7. Psychological Disorders (4%)

Biomedical Approach

Biomedical vs. Biopsychosocial Approach

Therapy includes interventions that rally around symptom-reduction of psychological disorders

Assumes that any disorder has roots in biomedical disturbances, and thus the solution should also be of a biomedical nature

Fails to take into account many of the other sources of disorders

Biopsychosocial Approach

Biomedical vs. Biopsychosocial Approach

This method assumes that there are biological, psychological, and social component's to an individual's disorder

Goal is to provide both direct therapy and indirect therapy

Direct Therapy

Direct vs. Indirect Therapy

Acts directly on the patient, such as medications or counseling

Indirect Therapy

Direct vs. Indirect Therapy

Consists of increasing social support for the individual by educating the family and friends of the patient

psychotic disorders

a general class of disorders marked by the following symptoms: delusions, hallucinations, disorganized thought, disorganized behavior, catatonia, and negative symptoms

Schizophrenia

Name the Psychotic Disorder

Marked by delusions, hallucinations, disorganized thought, disorganized behavior, catatonia and negative symptoms

Characterized by a break between an individual and reality

Positive Symptoms

Schizophrenia - Positive vs. Negative Symptoms

Symptoms of behaviors, thoughts, or feelings added to normal behavior

EX: delusions or hallucinations.

Negative Symptoms

Schizophrenia - Positive vs. Negative Symptoms

The absence of normal behaviors

EX: disturbance of affect and avolition

Delusions

Schizophrenia - Positive Symptoms

False beliefs discordant with reality and not shared by others in the individual's culture that are maintained in spite of strong evidence to the contrary

Delusions of Reference

Schizophrenia - Delusions of Reference vs. of Persecution vs. of Grandeur

The belief that common elements in the environment are directed toward the individual

A positive symptom

Delusions of Persecution

Schizophrenia - Delusions of Reference vs. of Persecution vs. of Grandeur

The belief that the person is being deliberately interfered with, discriminated against, plotted against, or threatened

A positive symptom

Delusions of Grandeur

Schizophrenia - Delusions of Reference vs. of Persecution vs. of Grandeur

The belief that the person is remarkable in some significant way

A positive symptom

Thought Broadcasting

Schizophrenia - Positive Symptoms

The belief that one's thoughts are broadcast directly from one's head to the external world

Thought Insertion

Schizophrenia - Positive Symptoms

The belief that thoughts are being placed in one's head

Hallucinations

Schizophrenia - Positive Symptoms

Perceptions that are not due to external stimuli but have a compelling sense of reality

Most common type is auditory

Disorganized Thought

Schizophrenia - Positive Symptoms

The loosening of associations that may be exhibited as speech in which ideas shift from one subject to another or as if their speech has no structure

Neologisms

Schizophrenia - Positive Symptoms

Sometimes schizophrenics create new words

A variation of disorganized thought

Disorganized Behavior

Schizophrenia - Positive Symptoms

A person's inability to carry out activities of daily living such as paying bills, maintaining hygiene, and keeping appointments

Catatonia

Schizophrenia - Positive Symptoms

Refers to certain motor behaviors characteristic of some people with schizophrenia

The patient’s spontaneous movement and activity may be greatly reduced or the patient may maintain a rigid posture, refusing to be moved

At the other extreme, behavior may include useless and bizarre movements not caused by an external stimuli, echolalia, or echopraxia

Echolalia

Schizophrenia - Positive Symptoms

Repeating other people's words

A specific type of catatonic behavior

Echopraxia

Schizophrenia - Positive Symptoms

Imitating other people's actions

A specific type of catatonic behavior

Affect

Schizophrenia

Refers to the experience and display of emotion

Disturbance of this is a negative symptom

Blunting

Schizophrenia - Disturbance of Affect/Negative Symptoms

A lack of emotional responsiveness, seen through limited facial expressions, flat vocal tone, and reduced gestures

Emotional Flattening (aka Flat Affect)

Schizophrenia - Disturbance of Affect/Negative Symptoms

Where a person shows a reduced or absent outward expression of emotion, even if they feel it internally

Inappropriate Affect

Schizophrenia - Disturbance of Affect/Negative Symptoms

When a person's emotional expression doesn't match the situation or their words

EX: laughing hysterically while describing a parent’s death

Avolition

Schizophrenia - Affective/Negative Symptoms

Marked by decreased engagement in purposeful, goal-directed actions

A severe lack of motivation or inability to initiate and persist in goal-directed activities, making everyday tasks like hygiene, chores, or social interaction difficult to start or finish

depressive disorders

a general class of disorders characterized by feelings of sadness that are severe enough, in both magnitude and duration, to meet specific diagnostic criteria

depressive disorders

What class of disorders are these symptoms of?

sadness, sleep, loss of interest (anhedonia), guilt, low energy, concentration, appetite, psychomotor symptoms, suicidal thoughts

(mnemonic = Sadness + SIG E. CAPS)

Major Depressive Disorder (MDD)

Depressive Disorders

A type of depressive disorder characterized by at least one major depressive episode

Classified by severity

Major Depressive Episode

Depressive Disorders

A period of at least two weeks with a depressed mood, loss of interest in life, appetite disturbances, substantial weight changes, sleep disturbances, low energy, difficulty concentrating, etc...

(at least 5/9 of the depressive symptoms are encountered, which must include either depressed mood or anhedonia & the symptoms must be severe enough to impair one’s daily social or work-related activities)

Anhedonia

Depressive Disorders

The loss of interest in formerly enjoyed activities

Persistent Depressive Disorder (PDD)

Depressive Disorders

A type of depressive disorder diagnosed to patients who lack the severity of major depressive disorder

When an individual experiences a period, lasting at least 2 years, in which they experience a depressed mood on the majority of days

Classified by duration

Dysthymia

Depressive Disorders

a depressed mood that is not on the scale of major depressive disorder.

Seasonal Affective Disorder (SAD)

Depressive Disorders

A type of major depressive disorder with season onset

The dark winter months are believed to be the source of depressive symptoms

Bipolar Disorders

a general class of disorders characterized by both depressive and manic symptoms, which if severe and persistent enough can be labelled as episodes

Manic Symptoms

Bipolar Disorders

symptoms thought of as prolonged and exaggerated emotion of happiness or joy

bipolar disorders

(***these are the MANIC symptoms)

What class of disorders are these symptoms of?

distractibility, irresponsibility, grandiosity, flight of thoughts, activity or agitation, sleep, talkative

(mnemonic = DIG FAST)

Hypomanic Episodes

Bipolar Disorders - Manic vs. Hypomanic Episodes

When manic symptoms are present for at least 4 days and include at least 3 or more of the 7 defined manic symptoms, yet the symptoms are not severe enough to impair the person’s social or work activities

Manic Episodes

Bipolar Disorders - Manic vs. Hypomanic Episodes

when manic symptoms (3 or more of the defined 7) are severe enough to impair a person’s social or work activities and persist for at least 7 days

Bipolar I Disorder

Bipolar Disorders

A type of bipolar disorder characterized by the presence of manic episodes

Depressive symptoms and major depressive episodes may also occur but are not a requirement for diagnosis

Bipolar II Disorder

Bipolar Disorders

A type of bipolar disorder characterized by the presence of both a major depressive episode and a hypomanic episode, but NOT a manic episode

Cyclothymic Disorder

Bipolar Disorders

A type of bipolar disorder characterized by the presence of less-severe manic and depressive symptoms for the majority of time over a 2-year (or longer) period

Monoamine/Catecholamine Theory of Depression

Bipolar Disorders

theory stating that too much norepinephrine or serotonin in the synapse leads to mania while too little leads to depression.

Anxiety Disorders

A general class of disorders characterized by irrational and excessive fear or anxiety that affects an individual’s daily functioning

They each are classified by the situation or stimulus that induces anxiety

Specific Phobias

Anxiety Disorders

A type of anxiety disorder in which anxiety is produced by a specific object or situation

The most common type of anxiety disorder

Social Anxiety Disorder

Anxiety Disorders

A type of anxiety disorder in which anxiety is brought about by social situations with the belief that the individual will be exposed, embarrassed, or simply negatively perceived by others

Avoidant behavior to the point of social or occupational impairment is necessary for diagnosis

Panic Disorder

Anxiety Disorders

A type of anxiety disorder characterized by repetitive panic attacks

Diagnosis requires the recurrence of unexpected panic attacks wherein there is no clear trigger and the panic attacks are seemingly random

Agoraphobia

Anxiety Disorders

A type of anxiety disorder in which anxiety brought about by being in places where escape would be difficult

People tend to be uncomfortable leaving their homes, using public transportation, being in open spaces, waiting in lines, or simply being in crowds

Generalized Anxiety Disorder (GAD)

Anxiety Disorders

A type of anxiety disorder defined as disproportionate and persistent worry about various things for at least 6 months

In addition, the worrying is difficult to control, even in cases where the individual knows that their worrying and fear is irrational

Obsessive Compulsive Disorder (OCD)

Anxiety Disorders

A type of anxiety disorder characterized by obsessions, which bring about tensions and compulsions that relieve tension but cause significant impairment to a person’s life

The relationship between the two is key → obsessions raise the individual’s stress level, and the compulsions relieve that stress

A diagnosis requires that the compulsions impair one’s daily activities

Body Dysmorphic Disorder

Anxiety Disorders

A type of anxiety disorder in which person has an unrealistic negative evaluation of their personal appearance and attractiveness, usually directed toward a certain body part (this is known as preoccupation, a type of worry which lacks the disastrous ideation that accompanies obsessions)

The belief persists even with clear evidence to the contrary

trauma- and stressor-related disorders

A general class of disorders characterized by a traumatic event being the source of symptoms

Typical responses include fear, helplessness, and anxiety but uniquely also include maladaptive symptoms such as anhedonia, dysphoria, aggression, or dissociation

Posttraumatic Stress Disorder (PTSD)

Trauma- & Stressor-Related Disorders

A type of trauma- and stressor-related disorder that occurs after experiencing or witnessing a traumatic event

Consists of intrusion symptoms, arousal symptoms, avoidance symptoms, and negative cognitive symptoms

To meet diagnostic criteria, a particular number of these symptoms must be present for at least one month

Avoidance Symptoms

PTSD - Avoidance vs. Intrusion vs. Negative Cognitive vs. Arousal Symptoms

Deliberate attempts to avoid the memories, people, places, and activities associated with the trauma.

Intrusion Symptoms

PTSD - Avoidance vs. Intrusion vs. Negative Cognitive vs. Arousal Symptoms

Recurring reliving of the event such as flashbacks and nightmares.

Negative Cognitive Symptoms

PTSD - Avoidance vs. Intrusion vs. Negative Cognitive vs. Arousal Symptoms

An inability to recall key features of the event.

Arousal Symptoms

PTSD - Avoidance vs. Intrusion vs. Negative Cognitive vs. Arousal Symptoms

An increased startle response, irritability, and anxiety.

Dissociative Disorders

a general class of disorders in which the person avoids stress by escaping from parts of their identity but otherwise still have an intact sense of reality

Dissociative Amnesia

Dissociative Disorders

a type of dissociative disorder characterized by an inability to recall past experiences due to trauma, not a neurological disorder

Dissociative Fugue

Dissociative Disorders - Dissociative Amnesia

A sudden, unexpected move or purposeless wandering away from one's home or location of daily activities

Individuals are confused about their identity and can even assume a new identity — they may actually believe they are someone else, with a complete backstory

Dissociative Identity Disorder (DID)

Dissociative Disorders

A type of dissociative disorder where there are two or more personalities that recurrently take control of a person's behavior

Results when the components of identity fail to integrate

In most cases, patients have suffered from severe physical or sexual abuse as young children

Depersonalization/Derealization Disorder

Dissociative Disorders

A type of dissociative disorder wherein a person feels detached from their own mind and body, or from their surroundings

These feelings cause significant impairment of regular activities, but even during these times such patients do not display psychotic symptoms like delusions or hallucinations

somatic disorders

a general class of disorders characterized by somatic (bodily) symptoms that cause significant stress or impairment

Somatic Symptom Disorder

Somatic Disorders

A type of somatic disorder characterized by having at least one somatic symptom, which may or may not be linked to an underlying medical condition, and that is accompanied by disproportionate concerns about its seriousness, devotion of an excessive amount of time and energy to it, or elevated levels of anxiety

Illness Anxiety Disorder

Somatic Disorders

A type of somatic disorder characterized by being consumed with thoughts about having or developing a serious medical condition

Most patients were previously classified under hypochondriasis in the DMS-IV-TR

Conversion Disorder

Somatic Disorders

A type of somatic disorder characterized by unexplained symptoms affecting voluntary motor or sensory functions that are incompatible with the patient’s neurophysiological condition

EX: paralysis or blindness without evidence of neurological damage

Was historically called hysteria

Personality Disorder

a general class of disorders characterized by a pattern of behavior that is inflexible and maladaptive, causing distress or impaired functioning in at least two of the following → cognition, interpersonal functioning, or impulse control

Ego-Syntonic

Ego-Syntonic vs. Ego-Dystonic

A psychological disorder is considered this when a person believes that their behavior is correct, normal, or in harmony with their goals

EX: Personality disorders

Ego-Dystonic

Ego-Syntonic vs. Ego-Dystonic

A psychological disorder is considered this when a mentally ill person believes their illness was thrust upon them

EX: most of the disorders covered in this chapter EXCEPT for personality disorders

Paranoid, Schizotypal, Schizoid

Personality Disorders

WORD BANK: Paranoid, Antisocial, Borderline, Avoidant, Dependent, Schizotypal, Schizoid, Obsessive-Compulsive, Histrionic, Narcissistic

name the 3 personality disorders found in Cluster A (all marked by behavior that is labeled as odd or eccentric by others)

Antisocial, Borderline, Histrionic, Narcissistic

Personality Disorders

WORD BANK: Paranoid, Antisocial, Borderline, Avoidant, Dependent, Schizotypal, Schizoid, Obsessive-Compulsive, Histrionic, Narcissistic

name the 4 personality disorders found in Cluster B (all marked by behavior that is labeled as dramatic, emotional, or erratic by others)

Avoidant, Dependent, Obsessive-Compulsive

Personality Disorders

WORD BANK: Paranoid, Antisocial, Borderline, Avoidant, Dependent, Schizotypal, Schizoid, Obsessive-Compulsive, Histrionic, Narcissistic

name the 3 personality disorders found in Cluster C (all marked by behavior that is labeled as anxious or fearful by others)

Paranoid Personality Disorder

Personality Disorders

WORD BANK: Paranoid, Antisocial, Borderline, Avoidant, Dependent, Schizotypal, Schizoid, Obsessive-Compulsive, Histrionic, Narcissistic

A type of Cluster A personality disorder

Marked by pervasive distrust of others and suspicion regarding their motives

In some cases, these patients may actually be in the prodromal phase of schizophrenia

Schizotypal Personality Disorder

Personality Disorders

WORD BANK: Paranoid, Antisocial, Borderline, Avoidant, Dependent, Schizotypal, Schizoid, Obsessive-Compulsive, Histrionic, Narcissistic

A type of Cluster A personality disorder

Refers to a pattern of odd or eccentric thinking

They may have minor delusions of reference, or magical thoughts and superstitious beliefs

Schizoid Personality Disorder

Personality Disorders

WORD BANK: Paranoid, Antisocial, Borderline, Avoidant, Dependent, Schizotypal, Schizoid, Obsessive-Compulsive, Histrionic, Narcissistic

A type of Cluster A personality disorder

Involves a pervasive pattern of detachment from social relationships and a restricted range of emotional expression.

Antisocial Personality Disorder

Personality Disorders

WORD BANK: Paranoid, Antisocial, Borderline, Avoidant, Dependent, Schizotypal, Schizoid, Obsessive-Compulsive, Histrionic, Narcissistic

A type of Cluster B personality disorder

Marked by a pattern of disregard for and violations of the rights of others

3x more common in males

Displayed by many serial killers and career criminals

People with this disorder make up ~ 20-40% of prison populations

Borderline Personality Disorder

Personality Disorders

WORD BANK: Paranoid, Antisocial, Borderline, Avoidant, Dependent, Schizotypal, Schizoid, Obsessive-Compulsive, Histrionic, Narcissistic

A type of Cluster B personality disorder

Marked by a pervasive instability in interpersonal behavior, mood, or self-image

Interpersonal relationships are often intense and unstable

May use splitting as a defensive mechanism, in which they view others as either all good or all bad

2x more common in females

Histrionic Personality Disorder

Personality Disorders

WORD BANK: Paranoid, Antisocial, Borderline, Avoidant, Dependent, Schizotypal, Schizoid, Obsessive-Compulsive, Histrionic, Narcissistic

A type of Cluster B personality disorder

Characterized by constant attention-seeking behavior;

Weird clothes, dramatic behavior, extremely extroverted

Narcissistic Personality Disorder

Personality Disorders

WORD BANK: Paranoid, Antisocial, Borderline, Avoidant, Dependent, Schizotypal, Schizoid, Obsessive-Compulsive, Histrionic, Narcissistic

A type of Cluster B personality disorder

One has a grandiose sense of self-importance or uniqueness, preoccupation with fantasies of success, a need for constant admiration and attention, and characteristic disturbances in interpersonal relationships such as feelings of entitlement

They often have very fragile self-esteem and are constantly concerned with how others view them

Avoidant Personality Disorder

Personality Disorders

WORD BANK: Paranoid, Antisocial, Borderline, Avoidant, Dependent, Schizotypal, Schizoid, Obsessive-Compulsive, Histrionic, Narcissistic

A type of Cluster C personality disorder

The affected individual has extreme shyness and fear of rejection

Dependent Personality Disorder

Personality Disorders

WORD BANK: Paranoid, Antisocial, Borderline, Avoidant, Dependent, Schizotypal, Schizoid, Obsessive-Compulsive, Histrionic, Narcissistic

A type of Cluster C personality disorder

Characterized by a continuous need for reassurance from others

Tend to remain dependent on one person to take action and make decisions

Obsessive-Compulsive Personality Disorder (OCPD)

Personality Disorders

WORD BANK: Paranoid, Antisocial, Borderline, Avoidant, Dependent, Schizotypal, Schizoid, Obsessive-Compulsive, Histrionic, Narcissistic

A type of Cluster C personality disorder

Where the individual is perfectionistic and inflexible, tending to like rules and order

Sometimes they are unable to discard worn-out objects, lack a desire to change, and excessively stubborn

Unlike OCD this is lifelong and ego-syntonic → (“I just like rules and order!” as opposed to “I can’t stop washing my hands because of the germs!”)

dopamine, neuroleptics, dopamine, neuroleptic, nerve, antipsychotics

Schizophrenia

Schizophrenia is highly associated with an excess of __________ in the brain. Many medications used to treat schizophrenia, such as ____________, block ____________ receptors. The term ____________ means that these medications depress ________ function. These drugs are also known as ________________.

Depressive Disorders

What are these biomarkers of? - Depressive vs. Bipolar Disorders

• High glucose metabolism in the amygdala.

• Hippocampal atrophy after a long duration of illness.

• Abnormally high levels of glucocorticoids.

• Decreased norepinephrine, serotonin, and dopamine.

Bipolar Disorders

What are these biomarkers of? - Depressive vs. Bipolar Disorders

• Increased norepinephrine and serotonin.

• Higher risk if a parent has it.

• Higher risk for a person with multiple sclerosis.

Alzheimer’s Disease

A type of dementia characterized by gradual memory loss, disorientation to time and place, problems with abstract thought, and a tendency to misplace things

Later stages are associated with changes in mood or behavior, changes in personality, difficulty with procedural memory, poor judgement, and loss of initiative

Alzheimer’s Disease

What are these biomarkers of? - Alzheimer’s vs. Parkinson’s Disease

• Diffuse atrophy of the brain on CT or MRI.

• Flattened sulci in the cerebral cortex.

• Enlarged cerebral ventricles.

• Deficient parietal lobe blood flow (correlated with cognitive decline)

• Acetylcholine reduction.

• Choline acetyltransferase reduction (the enzyme that produces acetylcholine).

• Reduced metabolism in the temporal and parietal lobes.

• Beta-amyloid plaques.

• Neurofibrillary tangles of hyperphosphorylated tau protein.

Parkinson's Disease

A neurological disease characterized by bradykinesia, resting tremor, pill-rolling tremor, masklike facies, cogwheel rigidity, and a shuffling gait

Resting Tremor

Parkinson’s Disease - Resting vs. Pill-Rolling Tremor

A tremor that appears when the muscles aren't being used.

Pill-Rolling Tremor

Parkinson’s Disease - Resting vs. Pill-Rolling Tremor

Flexing and extending the fingers while moving the thumb back and forth.

Masklike Faces

Parkinson’s Disease

A facial expression consisting of static and expressionless facial features.

Cogwheel Rigidity

Parkinson’s Disease

Muscle tension that intermittently halts movement as an examiner attempts to manipulate a limb.

Shuffling Gait

Parkinson’s Disease

Stooped posture with small shuffling steps of low ambulatory efficiency.

Parkinson's Disease

What are these biomarkers of? - Alzheimer’s vs. Parkinson’s Disease

Decreased dopamine production in the substantia nigra, which is a layer of cells in the brain that produces dopamine to permit proper functioning of the basal ganglia.

L-DOPA, dopamine

Parkinson’s Disease

Parkinson’s Disease can be partially managed with _______, a precursor that is converted to __________ once in the brain, replacing that which is lost due to Parkinson’s Disease.

Antipsychotic

Parkinson’s Disease

_____________ medications often lead to “parkinsonian” side effects, like muscle rigidity and flattened affect.

Parkinson’s Disease

Medications used in ____________ __________ often lead to psychotic side effects, such as hallucinations and delusions.