psychopathology exam 3

Dissociative disorders

• disconnect from one’s emotions, thoughts, surroundings

• relatively rare

Dissociative amnesia

• prior or total loss of important personal information

  • may occur suddenly after traumatic event or stressful circumstances

  • individuals may be unable to recall information such as name, address, relative’s names, yet remember the necessities of daily life

• significantly higher rate of:

  • prior head injury

  • depression or PTSD symptoms

  • family and financial problems

Localized dissociative amnesia

inability to recall a specific event or events

systematized dissociative amnesia

loss of memory for certain categories of information

selective amnesia

inability to remember certain details of an incident

dissociative fugue

• confusion over personal identity

  • complete loss of memory of one’s entire life

  • unexpected travel to a new location

• recovery is often abrupt

depersonalization disorder

characterized by feelings of unreality or being detached from oneself and the environment

derealization disorder

sense of unreality or dreamlike detachment from one’s environment

depersonalization/derealization diagnostic guidelines

• symptoms cause significant impairment or distress

• may feel things are unreal or a sense of being in a dreamlike state

• the person remains in contact with reality

dissociative identity disorder (DID)

• disruption of identity evidenced by 2 or more personality states: alterations in behaviors, attitudes, and emotions

• alternate personality states may appear to:

  • gaps in memories similar to symptoms of dissociative amnesia and fugue are present

  • may appear to help deal with difficult situations faced by primary personality

etiology of dissociative disorders (biological dimension)

• disruptions in memory coding due to acute stress

  • atypical brain function has been documented

• neuroimagining of the brain structure of individuals with DID and healthy controls reveal structural differences

psychological dimension of dissociative disorders

• psychodynamic theory

  • repression protects the individual from painful memories or conflict

  • individuals with DID often report inter-identity amnesia

• contemporary theory: post-traumatic model of DID

  • being exposed to overwhelming childhood stress

  • genetic or biological predisposition

  • environmental circumstances that prevent a child from developing a strong sense of self, resulting in many disconnected selves

social and sociocultural dimensions of dissociative disorders

• sociocognitive model of DID

  • individuals learn about DID through mass media and begin to act out its roles

Treatment of DID

• NO SSRIs

• trauma-focused therapy

  • help individuals develop healthier ways of dealing with stressors

  • major goal in integration of personalities

  • ex.

    • working on safety issues, symptom reduction

    • identify/work through any traumatic memories

    • focus on personality integration

emotional symptoms of depression

feelings of sadness, emptiness, hopelessness, worthlessness, or low self-esteem

cognitive symptoms of depression

rumination, inability to concentrate, or suicidal thoughts

behavioral symptoms of depression

fatigue, social withdrawal, or reduced motivation

psychological symptoms of depression

appetite and weight changes, sleep disturbance, unexplained aches and pains, or an aversion to sexual activity

major depressive disorder (MDD)

• at least 5 symptoms for at least 2 weeks

  • depressive mood most of the day, nearly every day

  • anhedonia: diminished interest or pleasure in all or almost all activities

  • significant weight loss/weight gain

  • atypical sleep patterns

  • restlessness

  • fatigue/low energy

  • feelings of worthlessness or excessive/inappropriate guilt

  • difficulty concentrating

  • recurrent thoughts of death, suicide

• ensure patient has never experienced an episode of mania or hypomania

  • helps differentiate between bipolar and depressive disorders

• consider severity and chronic nature of symptoms

• specifiers determine severity

  • mild, moderate, severe

  • single or recurrent

  • partial remission or remission (more stable)

MDD acronym

• S: sleep issues

• I: loss of interest

• G: excessive guilt

• E: low energy

• C: concentration

• A: change to appetite

• P: psychomotor (restlessness/physical pain)

• S: suidical intention/SIB

MDD w/ seasonal pattern

• mdd and bipolar may have seasonal pattern

  • impacted by decrease in sunlight as seasons change

• symptoms include:

  • low energy

  • increased sleep

  • social withdrawal

  • carbohydrate craving

  • light theraphy

persistent depressive disorder (dysthymia)

• symptoms present most of the day for more days than not for a 2 year period

• 2 or more of the following symptoms:

  • feeling of hopelessness

  • low self-esteem

  • poor appetite/overeating

  • difficulty concentrating

  • sleeping too much/too little

depressive reactions to grief

• normal grief-related reactions

  • often involves feelings of emptiness

  • may last for several years

  • frequency and intensity diminishes over time

• persistent complex bereavement disorder

  • must have significant effect on the person’s interpersonal relationships or sense of identity

  • need to carefully consider cultural, religious, and appropriate norms

prevalence of depressive disorders

• one of the most common psychiatric disorders

  • second leading cause of disabilities worldwide

• women at significantly greater risk

• depressive symptoms are also subject to external stressors

• chronic disorder for many people

• 15% fail to show significant symptom reduction

biological dimension of depression

• low level of neurotransmitters (serotonin, dopamine, norepinephrine)

• overproduction of cortisol can damage parts of brain

• genetic links in families

  • similar types of depressive disorders

  • similar responses to medications

  • may be more evident post-puberty

• genes interacting w/ environmental factors

• circadian rhythm: internal biological rhythm maintained by melatonin

  • sleep disturbances → irregular REM sleep, insomnia, etc

psychological dimension of depression

• behavioral explanations

  • depression occurs when people receive insufficient social reinforcement

  • learned helplessness: belief that we have little influence over what happens

    • assume that nothing they do will improve their circumstances

• cognitive explanations

  • depression is a disturbance in thinking rather than mood → negative self-schema

Beck’s Faulty thinking

• personalization

• overgeneralization

• polarized thinking

personalization

• individual takes excessive personal responsibility or blame for external events that are largely or entirely outside of their control

• ex. they don’t wave back so they must hate me

overgeneralization

• when you take a single, isolated negative event and view it as a never-ending pattern of defeat

• ex. low score on one quiz means you will fail at every quiz

polarized thinking

• when you view the world, yourself, or your experiences in absolute, binary categories

• ex. I have to be the skinniest person at the party

social dimension in depression

• maltreatment in early childhood strongly associated w/ later depression

  • increases reactivity to stress

  • alter function/structure of areas in brain

  • failure to develop secure attachments

• intergenerational; transmission of depression

• social rejection (ex. bullying)

sociocultural dimension of depression

• racial and ethnic differences

  • Africa American/Latin American women report somatic symptoms when experiencing depression

  • depression among Chinese adolescents often associated w. poor academic performance

  • ethnic-based bullying also increases likelihood of depression

• sexual and gender orientation

  • prejudice and discrimination related to having LGBGTQ+ orientation

  • lack of family acceptance, bullying, and social rejection

  • silence can result in personal distress

  • higher risk of suicidal attempts

• gender

  • depression far more common in women

  • socialization practices can influence feelings of self-worth

  • women more likely to have experienced childhood trauma, but more willing to seek help

  • cognitive patterns that increase risk of depression more common in women

treatments for depression

• antidepressants

  • SSRIs, SSRIs BUT may discontinue due to side effects

• light therapy for MDD seasonal pattern

• treatment-resistant MDD

  • ECT: using electrodes to induce a seizure

  • TMS: same procedure but with magnets

• behavioral activation therapy: focus on increasing exposure to pleasurable events, activities, and social interactions

• cognitive behavioral therapy: goal is to alter negative thought patterns associated w. negative feelings

  • less likely to relapse than those treated w. antidepressants

Bipolar disorders

• involved in episodes of hypomania or mania

• very strong genetic component

• peak age of onset is teens/early 20s

• much less frequent than depressive disorders

bipolar I disorder

• at least one weeklong manic episode

• mixed features on depressive episodes are common, but not required for diagnosis

• possible psychotic features

bipolar II disorder

• at least one major depressive episode

• at least one hypomanic episode

• no history of mania

cyclothymic disorder (longer duration)

• period involving milder hypomanic symptoms alternating w. milder depression for at least 2 years

• symptoms have never met the criteria for a hypomanic, manic, or major depressive episode

featues associated w/ bipolar disorders

• mixed features: 3 or more symptoms of either occurring during an episode from the opposite pole

• rapid cycling: 4 or more mood episodes per year

• comorbid anxiety or substance use disorders

• suicide risk is 20 times greater than general population

symptoms of hypomania

• at least 3 of the symptoms for 4 consecutive days

  • increased levels of activity or energy combined with:

  • may appear quite distractible, change topics frequently, flight of ideas, talk excessively, or dominate conversations

  • impulsivity and risk-taking may also appear

  • grandiosity: feeling superior or powerful

  • decreased need for sleep

  • rule out the person is using drugs FIRST

• IF PSYCHOSIS IS EVER PRESENT, NO HYPOMANIA ONLY MANIA

symptoms of mania

• at least 3-4 of the symptoms of hypomania lasting at least 1 week

• even more pronounced mood changes

• behaviors from euphoria to extreme irritability

• cause marked impairment in social or occupational functioning

• may involve psychosis or loss of contact w. reality

• obvious to others that something is amiss

emotional symptoms of hypomania

• unusually in high spirits

• full of energy and enthusiasm

• or uncharacteristically irritable

• may overreact w. anger/hostility

emotional symptoms of mania

• emotional lability: unstable & rapidly changing emotions

• inappropriate use of humor poor judgment in expressing feelings or opinions

• grandiosity

cognitive symptoms of hypomania

• energized, goal-oriented behavior

• may talk excitedly without concern about giving others an opportunity to speak

• unaware of inappropriateness of actions

cognitive symptoms of mania

• difficulty maintaining focus

• pressured speech

• display a flight of ideas by changing topics frequently, or making irrelevant/illogical comments

behavioral symptoms of hypomania

• energetic and productive, or agitated and angry

• uninhibited

• impulsivity and uncharacteristically risky behaviors

• may have difficulty delaying gratification

behavioral symptoms of mania

• rapid movement and incoherent speech

• paranoia, hallucinations and delusions

psychological symptoms for hypomania and mania

• high levels of physiological arousal

• increased libido

• decreased need for sleep

• weight loss due to high energy expenditure

diagnostic challenges

• depression is present in both depressive and bipolar disorders

• overlapping symptoms (irritability, depressed mood)

• presentation of symptoms vary

• may tend to not report hypomanic symptoms as they can still function

biological dimension for bipolar disorders

• complex genetic interactions

  • several genes influenced by lithium

  • genes that impact circadian rhythm

• neurological abnormalities

  • mania can develop due to overly ambitious pursuit of goals

  • anatomical brain irregularities

psychological dimension for bipolar disorders

• cope w/ stress by disengaging and tend to have limited adaptive coping or problem solving skills

• personality traits include impulsivity, ruminating tendencies

• problems w/ psychological flexibility, particularly regarding feedback

• maladaptive forms of emotional regulation

social/sociocultural dimension for bipolar disorders

• stressors during critical periods of brain development may impact brain functioning

• loss of social support or strained relations may trigger episodes

• women more likely to experience depressive episodes, severe mood symptoms, and sleep difficulties

• men are more likely to experience episodes of mania

  • more likely to abuse alcohol or other substances

treatment for bipolar disorders

• overall goal is to eliminate symptoms to the greatest degree possible

  • combining mood stabilizers, psychotherapy, and psychoeducation

• mood stabilizers

  • lithium

  • antidepressants may be added to deal with depressive symptoms but may exacerbate manic symptoms if used alone

  • major issue and reason for relapse is failure to take medications

psychotherapy treatment for bipolar disorders

• family-focused therapy

  • educating families reduces risk of relapse and hospitalization

• therapists teach clients to:

  • avoid stress/overly ambitious goals

  • identify sighs of impending mood episode

  • understand dangers of substance use

  • practice emotional regulation techniques

• interventions focused on regulating sleep patterns

• mindfulness interventions

non-suicidal self-injurious/self-injurious behavior

• involves intentionally inflicted superficial wounds

  • pain induces a temporary sense of calm & well-being

• intense negative thoughts or emotions and a preoccupational with engaging in self-harm typically precede episodes of NSSI

• those who repeatedly self-injure sometimes use self-harm as a coping strategy to avoid suicidal actions

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suicide

• the intentional, direct, and conscious taking of one’s own life

• approx. 90% of those who contemplate suicide have mental illness

• 10th leading cause of death in US

• most do not want to die, but end their pain

• passive suicidal intention: it would be best if I died

• active suicidal intention: plan, access to the plan, intent to follow the plan

psychological autopsy

• systematically examining information after a person’s death in effort to understand and explain behavior

• attempt to make psychological of a suicide by compiling and analyzing background info

methods of suicide

• firearms (51%)

• hanging/suffocation (29%)

• drug overdose (13%)

• older adolescents most frequently try hanging, jumping, and firearms

• girls more likely to use drug or alcohol intoxication

occupational risk factors

• male occupations

  • farmworkers, fishermen, lumberjacks, carpenters, miners, electricians

  • isolation is common

• female occupations

  • firefighters, police, correctional officers

  • women in male-dominated field, traumatic experiences

• medical professionals

  • psychiatrists because repetitively exposed to trauma

effects of suicide on friends & family

• attempts to understand and make meaning of tragedy

• development of risky behaviors

• altered relationships w/ friends

• surviving family members often feel guilt and responsibility

• increased rates of depression, anxiety, alcohol abuse, marital challenges

effects of suicide on children

• child has increased risk of developing mental health problems

• increased risk of suicide, especially if deceased parent was the mother

• increased likelihood of being hospitalized for depression or anxiety if deceased parent was father

• those who experienced parental suicide during adolescence or early adulthood had the highest risk of hospitalization for suicide attempts

children and adolescents

• highest suicide rate since 2000

• social media and substance use

• academic environments can serve as stressors

• increase in suicidality among African American children/adolescents

  • barriers to identification and treatment of depression

  • school experiences such as racial discrimination, low teacher expectations

• may have higher risk of suicidal ideation when taking SSRIs

• bullying

  • victim of bullying are more likely to consider suicide

  • cyberbullying may be strongly associated w. suicide attempts

  • LGBTQ+ teens at high risk

• copycat suicides

  • media reports of suicides seem to spark an increase in suicide

  • not sensationalizing the event

  • refrain from sharing specific details about the manner of death

  • including info on suicide prevention resources

members of the military

• increased rates of suicide

• impact of military culture: stigmatize mental health

  • bipolar disorder, substance use, PTSD

• barriers to mental health care

  • lack of support, financial and personal problems

• VA parking lot suicides: 6k suicides every year 08-16

college students

• 20% thought about suicide

• 9% attempted

• Asian Americans & multiracial students reported highest rate of ideation

• transgender students show higher risks

• stress from various sources was strongly related to suicide attempts and metal health

elderly population

• suicide rates for elderly men are the highest of any age group

  • higher for older Asian Americans than European Americans

• Factors for increased risk:

  • bereavement

  • physical ailments

  • social isolation

  • financial difficulties

• older adults also have widespread prejudice, etc.

psychache

• intolerable pain created from absence of joy

• acute state that encompasses shame, guilt, humiliation, loneliness, and fear

• unfulfilled psychological needs strongly associated w. suicical ideation

substance use & suicide

• 40% suicides and overdose deaths involve opioids

• cannabis use during adolescence is associated w. depression, suicidality

• alcohol

  • as many as 70% suicide attempts involve alcohol

  • strong correlation to successful attempt

  • may lower inhibitions related to fear/death

  • alcohol-induced myopia: when someone has been drinking, they become fixated

Gender

• 79% of all suicides committed by:

  • males

    • methods they use are more lethal → higher success rate

    • may avoid seeking help of expressing ideation to others

  • females

    • higher rates of suicidal thoughts/attempts

    • common methods: drug overdose, poisoning

preventing suicide

• early detection and successful intervention

• gatekeeping training: designated people within a system learn about risk factors and screening methods

• three step process:

  • know which factors increase likelihood of suicide

  • determine probability that the person will act on suicide wishing

  • implement appropriate actions

suicide risk factors examples

• previous suicidal intention/attempt

• substance abuse, chronic pain, physical illness

• hopelessness, shame, humiliation

• family turmoil

• important ones have died from suicide

suicide protective factors examples

• good emotional regulation, problem solving

• willingness to talk

• family and community

• restricted access to lethal means of suicide

treatment resources for suicide

• suicidal hotlines

  • crisis requiring immediate prevention assistance

• “No-Harm” Agreement aka Contract for Safety

  • minimal research supporting effectiveness

• Section 12

  • temporary involuntary hospitalization for evaluation of safety

  • at least 72 hours

psychotherapy for suicide

• treatment often involves both medication and psychotherapy

• CBT & DBT proven to reduce suicide risk by 50% compared to other therapies

CBT (cognitive behavior therapy)

question distorted thoughts, more realistic thoughts are identified and substituted

DBT (dialectical behavior therapy)

• focuses on helping clients accept current lives and manage emotional distress in healthy ways

• building a life worth living

recovery from a suicide attempt

• the aftermath of a suicide attempt often includes:

  • continuation of the emotion that led to it

  • complicated emotions including relief, anger

  • feeling alone and isolated