PSY 1.7 Psychological disorders

biomedical approach

to psychological disorders takes into account only the physical and medical causes of a psychological disorder. Thus, treatments in this approach are of a biomedical nature.

psychological disorders

characteristic set of thought, feelings or actions that cause noticeable distress to the sufferer are considered deviant by the individual’s culture or cause maladaptive functioning in society

maladaptive

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

biopsychosocial approach

considers the relative contributions of biological, psychological, and social components to an individual’s disorder. Treatments also fall into these three areas. 

direct therapy

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

indirect therapy

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

DSM

used to diagnose psychological disorders.

psychotic disorder

resent with one or more of the following symptoms: delusions, hallucinations, disorganized thought, disorganized behavior, catatonia, and negative symptoms

schizophrenia

distortion in reality and disturbances in the content and form of thought, perception and affect [spilt from reality]

the prototypical disorder with psychosis as a feature.

It contains positive and negative symptoms. 

not the same as dissociative identity (multiple personality)

associated with downward drift hypothesis (which states that schizophrenia causes a decline in socioeconomic status, leading to worsening symptoms, which sets up a negative spiral for the patient toward poverty and psychos)

phases of schizophrenia

Phases client goes through before being diagnosed

1. Prodromal phase

2. Active phase

3. Residual phase

prodromal phase

exemplified by clear evidence of deterioration, social withdrawal, role functioning impairment, peculiar behavior, inappropriate affect, and unusual experiences

active phase

pronounced psychotic symptoms are displayed.

recovery phase

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.

postive symptoms

add something to behavior, cognition, or affect and include delusions, hallucinations, disorganized speech, and disorganized behavior.

psychotic dimension (delusions and hallucinations) and the disorganized dimension (disorganized thought and behavior)

negative symptoms

are the loss of something from behavior, cognition, or affect and include disturbance of affect and avolition. 

delusions

false beliefs discordant with reality and not shared by others in the individual’s culture.

Delusions of reference

involve the belief that common elements in the environment are directed toward the individual. For example, people with delusions of reference may believe that characters in a TV show are talking to them directly.

Delusions of persecution

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

Delusions of grandeur

involve the belief that the person is remarkable in some significant way, such as being an inventor, historical figure, or religious icon.

thought broadcasting

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

thought withdrawal

the belief that thoughts are being removed from one’s head

thought insertion

the 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.

most common is auditory

disorganised thought

characterised by loosening of associations

eg 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

just words thrown together incomprehensibly

neologisms

invent new words

disorganised behaviour

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

catatonia

refers to certain motor behaviors characteristic of some people with schizophrenia.

echolalia

repeating another’s words

echopraxia

imitating another’s actions

blunting

severe reduction in the intensity of affect expression

flat affect

are virtually no signs of emotional expression

inappropriate affect

affect is clearly discordant with the content of the individual’s speech. For example, a patient with inappropriate affect may begin to laugh hysterically while describing a parent’s death

avolition

marked by decreased engagement in purposeful, goal-directed actions.

schizotypal personality disorder

Include both personality disorder and psychotic symptoms, with the personality symptoms having been already established before psychotic symptoms present.

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 in duration; 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 disorder

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

depressive symptoms

9 symptoms [SIG E. CAPS]

Sadness: Depressed mood, feelings of sadness and emptiness
Sleep: Insomnia or hypersomnia
Interest: Loss of interest and pleasure in activities that previously sparked joy, termed anhedonia
Guilt: A feeling of inappropriate guilt or worthlessness
Energy: Lower levels of energy throughout the day
Concentration: Decrease in ability to concentrate (self described, or observed by others)
Appetite: Pronounced change in appetite (increase or decrease) resulting in a significant change (5%+) in weight.
Psychomotor symptoms: Psychomotor retardation (slowed thoughts and physical movements) and psychomotor agitation (restlessness resulting in undesired movement)
Suicidal thoughts: Recurrent suicidal thoughts

major depressive disorder

contains at least one major depressive episode.

the episode is defined as a 2 week period in which 5 of 9 symptoms are encountered

persistent depressive disorder (dysthymia)

is the presence of depressive symptoms for at least two years that do not meet criteria for major depressive disorder. 

disruptive mood dysregulation

typically diagnosed between the ages of 6 and 10

and has the key diagnostic feature of persistent and recurrent emotional irritability in multiple environments (school, home, etc.)

premenstrual dysphoric disorder

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

seasonal affective disorder

dark winter months are believed to be the source of depressive symptoms and thus the disorder is best categorized as major depressive disorder with seasonal onset

bright light therapy to counter

post partum depression

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

treatment for depression

seretonin reuptake inhibitors SSRI, block the reuptake of seretonin in the synapse and relief of symptoms

bipolar and related disorders

have manic or hypomanic episodes.

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]

DIG FAST:

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

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.

Bipolar I disorder 

contains at least one manic episode.

also include depressive symptoms, often major depressive episodes, they are not a requirement

Bipolar II disorder

contains at least one major depressive episode and least one hypomanic episode.

Cyclothymic disorder

presence of both manic and depressive symptoms that are not severe enough to be considered episodes

These symptoms must persist for at least 2 years and be present the majority of that time.

catecholamine theory of depression

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

anxiety disorders

capture conditions in which excessive fear or anxiety impairs one’s daily functions. Anxiety disorders are differentiated by the stimuli that induces anxiety. 

for anxiety disorders clinicians must rule out hyperthyroidism—excessive levels of the thyroid hormones triiodothyronine (T3) and thyroxine (T4)—because

increasing the whole body’s metabolic rate will create anxiety-like symptoms.

phobias

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

claustrophobia

irrational fear of closed places,

acrophobia

irrational fear of heights

specific phobia

is one in which fear and anxiety are produced by a specific object or situation. Unlike other sources of anxiety, specific phobias lack a specific ideation or thought pattern and instead present as an immediate and irrational fear response to the specific object or situation.

separation anxiety disorder

fear of being separated from one’s caregivers or home environment

social anxiety disorder

is fear or anxiety towards social situations with the belief that the individual will be exposed, embarrassed, or simply negatively perceived by others.

selective mutism

disorder is the impairment of speech in situations where speaking is expected.

panic disorder

is marked by recurrent panic attacks: intense, overwhelming fear and misfiring sympathetic nervous system activity. It may lead to agoraphobia.

agoraphobia

is a fear of places or situations where it is hard for an individual to escape.

generalised anxiety disorder

is a disproportionate and persistent worry about many different things for at least six months. 

Obsessive–compulsive disorder related disorders

are characterized by perceived needs (obsessions or preoccupations) and paired actions to meet those needs (compulsions). 

Obsessive–compulsive disorder

is characterized by:

• obsessions (persistent, intrusive thoughts and impulses)

• compulsions (repetitive tasks that relieve tension but cause significant impairment in a person’s life).

obsessions

perceived needs with the accompanying ideation that if a particular need is not met, then disastrous events will follow.

compulsions

Actions paired with obsessions

body dysmorphic disorder

is characterized by an unrealistic negative evaluation of one’s appearance or a specific body part. The individual often takes extreme measures to correct the perceived imperfection. 

preoccupation

a type of worry which lacks the disastrous ideation that accompanies obsessions.

hoarding behaviour

is characterized by the reluctance of giving up one’s physical possessions. Often this behavior is associated with excessive acquisition of physical items. 

Posttraumatic stress disorder (PTSD) 

explained by the traumatic event and one’s reaction to it.

is characterized by intrusion symptoms, avoidance symptoms negative cognitive symptoms and arousal symptoms These symptoms can be explained from the behaviorist perspective. 

intrusion symptoms

reliving the event, flashbacks, nightmares [classical conditioning]

avoidance symptoms

avoidance of people, places, objects associated with trauma [operant conditioning]

negative cognitive symptoms

amnesia, negative mood and emotions [dissociation]

arousal symptoms

increased startle response, irritability, anxiety

dissociative disorder

avoid stress by escaping from parts of their identity

dissociative amnesia

is an inability to recall past experience without an underlying neurological disorder.

In severe forms, it may involve dissociative fugue, a sudden change in location that may involve the assumption of a new identity. 

dissociative fugue

a sudden, unexpected move or purposeless wandering away from one’s home or location of usual daily activities.

fugue state are confused about their identity and can even assume a new identity.

dissociative identity disorder

is the occurrence of two or more personalities that take control of a person’s behavior.

Depersonalization disorder

involves feelings of detachment from the mind and body

derealisation

involves feelings of detachment from their surroundings

Somatic symptom and related disorders

involve significant bodily symptoms

Somatic symptom disorder

involves at least one somatic symptom, which may or may not be linked to an underlying medical condition, that causes disproportionate concern.

illness anxiety disorder

is a preoccupation with thoughts about having, or coming down with, 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

conversion disorder

 involves unexplained symptoms affecting motor or sensory function and is associated with prior trauma. 

personality disorders

are patterns of inflexible, maladaptive behavior that cause distress or impaired functioning in at least two of the following: cognition, emotions, interpersonal functioning, or impulse control.

They occur in three clusters:

• A (odd, eccentric), paranoid, schizotypal, and schizoid

• B (dramatic, emotional, erratic), antisocial, borderline, histrionic, and narcissistic

• C (anxious, fearful). avoidant, dependent, and obsessive–compulsive 

cluster A

includes paranoid, schizotypal, and schizoid PDs.

cluster B

pervasive distrust of others and suspicion regarding their motives

antisocial, borderline, histrionic, and narcissistic PDs.

Cluster C

includes avoidant, dependent, and obsessive–compulsive PDs.

Paranoid PD

involves a pervasive distrust and suspicion of others.

Schizotypal PD

involves ideas of reference, magical thinking, and eccentricity. Schizoid PD involves detachment from social relationships and limited emotion. Antisocial PD involves a disregard for the rights of others. 

Borderline PD

involves instability in relationships, mood, and self-image. Splitting is characteristic, as are recurrent suicide attempts.

Histronic PD

involves constant attention-seeking behavior.

narcissistic PD

involves a grandiose sense of self-importance and need for admiration. 

Avoidant PD

involves extreme shyness and fear of rejection.

Dependent PD

involves a continuous need for reassurance.