PSYCH 2AP3 - final exam (weeks 7-12)

dissociative disorders

characterized by severe maladaptive disruptions or alterations of identity, memory, and consciousness that are experience as being beyond one’s control

dissociation

lack of normal integration of thoughts, feelings and experiences in consciousness and memory

dissociative amnesia

loss of memory for important facts about a person’s own life and personal identity, usually including the awareness of this memory loss

generalized dissociative amnesia

inability to remember anything, including identity

localized dissociative amnesia

inability to remember specific events (usually traumatic)

dissociative amnesia consists of

usually adult onset, some very traumatic event and comes away with it with a loss of memory

dissociative fugue

subtype of dissociative amnesia, disorder in which a person moves away and assumes a new identity, with amnesia for the previous identity

dissociative fugue consists of

loss of memory of past (usually generalized type) and personal identity, also travel suddenly, experienced a traumatic event, spur of the moment trip and abruptly stopping the trip, losing memory of their who autobiography and traumatic event

dissociative amnesia DSM criteria

inability to recall important autobiographical information, significant distress or impairment, specify with dissociative fugue

depersonalization-derealization disorder

syndrome marked by frequent episodes of feeling detached from one’s own body and mental processes as if one were an outside observer of oneself; symptoms must cause significant distress or interference with one’s ability to function

depersonalization-derealization disorder consists of

severe feelings of detachment (outside observer of own body or mind), significant distress or impairment, rare; onset usually follows traumatic event, can occur as early as early adolescence, moderate or heavy use of hallucinogens can produce this disorder if you have the vulnerability

depersonalization-derealization disorder may have

cognitive and perceptual deficits occur, tunnel vision and mind emptiness, deficits in emotion regulation, dysregulation in the HPA axis

depersonalization

lose sense of own reality

derealization

lose sense of reality of external world

depersonalization-derealization comorbid with

panic disorder, depression, PTSD, anxiety disorder

depersonalization-derealization DSM criteria

presence of persistent or recurrent experiences of depersonalization, derealization or both, reality testing remain intact, significant distress or impairment

depersonalization epidemiology

0.8%

derealization epidemiology

1.8%

depersonalization-derealization disorder epidemiology

1.5%

depersonalization-derealization affects

both men and women equally

depersonalization-derealization average age of onset

15.9-22.8 depersonalization

dissociative amnesia treatment

usually resolve without treatment, resolves on its own if it is going to resolve

depersonalization-derealization disorder treatment

CBT approaches may be helpful, shown to be effective for depersonalization

dissociative identity disorder

syndrome in which a person develops more than one distinct identity or personality, each of which can have distinct facial and verbal expressions, gestures, interpersonal styles, attitudes and even physiological

dissociative identity disorder average identities

15

dissociative identity disorder consists of

childhood onset, emphasis on the individualistic culture (western culture), experience recurrent memory gaps

host identity

asks for treatment, most of the time this is the original identity

alters

the different identities or personalities

switch

instantaneous transition from one personality

dissociative identity disorder DSM criteria

disruption of identity characterized by two or more distinct personality states, gaps in the recall, significant distress or impairment

dissociative identity disorder: posttraumatic model - child abuse

result of severe traumatic experience, take on different identities to escape, sought from physical and emotional pain, dissociates as a protective mechanism

dissociative identity disorder - suggestibility

dissociation as coping, less suggestible people may develop PTSD

autohypnotic model

suggestible people may use dissociation as a defence against trauma

dissociative identity disorder biological factors

roles of heredity and environment debated, temporal lobe epileptic seizures can be associated with dissociative symptoms, sleep deprivation

dissociative identity disorder etiology

real and false memories may be due to trauma, memories could be a result of suggestions from therapists, false memories can be created

dissociative identity disorder treatment

long-term psychotherapy (goal is to integrate all the alter identity into one coherent sense of self in which the client is able to develop the capacity for coping with distress and trusting healthy relationships), treatment of associated trauma similar to PTSD

mood disorders

gross deviations in mood, big mood changes

major depressive episode

most commonly diagnosed and most severe

anhedonia

inability to experience pleasure

mania

extreme pleasure in every activity; excessive euphoria

hypomanic episode

less severe version of manic episode

unipolar mood disorder

either depression or mania, experiencing only one form

bipolar mood disorder

alternate between depression and mania

mixed features

experience of both (manic but feel somewhat depressed at the same time), specifier in major depression disorder

major depressive disorder

depressed mood for most of the day, for more days than not for 2 weeks

major depressive disorder consists of

physical and cognitive symptoms (disruptions in sleep, appetite, sexual drive, feelings of worthlessness, guilt), possible to just have a single episode, most often is recurrent

major depressive disorder average duration

if untreated it is 9 months, after it slowly goes away, two or more depressive episodes separated by at least two months

major depressive disorder chronic course

median number of episodes is 4-7, median duration of recurrent episodes is 4-5 months

major depressive disorder DSM critieria

five or more in same 2-week period, at least one symptom is depressed mood or loss of interest or pleasure, weight loss or gain, insomnia or hypersomnia, psychomotor agitation or retardation, fatigue or loss of energy, feelings of worthlessness, diminished ability to think or concentrate, recurrent thoughts of death, cause significant distress

persistent depressive disorder

lasts 2+ years and the individual is never without symptoms for more than 2 months

persistent depressive disorder consists of

chronic state of depression (20-30) years, symptoms are same as MDD but less severe, persistence of symptoms = more severe outcomes

persistent depressive disorder compared to MDD

higher rates of comorbidity, less responsive to treatment, more dysfunction and impairment

persistent depressive disorder DSM critieria

depressed mood at least 2 years, insomnia or hypersomnia, fatigue or loss of energy, feelings of hopelessness, diminished ability to think or concentrate, poor appetite, low self-esteem, not been without symptoms for more than 2 months

double depression

individuals who suffer from both MDD and PDD, even more severe psychopathology and problematic course

depressive disorder with psychotic features specifier

hallucinations, delusions (mood-congruent or mood-incongruent)

depressive disorder with anxious distress specifier

mild to severe, indicator that some anxiety is present but not enough for anxiety disorder, likely due to depression disorder

depressive disorder with mixed features specifier

presence of at least three manic/hypomanic symptoms but does not meet criteria for a manic episode

depressive disorder with melancholic specifier

anhedonia, lack of mood reactivity, need 3 of the following: need depression, severe weight loss or loss of appetite, muscle agitation or retardation, early morning awakening, excessive guilt, worse mood in the morning

depressive disorder with atypical features specifier

over sleeping and eating, diabetes, has ability to react with pleasure to somethings, more suicide attempts and alcohol problems

depressive disorder with catatonic features specifier

catalepsy - somebody’s muscles become rigid and waxy

depressive disorder with peripartum specifier

postpartum depression

depressive disorder with seasonal pattern specifier

seasonal affective disorder (SAD) - person experiences major depression during winter months and then recovers fully during the summer

MDD with peripartum onset

mothers functional impairment, hard time leaving house, parenthood, taking care of baby, temperamental, social, emotional, cognitive, behavioural difficulties in children, can also occur in the non-birthing parent

MDD epidemiology

7-11.3% of canadians, mean onset is 25 years old

depression ranks

4th in terms of global burden of disease

PDD epidemiology

2.5%

subtypes of PDD

adult vs. adolescent onset (has implications for course and treatment)

PDD in adolescence

disorder last longer in their life time, relatively poor prognosis, harder to treat, stronger likelihood of disorder running through the family, higher comorbidity of personality disorders

depression in women

MDD: twice as many women than men, more common among women who have few financial resources, less education, unemployed, reproductive events

integrated grief

now live your life where grief is integrated, adjust to new normal, they adjust to the loss, assume a little to no dysfunction

complicated grief

now included in the DSM in diagnoses requiring specific study

premenstrual dysphoric disorder (PMDD)

severe emotional reactions during premenstrual period

disruptive mood dysregulation disorder

present in 6-18 years old

personality disorder

persistent pattern of emotions, cognitions and behaviour that results in enduring emotional distress for the person affected and/or for others (most of the time) and may cause difficulties with work relationships

personality

the characteristic ways a person behaves and thinks

ego syntonic

most people are largely comfortable with themselves, with their characteristic manner of behaving, feeling and relating to others - lack insight (ex. narcissistic pd)

ego dystonic

behaviours are actions that are inconsistent with your personal goals, values and beliefs (ex. OCD), not the pd’s

cluster A personaliy

odd or eccentric

cluster B personality

dramatic, emotional, erratic

cluster C personality

anxious, fearful

statistics and development

prevalence data lacking (except for antisocial PD), not a lot of insight into dysfunction from personality, don’t want to participate in studies

personality disorders originate

in childhood/teens, personality developing at this time

personality disorders are

rarer than many other disorders - may be a function of people not seeking help

gender differences - males

aggressive, structured, self-assertive, and detached

gender differences - female

submissive, emotional, and insecure

comorbidity

in general 0.5-2.5%, person with BPD also has 32% likelihood of another supposedly different PD

cluster A disorders

paranoid PD, schizoid PD, schizotypal PD

paranoid PD DSM

a pervasive distrust and suspiciousness of others such that their motives are interpreted as malevolent, beginning by early adulthood and present in a variety of contexts, four or more: suspects, preoccupied with doubts, reluctant to confide in others, etc.

paranoid PD - core fears

being exploited, others are lying to them, humiliation, betrayal, being vulnerable with or depending on other people

paranoid PD - biological causes

family studies: evidence that it can exist with some disorders on this spectrum

paranoid PD - psychological causes

early mistreatment/trauma (developed personality style to protect themselves), schemas (mental representations, learning caregivers are mistrustful, thought pattern about trusting people)

paranoid PD - cultural factors

prisoners, refugees, elderly, etc. - have more prevalence, increased amount of mistreatment, more danger - additionally people with hearing disabilities

paranoid PD - treatment

difficult due to lack of trust, reluctant to go to therapy, CBT - identify maladaptive thoughts, replace with adaptive thoughts

schizoid PD

a pervasive pattern of detachment from social relationships and a restricted range of expression of emotions in interpersonal settings, beginning by early adulthood and present in a variety of contexts as indicated by 4 (or more): neither desires nor enjoys close relationships, chooses solitary activities, little interest in sexual experiences, takes pleasure in few activities, etc.

schizoid PD - “loner”

someone who is a “loner”, detachment, do not enjoy closeness with others, limited range of emotions, aloof, cold, indifferent, no unusual thought processes

schizoid PD - fears

being controlled, failing relational expectations, being misunderstood

schizoid PD - causes

childhood shyness may be a precursor (trait may be inherited), abuse/neglect, overlap with autism spectrum

schizotypal PD

a pervasive pattern of social and interpersonal deficits marked by acute discomfort with, and reduced capacity for close relationships as well as by cognitive or perceptual distortions and eccentricities of behaviour, beginning by early adulthood and present in a variety of contexts, five or more: ideas of reference, odd beliefs or magical thinking, unusual perceptual experiences, etc.

schizotypal PD consists of

socially isolated, unusual behaviours (suspicious, odd beliefs, magical thinking), ideas of reference, motivated by difficulty interpreting one’s own perceptions and difficulty navigating social cues

schizotypal PD - biological causes

one phenotype of schizophrenia genotype, women’s exposure to influenza in pregnancy may increase chance in her child, damage to left hemisphere