Looks like no one added any tags here yet for you.
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)