MCAT Psych/Soc: Psychological Disorders and Consciousness

Mental disorder

A set of behavioral or psychological symptoms that are not in keeping with social norms and are severe enough to cause significant personal distress or impairment to social occupational, or personal functioning

• Diagnosable based on specific symptoms, treatable with various types of medication and/or therapy

When is behavior considered disordered?

1. It is unusual
2. It is maladaptive
3. It is characterized by perceptual or cognitive dysfunction
4. Disordered behavior is labeled as abnormal by the society in which it occurs

Biomedical approach to mental disorders

Assume illnesses can be fully attributed to biology

Biopsychosocial approach to mental disorders

Biology cannot account fully for the progression and onset of a disorder; instead can be explain through the integration of biological, sociocultural, and psychological factors

Anxiety disorders

• Stress response without immediate threat
• Excessive fear and/or anxiety
• Avoidance behaviors
• Sympathetic activation in the absence of threat
• Potential symptoms include: disproportionate fear and sadness without apparent cause, frequent suicidal ideations
• High distress and worry about the future
• Include phobias, panic disorder, generalized anxiety disorder, social anxiety disorder

Phobias

• A very specific fear
• Types of phobias include situational, natural environment, blood/injection/injury, and animal

Panic disorder

Includes panic attacks

Generalized anxiety disorder

Excessive anxiety without a specific cause

Social anxiety disorder

Fear/anxiety around social situations

Depressive disorders

Sad, empty, and/or irritable mood; not related to normal grief

Symptoms of major depressive disorder

• Depressed or irritable mood
• Fatigue/loss of energy
• Feelings of worthlessness or guilt
• Impaired concentration, indecisiveness
• Insomnia or hypersomnia
• Loss of interest or pleasure in almost all activities (anhedonia)
• Restlessness or feeling slowed down
• Recurring thoughts of death or suicide
• Significant weight gain or loss

The monoamine hypothesis of depression

Predicts that underlying pathophysiologic basis of depression is a depletion in the levels of serotonin, norepinephrine, and/or dopamine in the central nervous system; treat is primarily anti-depressants

Bipolar disorders

• Bridge between psychotic and depressive disorders
• Involves episodes and oscillations (cycles)
• Cycle between depressed and manic phases
• Depressed phase characterized by: low energy, low self esteem, lack of concentration, loss of interest, helplessness, and suicidal thoughts
• Manic phase characterized by: high energy, high self esteem, racing thoughts, quick talking, impulsiveness, irritability

Bipolar I vs. Bipolar II disorder

• Bipolar I: mood swings tend toward mania
• Bipolar II: dominant swings into depression, hypomania (less intense manic episodes)

Schizophrenia spectrum and psychotic disorders

• Delusions, hallucinations
• Disorganized speech and thoughts
• May involve “negative” symptoms
• Involve a general detachment from objective reality
• Specific diagnoses include: delusional disorder, brief psychotic disorder, schizophreniform disorder, schizophrenia, schizoaffective disorder

Positive symptoms of schizophrenia

Psychotic behaviors not seen in healthy people; hallucinations, delusions, disorganized speech or behavior

Negative symptoms of schizophrenia

Disruptions to normal emotions and behaviors, absence of normal patterns; avolition (loss of motivation to do things), flattened affect, reduced speech and/or interactions

Cognitive symptoms of schizophrenia

Thought patterns that make it hard to lead a normal life and cause emotional distress; poor executive functioning, trouble focusing or paying attention, problems with working memory

Biological indicators of schizophrenia

• Too much dopamine
• Enlarged brain ventricles

Trauma- and stressor-related disorders

• Exposure to traumatic or stressful event
• Exhibit any of a wide range of symptoms

Symptoms of Posttraumatic Stress Disorder (PTSD)

Intrusive thoughts/dreams, insomnia, general detachment from reality, avoidance of triggers

Acute stress disorder

PTSD, but it occurs and resolves itself within a month of exposure to the traumatic event

Adjustment disorders

Patient exposed to a mild trauma or stressor but has intense symptoms; typically the patient has a hard time coping

Personality disorders

• Enduring (often lifetime) patterns of inflexible behaviors across a range of settings and relationships
• Diagnosis begins in adolescence or early adulthood
• HIGH comorbidity with depression and anxiety

Cluster A personality disorders

Odd/eccentric disorders

• Paranoid, schizoid, schizotypal personality disorders
• Think of these as milder versions of schizophrenia

Cluster B

Dramatic/erratic personality disorders; antisocial, borderline, histrionic, and narcissistic personality disorder

Cluster C disorders

Anxious/fearful disorders; avoidant, dependent, and obsessive-compulsive personality disorders

Characteristics of paranoid PD, schizoid PD, and schizotypal PD

• Paranoid PD manifests the paranoid tendencies
• Schizoid PD manifests the social withdrawal and flattened affect (“zoid” → void → negative symptoms of schizophrenia)
• Schizotypal PD manifests odd behavior and distorted thinking/perception (positive symptoms of schizophrenia)

Antisocial PD

Sociopathy, with no regard for right or wrong or others’ rights

Borderline PD

Severe abandonment anxiety and emotional turbulence

Histrionic PD

Overdramatic attention seeking and emotional overreaction

Narcissistic PD

Inflated sense of self and lack of empathy

Avoidant PD

Very extreme shyness and fear of rejection

Dependent PD

Over-dependence on others to meet needs

Obsessive-compulsive PD

Rigid concern with order and perfectionism

Obsessive-compulsive disorders

Obsessions (thoughts or urges) and/or compulsions (repetitive behaviors)

Specific kinds of obsessive-compulsive disorders

Body dysmorphic disorder, hoarding disorder, trichotillomania (hair-pulling disorder)

Somatic symptom disorders

Excessive and/or medically unexplainable symptoms, commonly encountered in primary care

Specific somatic symptom disorders

Somatic symptom disorder, illness anxiety disorder (used to be called hypochondria), conversion disorder, factitious disorder

Factitious disorder

Someone deceives others by appearing sick, by purposely getting sick, or by self-injury

Conversion disorder

A person experiences physical and sensory problems, such as paralysis, numbness, blindness, deafness or seizures, with no underlying neurologic pathology

Dissociative disorders

• Disruptions and/or discontinuities in core identity
• Abnormal integration of consciousness, identity, emotion, etc.
• Specific diagnoses: dissociative identity disorder, dissociative amnesia, depersonalization/derealization disorder

Neurodevelopmental disorders

• Manifest early in development (early onset), usually before grade school
• Appear as deficits, generally difficult to treat
  • Characterized by intellectual disability, communication disorders
  • Includes ADHD, ASD, intellectual disability, and Tourette’s syndrome

Attention-Deficit/Hyperactivity Disorder (ADHD)

• Unknown causes
• Affects 2-4% of school age children
• Motor restlessness, difficulty paying attention, distractibility, impulsivity

Autism Spectrum Disorder (ASD)

• Range of complex neurodevelopmental disorders, characterized by social impairments, communication difficulties, and restricted, repetitive, and stereotypes patterns of behavior

Common signs of ASD

• Impaired social interaction (avoiding eye contact with people , difficulty interpreting what others are thinking or feeling, may lack empathy)
• Repetitive movements such as rocking and twirling, or self-abusive behavior such as biting or head-banging
• Inability to play interactively with other children

Neurocognitive disorders

• Cognitive decline from a previous level of performance in complex attention, executive function, learning, memory, language, perceptual-motor, or social cognition
• Symptoms may interfere significantly with a person’s everyday independence in a major neurocognitive disorder, but not in a mild neurocognitive disorder

Alzheimer’s Disease

• Progressive disease beginning with mild memory loss
• Destruction and death of nerve cells that causes memory failure, personality changes, problems carrying out daily activities and other symptoms of Alzheimer’s disease
• Two abnormal structures in the brain associated with Alzheimer’s disease:
  • Amyloid plaques: clumps of protein fragments that accumulate outside of cells
  • Neurofibrillary tangles: clumps of altered proteins inside cells

Parkinson’s Disease

• Primarily caused by abnormally low dopamine levels
• Dopaminergic neurons in the substantia nigra of the basal ganglia die off, making it harder to control movements
• Dopamine is involved in sending messages to areas of the brain that control coordination and movement
• Dopamine levels progressively drop, so symptoms gradually become more severe
• Abnormal aggregates of proteins called Lewy bodies develop inside neurons

Sleep-wake disorders

Disturbance in quality, timing, and/or amount of sleep

Insomnia

Inability to fall or remain asleep

Dyssomnias

Abnormalities in the amount, quality or timing of sleep (insomnia, narcolepsy, and sleep apnea)

Narcolepsy

Periodic, overwhelming sleepiness during waking periods

Sleep apnea

Intermittent cessation of breathing during sleep, which results in repeated awakenings

Parasomnias

Abnormal behaviors that occur during sleep

Somnambulism

Sleep walking

• Occurs in slow wave sleep (stage 3)
• Happens during the first third of the night
• Many children experience sleep walking but eventually grow out of it

Night terrors

Appear terrified, babbling, screaming while in deep sleep; usually occur during stage 3, unlike nightmares, which occur during REM sleep towards the morning

Substance-related and addictive disorders

Involve brain’s reward system, tolerance and withdrawal

• Substance use disorders, alcohol-related disorders, caffeine-, cannabis-, hallucinogen-, etc- related disorders
• Gambling disorder

Depressants examples, mechanism of action, effects

• Alcohol, barbiturates, opiates
• Depresses CNS (especially fight or flight reflex)
• Impaired motor control, organ failure from overdose

Stimulants examples, mechanism of action, effects

• Caffeine, nicotine, amphetamines, cocaine
• Increases availability and action of neurotransmitters
• Sympathetic activation; “rush” or “high” followed by crash

Hallucinogens examples, mechanism of action, effects

• LSD, marijuana, THC
• Distorts perceptions
• Hallucinations (lights, colors, etc.); impaired judgment, slowed reaction time

Dependence

Develops when a person needs to use a drug in order to function normally

Tolerance

Occurs when an individual must use more of a drug to achieve the desired effect

Withdrawal

Group of symptoms that occur when a person who has formed a drug dependence suddenly stops using; symptoms are drug-specific and dose-dependent

Addiction

Defined as compulsive drug use despite harmful consequences, an inability to stop using

Consciousness

Awareness we have of ourselves, our internal states, and the environment; important for reflection and directs our attention

Always needed to complete novel and complex tasks

States of consciousness include: alertness (being awake), sleep

Reticular activating system (RAS)

Controls alertness and arousal

Characteristics of alpha waves

Associated with relaxed, normal consciousness

Characteristics of beta waves

Higher frequency than alpha, more alert consciousness

Characteristics of theta waves

Seen in young children, meditative states, and stage 1 sleep

Characteristics of delta waves

Occurs during slow wave sleep

Circadian rhythms

Control the increases and decreases in our alertness in predictable ways over a 24-hr cycle

Biological indicators of a mammal’s circadian rhythms

Melatonin levels released from the pineal gland, body temperature, and serum cortisol levels

Suprachiasmatic nucleus (SCN)

Regulates sleep, melatonin production by the pineal gland, and body temperature. The daily pattern of cortisol production by the adrenal cortex is influenced by several interacting systems, only one of which is the master clock in the SCN

NREM1 Sleep Stage

• Associated with theta waves
• Slow eye rolling movements
• Moderate EMG activity
• Fleeting thoughts; non-REM sleep

NREM2

• Associated with sleep spindle and K-complex
• No eye movement
• Moderate EMG activity
• Increased relaxation, decreased temperature, heart rate, and respiration

NREM3 Sleep Stage

• Associated with delta waves
• No eye movement
• Moderate EMG activity
• Heart and digestion slow; growth hormones secreted; deepest level of sleep

REM Sleep Stage

• Similar to beta waves but more jagged
• Bursts of quick eye movements
• Almost no activity (“paradoxical sleep”)
• When dreams occur

Hypnosis

• State of consciousness in which attention is more focused and peripheral awareness is reduced
• Some studies demonstrate more low-frequency and fewer high-frequency waves during hypnosis

Meditation

Practice in which an individual induces a mode of consciousness for some purpose

• Stress reduction
• Increase activity in left frontal lobe → more optimism
• Improved concentration, lower blood pressure, better immune function
• Lower frequency alpha and theta waves