Psychopathology I Midterm

Mood vs Affect

Mood: Patient’s subjective emotional state

Affect: Clinician’s objective observation of emotional expression

Orientation x4

Person

Place

Time

Situation/event

Thought process vs thought content

Thought process: HOW thoughts are organized

Thought content: WHAT the person is thinking about (ex: Suicidal Ideation, Homicidial ideation, delusions, obsessions)

Insight vs Judgement

insight: Awareness of illness/condition

Judgement: ability to make safe decisions and avoid harm

What is a diathesis?

A vulnerability or predisposition that increases risk for a disorder

Examples of diathesis

Genetics

family history

childhood trauma

ACEs

low SES

What is a stressor?

An event or circumstance that triggers symptoms

(ex. breakup, trauma, job loss)

Protective factors

Factors that buffer against stress

(Ex: social support, resilience, secure attachment, activities/sports)

Predisposing Factors

Long standing vulnerabilities that increase risk

“What made them vulnerable”

Precipitating Factors

Events that trigger symptoms

“What started the problem”

Perpetuating Factors

Factors that maintain symptoms

“What keeps the problem going?”

Protective Factors

Strengths and Supports

“What helps recovery?”

What does WHODAS measure?

Disability and functional impairment

WHODAS Domains

Understanding

Getting around

Self Care

Getting along

Life Activities

Participation

PLUGGS

Psychodynamic Theory

Behavior is influenced by unconscious thoughts and feelings

Transference

Patient transfers feelings from important past relationships onto therapist

Countertransference

therapist transfers feelings onto client

Repression

Keeping distressing thoughts unconscious

Denial

Refusing to acknowledge reality

Projection

Attributing your own feelings to someone else

Displacement

Redirecting feelings toward a safer target

Regression

Returning to earlier developmental behavior under stress

Sublimation

Channeling unacceptable impulses into acceptable behavior

ABC Model

A- activating event

B - belief

C- consequence

Core beliefs

deep, long-standing beliefs about self and world

Automatic thoughts

Immediate thoughts that occur automatically

Schema

Mental framework used to interpret information

PTSD criterion A

Trauma exposure

PTSD criterion B

Intrusion (flashbacks, nightmares)

PTSD criterion C

Avoidance

PTSD criterion D

Negative thoughts and mood

PTSD criterion E

Arousal / reactivity

PTSD Duration

More than 1 month

Avoidant personality disorder

Wants relationships but fears rejection

Dependent Personality Disorder

Excessive need to be taken care of

OCPD

Perfectionism

Control

Rigidity

What concepts belong to Psychodynamic Theory?

Unconscious

Attachment

Object Relations

Defense Mechanisms

Transference

Countertransference

Early Experiences (childhood)

Psychic Causality

What concepts belong to CBT?

Cognitive Distortions

ABC Model

Schemas

Core Beliefs

Automatic Thoughts

Irrational Beliefs

Faulty Cognitions

Name the 6 defense mechanisms we learned.

Repression

Denial

Projection

Displacement

Regression

Sublimation

PTSD Criteria A-E

A = Trauma Exposure

 

B = Intrusion

 

C = Avoidance

 

D = Negative Cognitions/Mood

 

E = Arousal/Reactivity

TIANA

What disorders are in Cluster C?

Avoidant PD

Dependent PD

Obsessive Compulsive PD

Core themes of Cluster C

Avoidant = fear rejection

Dependent = need others

OCPD = need control

5 Parts of Cultural Formulation Outline

Identity

Concepts of distress

Stressors/supports

Clinician patient relationship

Overall assessment

“I CAN SEE CLIENTS OFTEN”

Avoidant PD vs Schizoid PD

Avoidant = wants relationships but avoids bc of fear or rejection (afraid)

Schizoid = little desire for relationships. prefers social detachment (uninterested)

PTSD vs acute stress disorder

PTSD: Over 1 month

ASD: 3 days - 1 month

Avoidant personality disorder differential diagnosis

Social anxiety disorder (only in social situations)

Schizoid personality disorder (does not desire relationships)

Obsessive compulsive personality disorder differential diagnosis

Obsessive compulsive disorder (compulsions + obsessions)

Hoarding disorder (i cant get rid of it)

Dependent personality disorder differential diagnoses

Borderline personality disorder

Histrionic personality disorder

depression

Panic disorder

Agoraphobia

PTSD differential diagnosis

Acute stress disorder

Adjustment disorder

Anxiety disorders

Mood disorders

Personality Disorders

avoidant personality disorder vs social anxiety disorder

APD: pervasive pattern of inadequacy and fear of rejection. Affects identity and many areas of life

(self problem)

SAD: fear of social sittuations and being negatively evaluated. not necessarily a personality style (situation problem)

OCPD vs OCD

OCPD: perfectionism, control, rigidity (ego-syntonic) - likes symptoms

OCD: obsessions and compulsions (ego-dystonic) - hates symptoms

OCPD vs hoarding

OCPD: difficulty discarding bc of perfectionism, control, rigidity (control)

Hoarding: primary problem is difficulty discarding. Accumulation is main issue (possessions)

Dependednt PD vs Borderline PD

both fear abandonment

DPS: responds w clinginess & submission

BPD: responds w anger, rage, emotional instability

Dependent PD vs Histrionic PD

Both seek reasurrance

DPD: passive, self-effacing, clingy

(need help)

HPD: actively seeks attention & approval

(need attention

PTSD vs adjustment disorder

PTSD: requires trauma exposure

(trauma)

Adjustment disorder: response to a stressor; no trauma required

(stress)

Cultural Identity: What does it assess?

“WHO is the patient”

• ethnicity

• language

• religion

• gender

• sexual orientation

• SES

How does the patient identify themselves?

How important is that identity in daily life?

Cultural concepts of distress: what does it assess?

HOW does the patient understand and explain their problem?

Beliefs about:

• causes

• meaning

• outcomes

Includes culturally specific ways of expressing distress

Cultural stressors and supports: What does it assess?

WHAT helps?

• family

• community

• religion

WHAT hurts:

• discrimination

• isolation

• acculturation stress

Cultural features of clinician-patient relationship: what does it assess?

how do cultural differences AFFECT:

• Communication

• trust

• expectations

• treatment preferences

• Potential barriers to care

• 
  

Overall cultural assessment: what does it assess?

Integrates all cultural info to guide:

• diagnosis

• treatment planning

• Interventions

• Resources

What is the Mental status exam (MSE)?

semi-structured eval. that is psychiatric equivalent of a physical exam

provides a snapshot of one’s mental functioning at a specific point in time

helps w diagnosis, treatment planning, and monitoring progress

Elements of Mental status exam

Appearance

Attitude

Behavior

Cooperation

Speech

Cognition

Though process

Thought content

Mood & affect

Insight & judgement

AABC SCTT MI

DSM-5 Personality disorder changes

1. kept personality disorders in section 2

2. alternative model placed in section 3

3. move from categorical to dimensional approach

4. more trait based approach

5. no longer on axis II

Categorical vs dimensional

Categorical:

Disorder present or absent

Dimensional:

Symptoms exist on a continuum & vary is severity

Ego dystonic vs ego syntonic

Ego-DYStonic: symptoms feel unwanted, distressing and inconsistent w persons self image

Ego-SYNtonic: symptoms feel correct, acceptable, and consistent w the persons self image

Object relations:

internalized mental images of important people from early life that serve as templates for future relationships

Psychic Causality

Nothing in mental life happens by chance.

Thoughts, feelings, bxs, motives have underlying psychological causes.

Cognitive Distortions

thinking errors that distort reality and negatively influence emotions and behavior. faulty thinking.

Unconscious mind

Thoughts, feelings, memories, and motives that exist outside of conscious awareness but still influence bx. The hidden part of the mind

attachment

the emotional bond formed with caregivers - influence relationships throughout life

Irrational beliefs

Illogical beliefs that distort reality, create unhealthy emotions, and lead to self defeating bx. Bad rules people live by.

Functional impairment

difficulty performing normal daily activities because of symptoms

Examples of CBT elements.

(schema, core belief, automatic thought, cognitive distortion, irrational belief)

Schema: People judge me harshly

Core belief: I am not good enough

Automatic thought: I failed

Cognitive distortion: a B- is terrible. Im a failure (all or nothing thinking- thinking error)

Irrational belief: I must get an A on every exam or im worthless (the rule she lives by)

Acute stress disorder criteria

A. Trauma Exposure

B. 9+ symptoms from:

intrusion

negative mood

dissociation

avoidance

arousal

C. Duration: 3 days-1mo

D. Functional Impairment

Adjustment Disorder Criteria

1. Emoional/bx symptoms in response to stressor occuring within 3 mo

2. Distress that is out of proportion to the severity of the stressor

3. Functional Impairment

4. Symptoms do not persist longer than 6 mo

Prolonged grief disorder criteria

a. Death of loved on occured at least 1 year ago

B. since the death, individual has demonstrated (nearly every day):

Intense lnging for the dceased person;

preoccupation w thoughts or memories of the deceased

C. 3+ nearly every day for at least a month:

Identity disruption

disbelief about death

avoidance of reminders

intense emotional pain

difficult reintegrating into relationship and activities

emotional numbness

feeling that life is meaningless

intense loneliness

Avoidant Personality Disorder criteria

1. avoids occupational activities bc fears of criticism, disapproval or rejection

2. unwilling to get involved

3. shows restraint w intimate relationships

4. preoccupied w being criticised

5. inhibited in new interpersonal situations

6. re;uctat to take personal risks

7. views self as socially inept

Dependent personality disorder:

1. feels helpless when alone bc fears of being unale to care for self

2. avoids being alone

3. preoccuped w fears of being left to care for self

4. difficulty making everyday decisions without excessive reassurance

5. urgently seeks new relationship when one ends

6. goes excessive lengths to obtain nurturance

7. difficlty expressing disagreeent w others

8. needs others to assume responsibility

9. has difficulty iniating projects o doing thins on their own - lack of confidence

General criteria for personality disorder:

A. Impaired personality functioning

B. One or more pathological personality traits

C. Inlexible and pervasive

D. Not better explained by mental disorder

E. Not due to physical or substances

F. Not related to diversity