Psychology 2300 Final Exam cruess

Somatic Symptom and related disorders

A group of disorders in which people experience significant physical symptoms for which there is no apparent organic cause, usually encountered in medical settings
-Conversion disorder
-Factitious disorder
-Illness anxiety disorder
-Somatic symptom disorder

Malingering

Exaggerate illness in order to escape duty or work

somatizers

a patient with frequent physical complaints for which no organic basis is found.

History of Somatic symptom disorders

Formerly called hysteria; caused by the wandering uterus

Charcot and Freud

Developed early theories of somatic symptom disorders:
-Hysterical conversions
-Hysterical neuroses
Charcot- induce pain or other physical pain in people just by suggesting it
Freud- used hypnosis to remove those types of connections in people
Recognizing it was a conflict and not medically related

Hysterical conversions

induce pain or other physical pain in people just by suggesting it
Hysterical neuroses: used hypnoses to remove those types of connections in people, recognizing it was a conflict and not medically related

Somatic symptom disorder DSM

-One or more somatic symptoms that disrupt daily life
-Excessive and disproportionate thoughts, feelings, behaviors related to the somatic symptoms
-State of being symptomatic is greater than 6 months

Somatization pattern

pain plus other types of symptoms; wide spread

Pain Pattern

anatomical pain

Illness anxiety disorder DSM

-Preoccupation with having or acquiring a serious illness
-Somatic symptoms are not present or only mild in intensity
-High level of anxiety about health and the individual is easily alarmed about personal health status
-Perform excessive health-related behaviors or maladaptive avoidance
· Two types:
o Care-seeking: will seek multiple doctors
o Care-avoidant: won't see doctor but still ruminate

where have we seen this type of thinking before? (Illness anxiety disorder)
-personality?

philosophizing- Mechanism is seen in panic attacks, and you see similar co-morbidity
-belief now is that this disorder may be a personality issue

Conversion Disorder DSM

-One or more symptoms of altered voluntary motor or sensory function
-Incompatibility between the symptom and recognized neurological or medical conditions

Glove anesthesia

Numbness beginning sharply at the wrists and extending evenly right to the fingertips; unlikely neurological due to uniformity across two separate nerves

La belle indifference

A condition in which the person is unconcerned with symptoms caused by a conversion disorder
- Neurologists and doctors called it Functional Neurological Symptom Disorder (or Psychogenic Non-epileptic Seizures)

Factitious disorder DSM

Falsification of physical or psychological signs, symptoms, of injury or disease, associated with identified deception
-Individual presents themselves to others as ill, impaired, or injured
-Deceptive behavior is evident even in the absence of obvious external rewards

Somatic symptom psychodynamic etiology

Propose that these disorders represented a conversion of underlying emotional conflicts into physical symptoms due to an Electra complex
-Primary gain
-Secondary gain

Primary gain

Bodily symptoms keep internal conflicts out of conscious awareness

Secondary gain

Bodily symptoms further enable people to avoid unpleasant activities or receive sympathy from others

Somatic symptom behavioral etiology

Propose that the physical symptoms of these disorders bring positive reinforcement to sufferers

Somatic symptom cognitive etiology

Propose tat these disorders are a form of conversion, providing a means for people to express difficult emotions; thoughts exacerbate somatic symptoms

Somatic symptom multicultural etiology

Propose that western clinicians hold a bias that sees somatic symptoms as an inferior way of dealing with emotions

Somatic symptom biological etiology

Propose that these disorders can be understood through research on placebos and the placebo effect.

Somatic symptom disorder treatment

-Insight: often psychodynamic oriented
-Exposure: client thinks about stressful event that triggered the physical symptoms
-Antidepressants
-Suggestion: usually an offering of emotional support that may include hypnosis
-Reinforcement: a behavioral attempt to change reward structures
-Confrontation: a more overt cognitive attempt to move patients out of the sick role

substance use disorder

a cluster of cognitive, behavioral and physiological symptoms that the individual will experience if they continue to use substances
-about 9% of teens and adults in the US display substance use disorders
-Only 11% receive treatment from a mental health profession...some don't have access though and there's a stigma behind it

Abuse

A use of a substance with no physiological need

Dependence

Physiological need for substance

Substance

Man-made or naturally occurring products that have psychoactive properties that effect perceptions, behaviors, thoughts, and emotions

Caffeine related disorders

-No use disorder
-Yes intoxication disorder
-Yes withdrawal disorder

Tobacco related disorders

-No use disorder
-No intoxication disorder
-Yes withdrawal disorder

Substance related disorders epidemiology

-22 million have used in past month
-25% of high school seniors used in last month
-9% of all teens/adults have disorder
-11% seek treatment

Alcohol use disorder DSM

-A problematic pattern of use leading to distress or impairment in functioning
-Taken in larger amounts over a longer than intended period
-Persistent desire to cut down on use
-Great deal of time in activities necessary to use, obtain, or recover
-Craving
-Failure to fulfill major obligations due to use
-Recurrent social/interpersonal problems caused by use
-Important activities are given up/reduced because of use
-Use in situations where hazardous
-Use continues despite knowledge of persistent problems
-Tolerance
-Withdrawal

Alcohol use disorder epidemiology

-7.4 % given year; 13% LTP
-Men 2:1
-High in native americans
-Low in asian americans
-Same in white, african, hispanics

Alcohol intoxication

-Recent ingestion
-Significant problems/changes developed during/after ingestion
-Slurred speech
-Incoordination
-Unsteady gait
-Nystagmus (eye twitching)
-Impairment in memory
-Coma

alcohol dehydrogenase

an enzyme that catalyzes the oxidation of ethanol and other alcohols aceteldehyde using NAD +, the first step in the metabolization of alcohol in the liver

Relaxation and comfort

BAC = 0.06

Intoxication

BAC = 0.09

Death

BAC > 0.55

Alcohol withdrawal DSM

Cessation of alcohol use that has been heavy and prolonged that causes:
-Autonomic hyperactivity
-Hand tremor
-Insomnia
-Nausea/vomitting
-Transient hallucinations
-Anxiety
-Psychomotor agitation
-Generalized tonic-clonic seizures

Substance related disorders psychodymanic etiology

-Propose individuals have powerful dependency needs caused by a lack of parental nurturing, leading to a certain "personality" as a result
-Possible link between early impulsive behavior and disorder

Substance related disorders behavioral etiology

Proposes operant conditioning may play a key role in disorder
-Tension reduction hypothesis
-Self-medication hypothesis
-expectancy based theory

Tension reduction hypothesis

States that individuals use substances to reduce stress; aided by a accommodating environment

Self medication hypothesis

States that substances are used to cope with psychological distress

expectancy based theory

setting yourself up to believe alcohol will provide rewards

Substance related disorders genetic etiology

-Animal and twin studies show genetic link
-Genetics affects reactivity/sensitivity
-Abnormal dopamine-2 receptor gene
-Men at greater biological risk

Substance related disorders biochemical etiology

-Ventral tegmental area, nucleus accumbens, frontal cortex
-Dopamine
-Incentive sensitization
-Reward deficiency syndrome

Incentive sensitization theory

The brain is trained to associate a substance with a reward

Reward deficiency syndrome

Substances have stronger reward effect than things in everyday life

Substance related disorders sociocultural etiology

-Stressed, low SES environments
-sociological gender differences
-Ethnic/Racial disparities
-Social learning (modeling) from family

Substance related disorders biological treatments

-Antianxiety or antidepressants
-Agonist or antagonist drugs

Substance related disorders behavioral treatments

-Aversion therapy
-Covert sensitization
-Exposure with response prevention

Covert sensitization

Behavioral treatment where the individual imagines a horrible aftermath of using a particular substance

Substance related disorders cognitive treatments

-Relapse prevention
-Support groups
-Harm reduction

Harm reduction

Scaling back substance use without pure abstinence (AA)

Pychosis

-The ability to perceive and respond to the environment is significantly disturbed
-Hallucinations and delusions
-Can be substance-induced, caused by brain injury, or from a disorder

Dementia Praecox

Coined by Emil Kraepelin referring to "early onset dementia"; Young adults with overt symptoms such as hallucinations/delusions
-Believed in neurobiological underpinnings

Eugen Bleuler

Coined "Schizophrenia"; people with negative symptoms such as association, vacant affect, autism, ambivalence.

the four As

-Associations
-Affect
-Autism
-Ambivalence

Kurt Schneider

Responsible for recognition of schizophrenia in early DSM

Schizophrenia criterion A

Two or more present for 1 month:
-Delusions
-Hallucinations
-Disorganized speech
-Disorganized or catatonic behavior
-Negative symptoms

Hallucination

Perceptions experienced without an external stimulus to the sense organs that have qualities similar to true perceptions

Formication

A combination of tactile and visual hallucinations

Delusions

Disturbances in inferential thinking that involve firmly held beliefs that are untrue

Disorganized speech

-Associative loosening (word salad)
-Illogical thinking/language
-Tangential replies
-Poverty of speech (no substance)
-Derailment (shifting off track during speech)

Persecutory

Delusion where some entity is out to get them

Grandiose

Delusion where the person believes they are special in some way

Somatic

Delusion where the person believes that they have a bodily impairment

Nihilistic

Delusion of death and destruction

Delusion of reference

Delusion where a person interprets special meaning from benign happennings

Capgras syndrome

Delusion where person thinks a friend or relative has been replaced with an alien double

Cotard's syndrome

Delusion that a vital organ has stopped working

Disorganized behavior

Behavior that is highly variable and can range from catatonic stupor to excitement
-Waxy flexibility
-Deterioration of social behavior
-Incongruity of affect

Waxy flexibility

Staying in humanly impossible postures for an extended period of time

Incongruity of affect

Displaying behavior or emotion inappropriate for the situation
-e.g. laughing at your mother's funeral

Negative symptoms

-Alogia
-Affective flattening
-Avolition
-Attentional impairment
-Anhedonia

Alogia

Lack of speech/response

Affective flattening

Emotional expression is wiped away from someone's face

Avolition

Lack of motivation toward goal-directed behavior

Schizophrenia criterion B

-For a significant portion of time since disturbance, level of functioning in major areas is markedly below the level achieved prior to onset.

Anosognosia

Lack of insight into one's illness

Schizophrenia criterion B

Continuous signs of the disturbance persist for at least 6 months, with 1 month of symptoms that meet active phase criteria.

Brief psychotic disorder

Schizophrenia symptoms lasting 1 day to 6 months

Schizophreniform disorder

Schizophrenia symptoms lasting 1 month to 6 months

Schizoaffective disorder

Met criteria for both schizophrenia and MDD/bipolar disorder

Delusional disorder DSM

-Presence of one or more delusions for 1 month or longer
-Haven't met criteria A for schizophrenia
-Functioning is not otherwise impaired and behavior is not otherwise obviously bizarre or odd
-Manic and or major depressive episodes if present are brief

Subtypes of delusional disorders

-Erotomanic
-Grandiose
-Jealous
-Persecutory

Erotomanic

Subtype of delusional disorder where the person believes that someone in the world is in love with them.

Grandiose

Subtype of delusional disorder where the person believes they have some special talent, insight, or are important

Jealous

Subtype of delusional disorder where the person believes their relationship partners are unfaithful

Delusional disorder epidemiology

-1% LTP
-Equal men and women
-Women have better long term outcome
-Onset age 21.4 in men, 26.8 in women
-Racial/ethnic bias in diagnosis

Elaine Walker studies

-Studied predictors of schizophrenia in childhood to provide evidence that symptoms may not just arise in teen years
-Left side motor weakness
-Emotional instability
-Academic problems
-Adjustment problems

Social and psychological effects of schizophrenia

-More likely to remain single or mate with mentally ill
-Low SES as artifact of disease
-Increased mortality (1/3 attempt suicide, 10% success)
-Cognitive impairment due to brain degenerization

Downward drift

Predisposition of schizophrenia leads to person becoming urban and homeless; Low SES is NOT a cause of schizophrenia

cognitive impairment

-attention and memory difficulties, have trouble with processing speed
-causes inability to relate to people, do well in school, hold a job

Phases of schizophrenia

1) Prodromal
2) Active
3) Residual

Prodromal phase

Beginning of deterioration with mild symptoms
-Mild hallucinations and delusions
-Negative symptoms

Active phase

Symptoms become apparent
-Full psychotic episode

Residual phase

A return to prodromal-like levels
-Maintained by medication

Variable course of schizophrenia

Phases of may last days or years. Fuller recovery is more likely in people with:
-Good premorbid functioning
-Stress-triggered disorder
-Abrupt onset
-Later onset
-Early treatment

Predictors of poor outcome of schizophrenia

-Male
-Poor premorbid functioning
-Social isolation
-Non-adherence to medication (if patient doesn't take medicine things will go wrong )
-Long active phase
-Psychiatric history
-Unmarried
-Childhood behavioral problems

Schizophrenia genetic etiology

-Twin studies indicate high genetic link
-10% chance of developing among first degree relatives
-COM-T gene deletion syndrome
-Most likely polygenic (multiple genes that affect)