Psychopathology Exam 2

mood disorders

involve severe alterations in mood which are intense and persistent enough to be clearly maladaptive and often lead to serious problems

• Must be clinically significant and significantly deviate from the individual’s base line or ordinary emotional state

euphoria, dysphoria

The two key moods involved in mood disorders are

euphoric mood (manic)

characterized by intense and unrealistic feelings of excitement and euphoria

dysphoria (depression)

feelings of extraordinary sadness and dejection

mixed features (mixed episode)

characterized by symptoms of both mania or hypomania with depressive features

depressive disorder

involves periods of symptoms in which an individual experiences an unusually intense sad mood

• The disorder’s essential element is an unusually elevated sad mood, known as dysphoria.

major depressive disorder (MDD)

a disorder in which the individual experiences intense but time limited episodes of depressive symptoms

major depressive episodes

a period in which the individual experiences intense psychological and physical symptoms accompanying feelings of overwhelming sadness

2, 2

Recurrent major depressive disorder with _ or more episodes within an interval of at least _ consecutive months

An affected person must experience the following:

• Dysphoria for most of the day, nearly every day for at least 2 consecutive weeks (persistent)

• Symptoms include:

  • Sleep and appetite disturbances

  • Low energy/fatigue

  • Low self-esteem

  • Difficulty concentrating or making decisions

  • Poor hygiene

  • Feelings of hopelessness

6 to 9

If untreated, a major depressive episode usually lasts _____ months and often recurs at some future point

Persistent Depressive Disorder (dysthymia), 4 to 5

chronic but less severe mood disturbance in which the individual does not experience a major depressive episode but a blue mood for a minimum of 2 years (1 year for children and adolescents)

• Average duration is ____ years, but can last for 20 or more

true

T/F: As compared to MDD, symptoms of PDD are mild to moderate but last much longer (chronic)

2, no, MDD

PDD vs MDD:

Periods of normal moods occur briefly but only last for a few days to a few weeks with a maximum of _ months

Beyond 2 months → qualify for diagnosis?

If no debilitating symptoms of depression, will not diagnose ____

mood swings

These intermittent normal ____ ___ are the most important characteristic distinguishing PDD from MDD

seasonal affective disorder (SAD)

mood disorder with episodes of depression typically occur during fall and winter, and subside during the spring

• More common among women and those who live in northern latitudes

unspecified mood disorder

applies to symptoms characteristic of a depressive disorder and cause clinically significant distress or impairment in social, occupational, or other important areas of functioning, however, symptoms do not meet the criteria for a depressive or bipolar disorder diagnosis

disruptive mood dysregulation disorder, 2, 6 to 18, puberty

a depressive disorder in children who exhibit chronic and severe irritability and have frequent temper outbursts

• Occur on average 3 or more times per week over at least 1 year and in at least ___ settings

• Diagnosis for children between ages ____

• Onset must be before age 10 (So that it isn’t due to ____)

premenstrual dysphoric disorder (PMDD), regular

disorder that involves depressed mood or changes in mood, irritability, dysphoria, and anxiety during premenstrual phase that subsides after the menstrual period begins for most of the cycles of the preceding year

• Occurs in the few days before menstruation

• Requires ____ cycle, if period already starts, then depressive symptoms cannot be fixed by medication

causal factors of depression, interactions

• biological: genetic influences are prevalent

• neurochemical: major depression is associated with altered neurotransmitter activity, but newer research focuses more on the complex _____ of neurotransmitters and how they affect cellular functioning.

  • So, it’s not how much, rather it’s how they interact with other hormonal and neurophysiological patterns.

• psychological: stressful life events (ex: loss of loved one, serious threats to important close relationships or to one’s occupation, economic or health problems), chronic stress, early adversity (ex: family turmoil, abuse, harsh or intrusive parenting), neuroticism, and learned helplessness

neuroticism

primary personality variable that serves as a vulnerability factor for depression (and anxiety), involves temperamental sensitivity to negative stimuli and are prone to experiencing a broad range of negative moods

learned helplessness model of depression

when perceived lack of control is present, helplessness may result in depression

• the result: people make attributions that are central to whether they become depressed

internal/external, global/specific, stable/unstable

3 critical dimensions of learned helplessness model of depression

internal

it’s all about you, your pain, struggle to look outside of yourself

global

although one area of life causes sadness, it becomes your whole world

stable

you cannot see the light at the end of tunnel, you think this sadness will last forever

pessimistic

Those with a _____ attribution style have a vulnerability for depression.

bipolar disorder, mood stabilizers

mood disorder involving euphoric episodes, intense, and very disruptive experiences of heightened mood referred to as a euphoric mood, possibly alternating with a major depressive episode

• Originally named bi = highs and lows

• For Diagnosis, only need to switch between 2 states (ex: euphoric and normal), not necessarily between highs and lows

• Sometimes too much or too little NTs

• Medication: ________

• Hereditary

Bipolar I

distinguished from MDD by at least one or more euphoric episodes or mixed features for at least 1 week

Bipolar II

person had one or more major depressive episodes and at least one mixed with clear-cut hypomanic episodes

hypomanic episodes

involves milder versions of euphoria but must last at least 4 days, same symptoms but less impairment and never need hospitalization

cyclothymic disorder, 2, 2

defined as more chronic but less severe version of BD (lacks certain extreme symptoms and psychotic features)

• In depressed phase, similar to PDD (dysthymia)

• In hypomanic phase, involves creative and productive physical and mental energy

• Must be at least ___ years of numerous periods with hypomanic and depressed symptoms (1 year for children and adolescents) and symptoms must cause significant distress or impairment in functioning

• Never symptom-free for more than __ months

equal

is bipolar more common in men or women?

adolescence or young adulthood

Bipolar I onset in

on average 5 years later

Bipolar II onset

one

Cannot be diagnosed with bipolar disorder unless exhibited at least ____ manic or mixed episode

rapid cycling

experience at least 4 episodes in a year

BD, marijuana

Of all the psychological disorders, ____ is the most likely to occur in people who also have problems with substance abuse → attempting to self-medicate, helps them feel better

• _____ implicated in worsening mood disorders

BD and substance abuse

with both: ______

• Earlier onset of BD

• More frequent episodes

• Greater chance for anxiety and stress-related disorders

• Aggressive behavior

• Problems with the law

• Risk of suicide

causal factors (bipolar disorder), norepinephrine, serotonin, thyroid

• biological causes: genetic influences

• neurochemical factors: excesses of ______ during manic episodes, less ____ in both depressive and manic phases

  • abnormalities of hormonal regulatory systems (some evidence of abnormalities of ___ function are frequently accompanied by changes in mood)

• psychological factors: stress life events, as in depressive disorder (which exacerbates this disorder)

depressive disorder due to another medical condition

Mood disorder diagnosis where there is a prominent and persistent period of depressed mood or markedly diminished interest/pleasure thought to be related to the direct physiological effects of another medical condition

• Some well-known illnesses that can lead to a diagnosis of mood disorder caused by a general medical condition can include: neurological disorders (Huntington’s, Parkinson’s, Alzheimer’s), multiple sclerosis, hypothyroidism, traumatic brain injury, strokes, heart attacks

Criterion for Depressive Disorder due to another medical condition

• A prominent and persistent period of depressed mood or markedly diminished interest or pleasure in all, or almost all, activities that predominates in the clinical picture

• The disturbance is not better explained by another mental disorder (e.g. - adjustment disorder with depressed mood, in which the stressor is a serious medical condition)

• The disturbance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning

substance-induced mood disorder

• Symptoms of depression that are due to the effects of medicine, drug abuse, alcoholism, exposure to toxins, or other forms of treatment

• Substance-induced mood disorder is a change in the way you think, feel, or act, caused by taking or stopping a drug

• These changes in your mood can last days or weeks

• The brain makes chemicals that affect thoughts, emotions, and actions

• Without the right balance of these chemicals, there may be problems with the way you think, feel, or act

• Many drugs change the amounts of these chemicals

true

T/F: Some drugs can cause mood problems while you are taking them, other drugs can cause mood problems for several weeks after you stop taking them

drugs/medicines that can cause mood problems

• Alcohol, marijuana, and illegal drugs such as cocaine and LSD

• Nonprescription medicines such as some decongestants

• Prescription medicines such as those to treat heart problems, high blood pressure, anti-anxiety medicines, antidepressants, pain medicines, and others

depression symptoms

• Feel sad and uninterested in things you usually enjoy

• Have trouble falling asleep, wake up very early, or sleep too much

• Have changes in your appetite and weight, either up or down

• Have low energy

• Lose sexual desire

• Feel worthless and guilty

• Not be able to concentrate or remember things

• Feel hopeless or just not care about anything

• Have physical symptoms (headaches, joint pain)

• Think often about death/suicide

euphoria symptoms

• Have a very high sense of self-worthy and feeling of being “on top of the world”

• Be very talkative and talk so fast that others have trouble following what you are saying

• Have racing thoughts and trouble concentrating

• Be very restless

• Have more feelings of anxiety and panic

• Go for days with little or no sleep and not feel tired

• Be very irritable and get into fights with others

• Be extremely active and act recklessly, such as going on spending sprees or having unsafe sex

group, individual

Substance-induced mood disorder can be treated with either ____ or ____ therapy

• Therapy in a group with other people who have substance abuse problems is often very helpful

• In some cases, medicines for depression or anxiety may help you to stop substance abuse

• Self-help groups such as Narcotics Anonymous, support groups, and therapy may be helpful

• Learning ways to relax may help, yoga and meditation

side effects

Claims have been made that certain herbal and dietary products help control cravings or withdrawal symptoms

• Supplements = not tested or standardized, may vary in strengths and effects

• They may have ___ ____ and are not always safe

Talk with healthcare provider before taking supplement

suicide

fatal self-inflicted destructive act with explicit or inferred intent to die

suicidal ideation, developing a plan, suicide attempt, suicide

suicidal continuum

suicidal ideation

thinking about ending one’s life

suicide attempt

nonfatal suicidal behavior

suicide

actual ending of one’s life

intent

The DSM-5-TR has added self-harm without the presence of suicidality to its list of diagnoses

• Because not everyone who has engaged in self-harm may do so with the ____ of ending their life, lumping it into suicidality could blur assessments made by clinicians.

• The intent of the injury is the focus, which makes it easier to track harmful behaviors and assess risk

• In addiction, diagnostic codes for suicidal behavior without the presence of other mental health disorders have been included in the new updates

positive psychology

focuses on the power of resilience

• risk for suicide unlikely when high in resilience

you can overcome adversity with good coping skills

resilience is the psychological construct, a belief that

MAOIs, tricyclic antidepressants, SSRIs, mood-stabilizing drugs

antidepressant drugs

monoamine oxidase inhibitors, lethals, withdrawal

MAOIs stands for

• 1950s: intense side effects are ____, interactions with certain foods, significant ____ effects

suicidal thoughts, appetite

Tricyclic antidepressants

• Intense side effects, increase ___ ____ particularly in children and adolescents, Elavil, Anafranil

• Elavil and Anafranil = incessant ____, lots of weight gain

selective serotonin reuptake inhibitors, 3 to 5, instantaneously

SSRIs

• ____ weeks to take effect

• often placebo _______

mood-stabilizing drugs

for both depressive and euphoric episodes of bipolar disorder

• mostly common is lithium

ECT, TMS, DBS

alternative biological treatments (if nothing else works)

ECT (electroconvulsive therapy)

treatments induce seizures, used with severely depressed patients who may present serious suicidal risk

TMS (transcranial magnetic stimulation)

focal stimulation of the brain, stimulates nerve cells in the brain to improve symptoms of major depression (also OCD, anxiety, and PTSD), noninvasive as there is no surgery involved

DBS (deep brain stimulation, neuromodulation)

implanting an electrode in the brain (via tiny holes) and stimulating that area with electric current, controlled by a pacemaker type device placed under the skin in the upper chest, a wire travels under the skin connecting the device with the electrodes

CBT, behavioral activation treatment, interpersonal therapy, family and marital therapy

psychotherapy methods

behavioral activation treatment

focuses intently on getting patients to become more active and engaged with their environment and with interpersonal relationships

interpersonal therapy

focuses on current relationship issues and understanding, and change of maladaptive interaction patterns

dissociative disorders

conditions that involve disruptions or breakdowns of memory, awareness, identity, or perceptions

dissociative identity disorder (DID)

the most common of dissociative disorders is

DID

a dissociative disorder, formerly called MPD, in which an individual develops more than one self or personality

• Must have 2 distinct identities and when inhabiting identity one, are not aware that they also inhabit the other identity

• As a result, will have large gaps in memory

alter, unconsciously, stress

Individuals with dissociative identity disorder have learned to cope with extremely stressful life circumstances by creating “___” personalities that _____ control their thinking and behavior when they are experiencing ____

true

T/F: Oftentimes, dissociative disorders involve mood, anxiety, and PTSD

dissociative amnesia

inability to remember important personal details and experiences, usually associated with traumatic or very stressful events

fugue state

travel or wander without knowing their identity

depersonalization

condition in which people feel they are detached from their own body

derealization

condition in which people feel a sense of unreality or detachment from their surroundings

depersonalization/derealization disorder

condition in which the individual experiences recurrent and persistent episodes of depersonalization/derealization

somatic symptoms

symptoms involving physical problems and/or concerns about medical symptoms

• somatic from greek word “soma” meaning body

somatic symptom disorder

somatic disorder involving actual physical symptoms that may or may not be accountable by a medical condition, accompanied by maladaptive thoughts, feelings, and behaviors

• Manifests as physical symptoms that suggest illness or injury but cannot be explained fully by a general medical condition or by the direct effect of a substance and are not attributable to another mental disorder

worry, severity

for somatic symptom disorder

• medical test results are either normal or do not explain the person’s symptoms, and do not indicate the presence of a known medical condition.

• For a diagnosis, there must also be excessive ____ about their symptoms, and this worry must be judged to be out of proportion to the ____ of the physical complaints

6

A diagnosis of somatic symptom disorder requires that the subject have recurring somatic complaints for at least ___ months

adolescence, 30

Somatic symptom disorder:

Symptoms are sometimes similar in various illnesses and may last for years. Usually, the symptoms begin appearing during _____ , and patients are diagnosed before the age of ___ years

• Symptoms may occur across cultures and gender

anxiety, depression

for somatic symptom disorder: other common symptoms include ____ and ____ . However, since they are common in those with confirmed medical illnesses, it remains possible that such symptoms are a consequence of a physical impairment, rather than a cause.

false

T/F: Somatic symptom disorders are the result of conscious malingering (fabricating or exaggerating symptoms for secondary motives) or factitious disorders (deliberately producing, feigning, or exaggerating symptoms).

true

T/F: Somatic symptom disorder is difficult to diagnose and treat.

illness anxiety disorder, unnecessary, unsatisfied

a somatic symptom disorder characterized by the misinterpretation of normal bodily functions as signs of serious illness, does not involve actual physical symptoms

• Known as hypochondriasis in DSM-4

• Individuals do not experience any specific physical ailment, but instead, they are preoccupied with concern about developing a severe medical condition.

• Easily alarmed about their health and seek _____ medical tests and procedures to rule out or treat exaggerated or imagined illnesses.

• They remain _____ with the reassurance of physicians and can cause a huge burden on the resources of health care facilities and on health care providers.

functional neurological symptom disorder (conversion disorder),

a somatic symptom disorder involving the translation of unacceptable drives or troubling conflicts into physical symptoms

• Once known as “hysteria”

• “Conversion” refers to the presumed transformation of psychological conflict → physical symptoms

• Physical ailments include: “pseudoseizures”, disorders of movement, paralysis, weakness, disturbances of speech, blindness, and other sensory disorders and cognitive impairment

malingering, fictitious disorder imposed on self or another, factitious disorder

conditions related to somatic symptom disorder

malingering, primary

involves deliberately fabricating physical or psychological symptoms for some ulterior motive

• Want direct benefit or reward

• involves _____ gain

primary gain

relief from anxiety or responsibility due to the development of physical or psychological symptoms, direct benefits occupying the sick role (disability, lawsuit, insurance benefits, time off from work)

fictitious disorder imposed on self

fake symptoms or disorders not for purpose of any particular gain, but because of an inner need to maintain a sick role (Munchausen’s syndrome)

• Done for sympathy, support

fictitious disorder imposed on another

inducing physical symptoms in another person who is under their care (Munchausen’s syndrome by proxy)

factitious disorder

faking or exaggerating symptoms for secondary gains

secondary gain

sympathy and attention that a sick person receives from other people, motives are internally driven, not externally

trauma, change, maladaptive

Theories/Treatment

• Dissociative and Conversion disorders are nearly always precipitated by some prior ____

• Cognitive Behavioral Therapy (CBT): help clients identify and ____ their thoughts linked to their physical symptoms and change their _____ behavior that accompanies those irrational thoughts, focus is on the unusually high level of health anxiety: worry about physical symptoms and illness

• Hypnotherapy and Medication

psychological factors affecting other medical conditions, physiological

disorder in which clients have a medical disease or symptom that appears to be exacerbated by psychological or behavioral factor

• include mental disorders, stress, emotional states, personality traits, and poor coping skills

• all interact with _____ conditions

stress

the unpleasant emotional reaction that a person has when an event is perceived as threatening

stressful life event

an event that disrupts the individual’s life

coping

the process through which people reduce stress in a healthy manner