[2Y2T2S] [PT10110] [1.2] Recognizing Psychopathology (Anxiety Disorders - Somatic Disorders)

Excessive fear and anxiety and related behavioral disturbances

Anxiety disorders

• Diffuse, unpleasant, vague sense of apprehension

• Warns of impending danger

• Enables us to take measures to deal with threat (adaptive)

Normal anxiety

Two (2) components of Normal Anxiety

1. Awareness of physiological sensation

2. Awareness of being nervous or frightened

PATHOLOGICAL ANXIETY

Does prevalence increase with higher socioeconomic status?

No

Prevalence decreases with higher socioeconomic status

PATHOLOGICAL ANXIETY

What is the sex predilection?

Female

PATHOLOGICAL ANXIETY

What is the general percent of prevalence?

17.7%

PSYCHOSOCIAL SCIENCES — ANXIETY

• Signal of danger in the unconscious

• Result of psychic conflict between unconscious sexual or aggressive wishes and corresponding threats from the superego or reality

Psychoanalytic theory

PSYCHOSOCIAL SCIENCES — ANXIETY

Treatment for psychoanalytic theory?

Increase tolerance (not eliminate)

PSYCHOSOCIAL SCIENCES — ANXIETY

Four (4) types of anxiety under developmental issues?

1. Disintegration anxiety

2. Persecutory anxiety

3. Castration anxiety

4. Superego anxiety

PSYCHOSOCIAL SCIENCES — ANXIETY

Fear that self will fragment because others are not responding with needed affirmation and validation

Disintegration anxiety

PSYCHOSOCIAL SCIENCES — ANXIETY

Self is being invaded and annihilated by an outside malevolent force

Persecutory anxiety

PSYCHOSOCIAL SCIENCES — ANXIETY

Oedipal phase in boys in which a parental figure (usu father) may damage the boy’s genitals or cause bodily harm

Castration anxiety

PSYCHOSOCIAL SCIENCES — ANXIETY

Guilt feelings about not living up to internalized standards derived from parents

Superego anxiety

PSYCHOSOCIAL SCIENCES — ANXIETY

Conditioned response to a specific environmental stimulus thus developing mistrust

Behavioral theories

PSYCHOSOCIAL SCIENCES — ANXIETY

• No specifically identifiable stimulus

• Person experience feelings of living in a purposeless universe

• Anxiety is their response to perceived void in existence and meaning

Existential theories

BIOLOGICAL SCIENCES — ANXIETY

• Increased sympathetic tone

• Adapt slowly to repeated stimuli

• Respond excessively to moderate stimuli

ANS

BIOLOGICAL SCIENCES — ANXIETY

• Increased cortisol during stress but altered in anxious patients

HPA axis

BIOLOGICAL SCIENCES — ANXIETY

• Increased during stress thereby activating HPA axis and increases cortisol

CRH

BIOLOGICAL SCIENCES — ANXIETY

True or False: Almost half of all patients with panic disorder have at least one affected relative

True

BIOLOGICAL SCIENCES — ANXIETY

True or False: There is higher frequency in first-degree relatives

True

BIOLOGICAL SCIENCES — ANXIETY

What are the neuroanatomical considerations? (2)

1. Limbic system

2. Cerebral cortex

Abrupt surge of intense fear or intense discomfort that reaches a peak within minutes

Panic attack

• Recurrent unexpected panic attacks

• Persistent concern or worry

• A significant maladaptive change in behavior related to the attacks

Panic disorder

PANIC DISORDER

How long is the duration of the symptoms?

1 month (or more)

PANIC DISORDER

True or False: Panic disorder is more prevalent among Asians compared to Americans

False: Panic disorder is more prevalent among Americans compared to Asians

• Asian prevalence = 0.1-0.8%

• American (adults & adolescents) prevalence = 2-3%

PANIC DISORDER

Two (2) factors that can further complicate panic disorder

1. Depression

2. Alcohol dependence

PANIC DISORDER

Give the two (2) treatment methods for panic disorder

1. Pharmacotherapy

2. Psychotherapy

PANIC DISORDER

Give the four (4) psychotherapy methods for panic disorders

1. Supportive psychotherapy

2. Insight oriented psychotherapy

3. Behavior therapy

4. Cognitive psychotherapy

PANIC DISORDER

What psychotherapy method is being described below:

• Use of psychodynamic concepts promoting adaptive coping

Supportive psychotherapy

PANIC DISORDER

What psychotherapy method is being described below:

• Increase the development of insight into psychological conflicts

Insight oriented psychotherapy

PANIC DISORDER

What psychotherapy method is being described below:

• Positive and negative reinforcements

• Relaxation techniques

Behavior therapy

PANIC DISORDER

What psychotherapy method is being described below:

• Instruction on false beliefs and information about panic attacks

Cognitive psychotherapy

• Marked fear or anxiety triggered by real or anticipated exposure to:

  • Using public transportation

  • Being in open spaces

  • Being in enclosed spaces

  • Standing in line or being in a crowd

  • Being outside of home alone

• Escape might be difficult or help might not be available in the event of development of symptoms

Agoraphobia

• Excessive anxiety and worry

• The individual finds it difficult to control the worry

• Symptoms can cause clinically significant distress or impairment

Generalized Anxiety Disorder

GENERALIZED ANXIETY DISORDER

How long is the duration of symptoms?

At least 6 months

• Intrusive thoughts, rituals, preoccupations, and compulsions

• Cause severe distress

• Time consuming

• Interfere significantly with patient’s routine, occupational functioning, social activities, and relationships

• Patient may try to resist but unbearable anxiety builds up

Obsessive Compulsive Disorder

OBSESSIVE COMPULSIVE DISORDER

What is the prevalence of OCD?

2-3%

OBSESSIVE COMPULSIVE DISORDER

What is the sex predilection?

None.

M = F

OBSESSIVE COMPULSIVE DISORDER

When can OCD usually occur?

Adolescence or childhood

OBSESSIVE COMPULSIVE DISORDER

What is the mean age of onset?

20 y/o

• Preoccupation with one or more perceived defects or flaws in physical appearance that are not observable or appear slight to others

• Performed repetitive behaviors or mental acts in response to the appearance concerns

• The preoccupation causes clinically significant distress or impairment

Body Dysmorphic Disorder

• Pattern or markedly disturbed and developmentally inappropriate attachment behaviors

• Absent or grossly underdeveloped attachment between the child and putative caregiving children

Reactive Attachment Disorder

• Absence of expected comfort seeking and response to comforting behaviors

• Diminished or absent expression of positive emotions during routine interactions with caregiver

• Display episodes of negative emotions of fear, sadness, or irritability

Reactive Attachment Disorder

REACTIVE ATTACHMENT DISORDER

What are the three (3) patterns of extremes of insufficient care experienced by the child?

1. Social neglect or deprivation

2. Repeated changes of primary caregivers

3. Rearing in unusual settings

REACTIVE ATTACHMENT DISORDER

When should the disturbance be evident?

Before the age of 5

REACTIVE ATTACHMENT DISORDER

What is the minimum developmental age of the child?

At least 9 months

• Pattern of behavior that is culturally inappropriate, overly familiar behavior with relative strangers

• Has experienced a pattern of extremes of insufficient care

• At least 9 months of age

Disinhibited Social Engagement Disorder

• Exposure to actual or threatened death, serious injury, or sexual violence

• Presence of intrusion symptoms associated with the traumatic events

• Persistent avoidance of stimuli associated with the traumatic events

Posttraumatic Stress Disorder

• Negative alterations in cognitions and mood

• Marked alterations in arousal and reactivity associated with the traumatic event/s

• Causes clinically significant distress or impairment

Posttraumatic Stress Disorder

POSTTRAUMATIC STRESS DISORDER

How long is the duration of the disturbance?

More than 1 month

POSTTRAUMATIC STRESS DISORDER

Which survivors have the highest rates of developing PTSD? (4)

Survivors of:

1. Rape

2. Military combat and captivity

3. Ethnically or politically motivated internment

4. Genocide

POSTTRAUMATIC STRESS DISORDER

When will symptoms begin?

Within first 3 months after trauma

POSTTRAUMATIC STRESS DISORDER

When will there be complete recovery for ~1/2 of adults?

Within 3 months (occur in ~1/2 of adults)

• Exposure to actual or threatened death, serious injury, or sexual violation

• Presence of intrusion, negative mood, dissociative, avoidance, and arousal symptoms

• Causes clinically significant distress or impairment

Acute Stress Disorder

ACUTE STRESS DISORDER

How long is the duration after trauma exposure?

3 days to 1 month

Presence of emotional or behavioral symptoms in response to an identifiable stressor

Adjustment disorder

ADJUSTMENT DISORDER

Three (3) examples of stressors

1. Romantic relationship breakup

2. Marked business difficulties

3. Marital problems

ADJUSTMENT DISORDER

What is the prevalence?

5-20%

ADJUSTMENT DISORDER

When is the onset of the symptoms (with respect to the onset of the stressors)?

Within 3 months of the onset of stressors

ADJUSTMENT DISORDER

What will happen if the stressor or its consequences have terminated?

Symptoms will not persist for more than an additional 6 months

Disruption of and/or discontinuity in the normal integration of consciousness, memory, identity, emotion, perception, body representation, motor control and behavior

Dissociative disorders

• Unbidden intrusions into awareness and behavior, with accompanying loss of continuity in subjective experience

• Inability to access information or to control mental functions

Dissociative symptoms

• Clinically significant persistent or recurrent depersonalization and/or derealization

• Intact reality testing

Depersonalization/Derealization Disorder

Inability to recall autobiographical information that is inconsistent with normal forgetting

Dissociative Amnesia

DISSOCIATIVE AMNESIA

What type of dissociative amnesia is described below:

• Unable to remember an event or period of time

• Most common

Localized

DISSOCIATIVE AMNESIA

What type of dissociative amnesia is described below:

• Unable to remember a specific aspect of an event or sometimes within a period of time

Selective

DISSOCIATIVE AMNESIA

What type of dissociative amnesia is described below:

• Complete loss of identity and life history

Generalized

• Multiple personality disorder

• Presence of 2 or more distinct personality states or an experience of possession

• Recurrent episodes of amnesia

Dissociative Identity Disorder

DISSOCIATIVE IDENTITY DISORDER

What are the four (4) experiences felt by a person with DID?

1. Recurrent, inexplicable intrusions into conscious functioning and sense of self

2. Alterations in sense of self

3. Odd changes of perception

4. Intermittent functional neurologic symptoms

Prominence of somatic symptoms associated with significant distress and impairment

Somatic Symptom and Related Disorders

• One or more somatic symptoms that are distressing or result in significant disruption of daily life

• Excessive thoughts, feelings, or behaviors related to the somatic symptoms or associated health concerns

• The state of being symptomatic is persistent

Somatic Symptom Disorder

SOMATIC SYMPTOM DISORDER

How long should the state of being symptomatic be persistent?

Typically more than 6 months

SOMATIC SYMPTOM DISORDER

True or False: A distinctive characteristic of somatic symptom disorder is the person’s presentation and interpretation of the symptoms

True

• Preoccupation with having or acquiring a serious illness

• Somatic symptoms are not present or, if present, are only mild in intensity

• High level of anxiety about health

• Performs excessive health-related behaviors or exhibits maladaptive avoidance

Illness Anxiety Disorder

ILLNESS ANXIETY DISORDER

How long should illness preoccupation be present?

At least 6 months

• One or more symptoms of altered voluntary motor or sensory function

• Incompatibility between the symptom and recognized neurological or medical conditions

• Causes clinically significant distress or impairment

Conversion Disorder

(Functional Neurological Symptom Disorder)

FACTITIOUS DISORDER

Which factitious disorder does description impose on?

• Falsification of physical or psychological signs or symptoms

• Presents himself or herself to others as ill, impaired, or injured

• Evident even in the absence of obvious external rewards

Factitious Disorder Imposed on Self

FACTITIOUS DISORDER

Which factitious disorder does description impose on?

• Falsification of physical or psychological signs or symptoms

• Presents another individual (victim) to others as ill, impaired, or injured

• Evident even in the absence of obvious external rewards

Factitious Disorder Imposed on Another