior.

theories: managing self views, developed from overevalutation by others during childhood

treatment: CBT, majority doesn't seek treatment

Cluster C: Anxious-Fearful Personality Disorder

Avoidant Personality Disorder

Dependent Personality Disorder

Obsessive-Compulsive Personality Disorder

Avoidant Personality Disorder

engage in behaviors to avoid interactions

prone to shame

hypersensitive to criticism

isolated form others

anxiety about social situation

more common in females than males

theories: genes, rejection in early childhood

treatment: CBT, SSRI

Obsessive Compulsive Personality Disorder

shares features of OCD

very rigid, perfectionistic, emotionally blocked

think their way is the best way

impairs relationshipships

don't believe they require treatment

theories: genes, harbor strong rigid beliefs

treatment: supportive therapies, behavioral therapy, SSRI

DSM-V Criteria for Conduct Disorder

persistent patterns of violating societal normals out of age appropriate.

aggression to people and animals

destruction of property

deceitfulness or theft

serious violation of rules

childhood onset: before age 10

adolescent onset: age 10 or later

Psychopathy

callous unemotional presentation

less reactive to fear

less sensitive to punishment

being fearless and thrill seeking

lack of remorse

oppositional defiant disorder

children are chronically negativistic, defiant, disobedient, and hostile

Contributors to Conduct Disorder and Oppositional Defiant Disorder

biological factors

-genes

-less amygdala response

-exposure to neurotoxins

social factors

-lower classes

-parenting

-abuse or neglect

Drug Therapy for Conduct Disorder and Oppositional Defiant Disorder

antidepressants, antipsychotics, mood stabilizers

Antisocial Personality Disorder

exhibiting chronic antisocial behaviors

impairment in ability to form positive relationships

tendency to engage in behaviors that violate basic norms

focus on gratifying desire

poor control of impulses

most common PD

men > women

increased risk for suicide

Intermittent Explosive Disorder

engaging in frequent impulsive, severe acts of aggression

18 or older

may be verbal or physical but out of proportion

theories: caused by imbalance in serotonin, genes

treatment: CBT, SSRI, mood stabilizers