Psychopathology Exam 2

mood disorders

involve severe alternations 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

Euphoric mood (mania)

characterized by intense and unrealistic feelings of excitement and euphoria

dysphoria (depression)

feelings of extraordinary sadness and dejection

Mixed features (mixed episode of euphoria and dysphoria)

characterized by symptoms of both mania and 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, dysphoria

major depressive disorder

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

recurrent major depressive disorder

two or more episodes within an interval of at least 2 consecutive months

symptoms and characteristics of major depressive

- dysphoria for most of the day, nearly every day for at least 2 consecutive weeks

symptoms: sleep and appetite disturbances, low energy/fatigue, low self-esteem, difficulty concentrating or making decisions, poor hygiene, feelings of hopelessness

- if it goes untreated can last 6 to 9 months and often recur in the future

persistent depressive disorder (dysthymia)

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 two years (1 year for children and adolescents)

- average duration is 4 to 5 but can last 20 or more

persistent depressive disorders symptoms and characteristics

average mood on a regular basis is just sad; daily

- symptoms are mild to moderate compared to MDD but last much longer

- periods of normal moods occur briefly but only last for a few days to a few weeks with a maximum of 2 months

- intermittent normal mood swings are the most important characteristic

seasonal affective disorder (SAD)

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

- more common among women and those who live in northern latitudes

seasonal affective disorder stories

- had a patient that said he got depressed every time it rains, she explained to him that he actually conditioned himself to be depressed when it rains-- just needs to stop making that connection

- a patient felt depressed around trees, didn't like Maine

- her mom got depressed every december because of lost loved ones; professor conditioned her to start associating december with fun christmas activities

unspecified mood disorder

applies to symptoms characteristics 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

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

- occur on average 3 or more times/week over at least 1 year and in at least 2 settings (class and home);diagnosis for children between ages 6 to 18. onset must be before age ten

disruptive mood dysregulation story

same kid from before with reactive attachment disorder (comorbid)

- had a lot of tantrums, not anger related

- he would get frustrated because he couldn't decide which toy to get, or didn't get a good test score (wanted to get 100 but got a 98)

premenstrual dysphoric disorder

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

neurochemical factors of depression

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

- not how much, rather how they interact with other hormonal and neurophysiological patterns

psychological causes of depression

stressful life events, chronic stress, early adversity (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; 3 critical dimensions: 1. Internal/External 2. Global/Specific 3. Stable/Unstable

Internal/external

unable to look for help

Global/specific

focus just on the one thing- rather than the other good aspects of your life

Stable/unstable

this will end but you can't see the light at the end of the tunnel, think youll be depressed forever

bipolar disorder

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

- two main categories

bipolar I

distinguished from major depressive disorder by at least one or more euphoric episodes or mixed features for at least 1 week; onset in adolescence or young adult

bipolar II

person had one or more major depressive episodes and at least one mixed with clear-cut hypomanic episodes; on average diagnosed 5 years later

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

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

cyclothymic disorder characteristics

depressed phase is similar to PDD; hypomanic phase involves creative and productive physical and mental energy; must have at least 2 years of numerous periods with hypomanic and depressed symptoms (1 for children and adolescents) and symptoms must cause significant distress or impairment in functioning; never symptom free for more than 2 months

rapid cycling

experience at least 4 episodes in a year; bipolar disorder

Bipolar stories

- Robin Williams had bipolar- didn't take his meds so he was funnier; always unscripted in movies

- professor thinks her friend is bipolar, shes always starting new projects; decided to remove a window by herself, and put a bunch of holes in the walls, brought four new patio sets for a 10 person party; bought a bird house for $120

bipolar and substance abuse:

of all the disorders, most likely to occur in people who also have problems with substance abuse; with both; earlier onset, more frequent episodes, greater chance for anxiety and stress related disorders, aggressive behavior, problems with the law, risk of suicide

factors influencing bipolar disorder

biological: genetic influences

neurochemical: excesses of norepinephrine during manic episodes, less serotonin in both depressive and manic phases

abnormalities of hormonal regulatory systems: some evidence of abnormalities of thyroid function are frequently accompanied by changes in mood

psychological factors: stressful life events as in depressive disorders

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

illnesses that can to mood disorders

neurological disorders (huntington's disease, Parkinson's disease, Alzheimer's disease), multiple sclerosis, hypothyroidism, traumatic brain injury, strokes, and heart attacks

depressive disorder due to another medical condition, story

her mother went through a bad depressive episode due to too much blood-pressure medicine; wouldn't eat, didn't want to do anything, stopped taking it and after a week she was better

criteria for depressive disorder due to another medical condition

- prominent and persistent period of depressed mood, diminished interest and pleasure in all activities

- disturbance cant be explained by another mental disorder

- causes 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

- change in the way you think, feel, or act, caused by taking or stopping a drug, can last days or weeks

- brain makes chemicals that affect thoughts, emotions, and actions; without the right balance of these chemicals, there may be problems, many drugs change the amounts of these chemicals

drugs and medicines that cause mood problems

some drugs cause mood problems while taking them, others cause problems when you stop taking them:

- alcohol, marijuana, cocaine, LSD

- nonprescription medicines, some decongestants

- prescription medicines, high blood pressure medicine, antianxiety medicines, antidepressants, pain medicines

substance-induced mood disorder, story

a patient started smoking pot everyday, diagnosed with drug-induced psychosis, but also this, completely fried his brain, couldn't make any decisions

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, such as headaches and joint pain

- think often about death or suicide

euphoria symptoms

- high sense of self-worth and feeling on top of the world

- very talkative and talk so fast other have trouble following

- racing thoughts and trouble concentrating

- very restless

- have more feelings of anxiety and panic

- go for days with little or no sleep and not feel tired

- irritable and get into fights with others

- extremely active and act recklessly, spending sprees or having unsafe sex

treatment for substance-induced mood disorder

- can be treated with group or individual therapy

- group therapy is often very helpful

- in some cases, medicines for depression or anxiety may help you to stop substance abuse

- NA, support groups

- learning ways to relax, yoga, meditation

suicide

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

suicide continuum

1. Suicidal ideation: thinking about ending one's life

2. Developing a plan: considering how and when (not true that they don't tell anyone)

3. Suicide attempt: nonfatal suicidal behavior- not completed

4. Suicide: actual ending of one's life

suicide, stories

- her son's friend posted about how he doesn't want to live, he tells the professor, and professor tells the boys parents; the friend is "mad" but her son tells him "i'm glad your alive to be mad at me"

- her son has an assembly at school: few different people talk about their life, and pictures of people doing things (completed suicides), everyone of them had a suicide attempt, someone had gotten there in time to save their life

self-harm without the presence of suicidality

- not everyone who engages in self-harm has intent to end their life, which is why it is separate

- about defiance, self harming makes them feel in control, its addictive

self harm, story

one of her patients; self-harming her thighs, professor tells her mother that she should check on the girl every hour, next session shes a week without self-harming (bc she didn't know when her mom may walk in on her)

resilience

- a belief you can overcome diversity, good coping skills

- risk for suicide but unlikely when high in resilience

-positive psychology

monoamine oxidase inhibitors (MAOIS)

1950's, side effects lethal, interactions with certain food significant withdrawal effects

- antidepressant

tricyclic antidepressants

intense side effects, increase suicidal thoughts particularly in children and adolescents, Elavil, Anafranil

selective serotonin reuptake inhibitors (SSRIs)

3 to 5 to take effect

- antidepressants

mood-stabilizing drugs

for both depressive and euphoric episodes of bipolar disorder, most common, Lithium

Electroconvulsive therapy (ECT)

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

Transcranial Magnetic Stimulation (TMS)

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

Deep Brain Stimulation (DBS)

implants 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 skin connecting the device with the electrodes

Behavioral Activation Treatment

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

Interpersonal Therapy (IPT)

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

dissociate disorders

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

dissociative identity disorder

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

- will have large gaps in memory

dissociative identity disorder, kim noble

- kim noble; famous DID, has at least 20 different identities, learned to dissociate due to severe child abuse, patricia is the main identity, sometimes she a gay man, ken; bonnie is the mother figure that would take care of her daughter, she also is an artist and one of her personalities depicts abuse in paintings; salome is deeply religious and agitated

DID story

- when professor was working everyone believe a guy was faking the disorder, but the psychiatrist said well if he is faking it then clearly he is still ill bc he feels a need to fake it

DID characteristics

- have learned to cope with extremely stressful life circumstances by creating "alter" personalities that unconsciously control their thinking and behavior when they are experiencing stress

- usually happens as a result of severe childhood abuse or trauma

dissociative amnesia

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

Dissociative Amnesia with Dissociative fugue

- go into fugue states where they travel or wander without knowing their identity

- get an intense need to leave during the amnesia, when they get to the destination they have no idea what triggered the state

depersonalization

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

depersonalization story

professor experienced this when an older patient started crashing bc of ECT for her depression, professor went into a state, another nurse had the same experience, and it helped that they were both going through it at the same time

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

depersonalization/derealization disorder, stories

- a client had it, called it going into the twilight zone, she would drink when she went into that state to cope, ending up becoming an alcoholic

- another guy would go into those stated right before he got sick

somatic symptoms

symptoms involving physical problems and/or concerns about medical symptoms

- "somatic" comes from the Greek word "soma" meaning body

somatic symptom disorder

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

somatic symptom disorder, stories

-professors mother would go to the doctor for every little thing, ended up actually being good sometimes because they would catch everything early

- a client would go crazy every time he got a sensation; he would call his gf or mother and would just freak out about it, would get on a scale twice a day and make the school nurse take his blood-pressure every morning (teacher); she started doing systematic desensitization, can only call once and weigh himself once; his foot touched a slug once and thought he got a disease from it; she had to tell his family to only answer his call once and then ignore him; he ending up getting better but got really sick and regressed a little but now hes fine

somatic symptom disorder characteristics

- medical tests are either normal or don't explaining the person's symptoms, don't indicate medical condition, diagnosed after 6 months

- symptoms sometimes similar in other illnesses and may last for years

- usually diagnosed before 30

- not the result of conscious malingering of factitious disorders

- difficult to diagnose and treat

illness anxiety disorder (hypochondriasis)

a somatic symptom disorder characterized by the misinterpretation of normal bodily functions as signs of serious illness, does involve actually physical symptoms

- no actual physical ailment, just concerned about developing a medical condition

- may seek unnecessary medical tests and procedures to rule out or treat exaggerated or imagined illnesses

illness anxiety disorder, story

one of her friends won't go to the doctor because she's afraid to know the results

functional neurological symptom disorder (conversion disorder)

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

- "pseudoseizures," disorders of movement, paralysis, weakness, disturbances of speech, blindness, and other sensory disorders and cognitive impairment

conversion

refers to the presumed transformation of psychological conflict to physical symptoms

functional neurological symptom disorder stories

- in a movie, an explosion happens no sound, person goes deaf during the explosion despite the sound going on

- a client has a reaction to seeing her bf talking to a girl at the gym, she went blind from the stress of seeing that

malingering

involves deliberately fabricating physical or psychological symptoms for some ulterior motive (not a disorder)

- direct benefits from sick role (disability, lawsuit, insurance benefits,etc).

fictitious disorder imposed on self

fake symptoms or disorders not for the purpose of any particular gain but because of an inner need to maintain a sick role

- to get attention or sympathy from other people, internally driven goals

fictitious disorder imposed on another

inducing physical symptoms in another person who is under their care

- parents will actually make the child sick, by putting things in their food; may potentially lead to their parents killing them

fictitious disorder imposed on another story

in sixth sense, boy sees dead people, at a child's funeral the dead kid comes up to him and gives him a tape of his mother putting poison in his sister's food

theories and treatment of dissociative and conversion disorders

- nearly always precipitated by some prior trauma

CBT: help clients identify and change their thoughts linked to their physical symptoms and changed their maladaptive behavior that accompanies those irrational thoughts

- hypnotherapy and medication

psychological factors affecting other medical conditions

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

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

stress

the unplesant emotional reaction that a person has when an event is percieved as threatening

stressful life event

an event that disrupts the individual's life

coping

the process through which people reduce stress in a healthy manor

daily hassles

relatively minor events that can add up and cause significant stress that can impair mental health

problem focused coping

coping in which the individual takes action to reduce stress by changing whatever it is about the situation that makes it stressful

problem focused coping pickle story

had a boss who was horrible, making everyone cry everyday; so professor made everyone pitch in 5 dollars, put a bunch chocolate bars in a pickle jar; whoever got the worst comment from their boss that day would get a chocolate bar; professor went weeks without getting one and then finally got one

emotion based coping

coping in which a person does not change anything about the situation itself, but instead tries to improve feelings about the situation

emotion based coping story

- her son was at college and asked her to put up the christmas lights, she was overwhelmed with stress and she looks over to see her daughter wrapped up in the lights, has revelation what does she have to be stressed about, she is able to put up the christmas lights on her own house

type A-behavior pattern

a pattern of behaviors that include being hard-driving competitive, impatient, cynical and suspicious, easily irritated, and hostile towards others

type d personality

people who experience emotions that include anxiety, irritation, and depressed mood

eating disorders

persistent disturbances of eating or eating related behavior that result in changes in consumption or absorption of food

- eating behavior significantly impair the individuals physical and psychosocial functioning

feeding disorders

characterized by extreme food selectivity (beyond pickiness)

- direct result of food preferences or perceived intolerances

- issues with colors, textures, size, smells of food

feeding disorders stories

- a kid couldn't eat anything or see anything white, someone gave him a white chocolate bunny and he was very upset

- the client with reactive attachment- was very sensitive to smells, professor couldn't eat pickles, potato chips, tuna because he couldn't stand the smells and would make her go outside for the session if she did

characteristics associated with eating disorders

- body dysmorphia and related behaviors, such as negative body talk, body checking, or frequent weighing

- compensatory behaviors, self-induced vomiting or laxative abuse

- feeding and eating disorder can co-occur