Psychology 2300 Final Exam cruess

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108 Terms

1

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

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Malingering

Exaggerate illness in order to escape duty or work

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somatizers

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

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History of Somatic symptom disorders

Formerly called hysteria; caused by the wandering uterus

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5

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

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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

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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

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Somatization pattern

pain plus other types of symptoms; wide spread

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9

Pain Pattern

anatomical pain

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10

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

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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

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12

Conversion Disorder DSM

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

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13

Glove anesthesia

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

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14

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)

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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

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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

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Primary gain

Bodily symptoms keep internal conflicts out of conscious awareness

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Secondary gain

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

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Somatic symptom behavioral etiology

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

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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

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Somatic symptom multicultural etiology

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

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Somatic symptom biological etiology

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

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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

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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

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Abuse

A use of a substance with no physiological need

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Dependence

Physiological need for substance

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Substance

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

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Caffeine related disorders

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

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Tobacco related disorders

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

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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

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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

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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

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Alcohol intoxication

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

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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

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Relaxation and comfort

BAC = 0.06

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Intoxication

BAC = 0.09

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Death

BAC > 0.55

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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

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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

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Substance related disorders behavioral etiology

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

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Tension reduction hypothesis

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

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Self medication hypothesis

States that substances are used to cope with psychological distress

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expectancy based theory

setting yourself up to believe alcohol will provide rewards

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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

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Substance related disorders biochemical etiology

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

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Incentive sensitization theory

The brain is trained to associate a substance with a reward

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Reward deficiency syndrome

Substances have stronger reward effect than things in everyday life

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Substance related disorders sociocultural etiology

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

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Substance related disorders biological treatments

-Antianxiety or antidepressants
-Agonist or antagonist drugs

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Substance related disorders behavioral treatments

-Aversion therapy
-Covert sensitization
-Exposure with response prevention

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Covert sensitization

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

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Substance related disorders cognitive treatments

-Relapse prevention
-Support groups
-Harm reduction

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Harm reduction

Scaling back substance use without pure abstinence (AA)

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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

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Dementia Praecox

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

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Eugen Bleuler

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

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the four As

-Associations
-Affect
-Autism
-Ambivalence

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Kurt Schneider

Responsible for recognition of schizophrenia in early DSM

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Schizophrenia criterion A

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

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Hallucination

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

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Formication

A combination of tactile and visual hallucinations

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Delusions

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

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Disorganized speech

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

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64

Persecutory

Delusion where some entity is out to get them

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Grandiose

Delusion where the person believes they are special in some way

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Somatic

Delusion where the person believes that they have a bodily impairment

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Nihilistic

Delusion of death and destruction

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Delusion of reference

Delusion where a person interprets special meaning from benign happennings

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Capgras syndrome

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

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Cotard's syndrome

Delusion that a vital organ has stopped working

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Disorganized behavior

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

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Waxy flexibility

Staying in humanly impossible postures for an extended period of time

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Incongruity of affect

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

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Negative symptoms

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

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Alogia

Lack of speech/response

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Affective flattening

Emotional expression is wiped away from someone's face

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Avolition

Lack of motivation toward goal-directed behavior

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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.

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Anosognosia

Lack of insight into one's illness

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Schizophrenia criterion B

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

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Brief psychotic disorder

Schizophrenia symptoms lasting 1 day to 6 months

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Schizophreniform disorder

Schizophrenia symptoms lasting 1 month to 6 months

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Schizoaffective disorder

Met criteria for both schizophrenia and MDD/bipolar disorder

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84

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

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Subtypes of delusional disorders

-Erotomanic
-Grandiose
-Jealous
-Persecutory

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Erotomanic

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

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Grandiose

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

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Jealous

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

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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

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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

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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

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Downward drift

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

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cognitive impairment

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

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Phases of schizophrenia

1) Prodromal
2) Active
3) Residual

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Prodromal phase

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

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Active phase

Symptoms become apparent
-Full psychotic episode

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Residual phase

A return to prodromal-like levels
-Maintained by medication

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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

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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

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100

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)

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