Advanced Psychopathology
Terms
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- step to consider when making a diagnosis
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1.) Rule out- Drugs/alcohol, medical condition, are the symptoms real?
2.)determine categories/sub-categories-start with heirarchy of disorders (psychotic d/o first)
3.) establish if it's truly a mental disorder- does the disturbance cause impairment
4.) diagnostic efficiency-parsimony (choose single most economical, efficient diagnosis that accounts for all available data) - Features of manic episode
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-at least one week of excessively high, elevated, expansive mood.
-talkativeness, grandiose sense of self, racing thoughts, increased sexual drive, decreased need for sleep, and disregard for consequences of behavior. (spending, drug abuse, intrusive..) - features of major depressive episode
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-depressed mood that last for at least two weeks
-lasting sad, anxious, or empty mood. Loss of interest or pleasure, decreased energy, feeling of fatigue, restless/irritable, too much or no sleep, suicidal thoughts or behaviors - Mood Disorders
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-Major depressive d/o
-Dysthymia
-Cyclothymia
-Bipolar I
-Bipolat II - Major Depressive Disorder
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Single Episode:
lasting at least two weeks with no history of Manic Episode. Begins at any age.
Recurrent:
two or more M.D.Episodes, separated by two consecutive months or more, wiht no history of a manic or mixed episode.
with Psychotic Features:
Hallucinations, delusion, aware that these thoughts aren't true. - Dysthymia
- depressed mood most days for at least two years (1 year for children or adolescents, 2 yrs for adults with two solid months of depression) water-ed down depression. Keeps them from fully functioning
- Depressive disorders can be..
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Acute- severe and sudden, prior to this severe depression the person was much less depressed, perhaps not at all
Chronic- had it for years
situational-have clear causes, connection
unprovoked-"out of the blue", no event associated - Prolonged grief
- Deep grief. Loss of loved one. Looks like depression, but most people feel themselves coming out of it, starting within a few days or weeks. If it goes beyond one month, it's considered prolonged. May need help.
- Etiology of Depression
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-monoamine impairment
-Stressful life events
-loss of loved one, parental neglect, abuse,
-Cognitive thoughts: how do they view and interpret stressful events
-Learned helplessness - Bipolar I
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at least one manic or mixed episodes. there may or may not have a history of major depressive episodes. (mania)
Differentials: - Bipolar II
- Presence of history of at least one major depressive episode and at least one hypomanic episode.
- Cyclothymia D/O
- A chronice mood disturbance of at least a two year duration involving several hypomanic episodes and periods of depressed mood or loss of interest/pleasure. Lack the severity and duration to be Major Depression or Manic Episode.
- Etiology for Bipolar D/O
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-runs in families
-Greater among first-degree relatives. -
Panic D/O
with or with Agoraphobia -
Spontaneous, out-of-the-blue panic attacks and are preoccupied with the fear of another happening.
-recurrent attacks followed by at least one month or more of persistent concern or worry about another - Panic attack
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period of intense fear where one feels doom or death, or that they are going crazy, chest pain, lightheadedness, dissociation, nausea, heart palpitations.
-symptoms develop abruptly and peak within 10 minutes -
Agoraphobia
(without history of P. D/O) -
fear of being in places or situations where escape might be hard or embarrassing. These places are avoided as the person fears having a panic attack.
Differentials: Social phobia, Separation Anxiety, Specific Phobia - Specific Phobia
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Irrational dread or desire to avoid a specific object, situation or activity that is usually common. Phobic know their fears are unreasonable. They are ALWAYS anticipatory.
5 types: Animal, Environment, Blood/injury/injection, Situational, other.
Sx: if under 18, must be present for at least 6 months - Social Phobia
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Fear of being judged, scrutinized, or humilitated. An excessive fear of one or more social situations. Interferes with occupational or social activites/relationships.
Differential: avoidant p. d/o
Sx: if under 18, must be present for at least 6 months. - OCD
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obessions and compulsions that interfere with daily rountine, school, job. family, and social activites. Several hours may be spent.
Obsessions: Intrusive thoughts or ideas
compulsions: intentional rituals or behaviors performed to reduce anxiety. - PTSD
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occurs after a person has witnessed a traumatic/life-threatening event.
-May re-experience trauma through recollections, flashbacks, and nightmares.
-emotional numbness, little hope for future
-avoidance of person, places, activities that are reminders
-difficulty sleeping and concentrating, feel jumpy, easily irritated and angered.
Sx: must last one month or more - Acute Stress D/O
- Sx similar to PTSD but only last 2 days to 4 weeks after trauma occurred.
- Generalized Anxiety D/O
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Persistent, excessive and unrealistic worry about everyday things. Worry must occur about two or more situations and must last for 6 months+, and occur more days than not.
Sx- (physical) muscle tension, fatigue, restlessness, trouble sleeping, irritability, gas discomfort or diarrhea. - Anxiety D/O's
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Panic, Specific, Social, PTSD, Acute, G.A.D, OCD
Etiology-genetics (relatives), biochemistry (abnormalities in the amygdala), environment, history and psychological profile (unresolved conflict from childhood) all contribute.
Neurotransmitters (GABA) and serotonin - Somatoform D/O
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Somatization, Conversion, hypochondriasis, Pain, Body Dysmorphic
People with this disorder speak not with words or about feelings, but with their bodies - Somatization D/O
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starts in teens or adolescence (before age 30)
-has had many physical complaints occuring over several years and has sought Tx. Impaired social, personal, or occupational functioning.
-must have four complaints: Pain, gastrointestinal, sexual, pseudoneurological. - Conversion D/O
- loss of a bodily disorder. i.e. blindness, paralysis, speech. It's involuntary but there's no physical cause for the dysfunction.
- Pain D/O
- Sx are physical but are not understood as a consequence of a general medical condition or use of substance. Pain is not intentionally produced. Sometimes there is a physical condition but complaining is HIGHLY exaggerated.
- Hypochondriasis
- No real illness, but person is overly obsessed over normal bodily functions. Become preoccupied with ideas of fears of having a serious illness. 6 months+
- Body Dysmorphic D/O
- Appears normal but is excessively preoccupied with an imagined defect in appearance or slight physical flaw. Frequent and somtimes long mirror checking. Or avoidance of mirrors
- Factitious D/O
- FAKING physical or psychological Sx in order to assume the sick role. Goes to extreme lengths to intentionally create the appearane of illness.
- Fact. D/O with mostly psychological Sx
- Mimicing behavior typical of a mental disorder. Might appear confused or reports hallucinations.
- Fact. D/O with mostly physical Sx
- Claim to have Sx related to a physical illness i.e. chest pain, stomach probs or fever. (Munchausen Syndrome)
- Fact. D/O with both psy'l and phy's Sx
- report Sx of both psychological and physical
- Fact. D/O NOS
- also known as Fact. D/O by proxy. People produce or fabricate Sx of illness in another person under their care. Sixth Sense mom.
- Malingering
- V-Code. Produce phys. and psych.'l Sx for external incentives (i.e. avoiding military duty, work, obtaining financial gain..)
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Dissociative D/O
-Depersonalization and Dissociative Amnesia or Fugue
-DID -
Characterized by changes in a persons sense of identity, memory or consciousness.
-splitting from conscious awareness. Part of person is elsewhere. Most arise from stressful trigger, and are sudden and end abruptly. - Dissociative Amnesia
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Most common in young adults. Suddenly unable to recall important personal information. Know they have forgotten something, but don't know what. Don't remember amnesia when memory is back
-Usually only hours to days - Dissociative Fugue
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total amnesia. Person moves away, assumes a whole new identity. Can't remember what happened during fugue.
-Several days to weeks or months. - Depersonalization D/O
- Person's perception or experience os self is altered. Feel detached from self as if in a dream or an outside observer. Must interfere. Usually resolves on it's own.
- DID- Dissociative Identity D/O
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Two or more independent personality states control at different times.
-Initially produced by abuse, then it's repression of unacceptable memories of sexual or physical abuse. It's an escape response motivated by high levels of anxiety. Dont' know what other personalities do.