EPPP - Abnormal Psychology DSM-IV (OLD) Part 1

The American Psychiatric Association’s Diagnostic & Statistical Manual of Mental Disorders (DSM) Version IV & Text Revision (TR). Published in 2000

The DSM-IV-TR is a diagnostic system that:

Uses a categorical approach (divides the mental D/O’s into types that are defined by a set of Dx criteria) & polythetic criteria sets (for most D/O’s requires the indiv. to present only w/a subset of characteristics from a larger list);

Predominantly a theoretical w/regard to etiology; &

Makes use of a multiaxial classification system that involves describing a person’s condition in terms of 5 dimensions.

The DSM-IV-TR utilizes a categorical approach that divides mental D/O’s into types that are defined by a set of diagnostic criteria:

Involves determining whether or not a person meets the criteria for a given Dx.

Works best when all members of each category are homogeneous, which does not always apply to people w/mental D/O’s.

Used by the DSM-IV-TR

This approach conceptualizes behavior in terms of a continuum that ranges from normal/healthy to pathological & involves rating a person on each Sx or other characteristic (e.g., on a scale 1 to 10)

The DSM includes a Polythetic criteria set for most D/O’s to allow for heterogeneity that requires an indiv. to present w/only a subset of characteristics from a larger list.

Ex: 2 ppl can have somewhat different Sx but receive the same Dx.

The DSM-IV-TR includes a polythetic criteria set.

5 dimensions or axes

biopsychosocial model

The GAF scale is used to rank the indivs. psychological, social, & occupational Fx on a scale from 0 to 100 (w/100 representing superior functioning) on Axis V.

Two factors are considered when assigning a GAF score:

Sx severity and

Level of Fx.

The multiaxial diagnostic system describes a person’s condition in terms of 5 dimensions/axes that “promote the application of the biopsychosocial model in clinical, educational, & research settings” (p. 27):

Axis I:* Clinical Disorders & Other Conditions that may be a Focus of Clinical Attention (v codes).

Axis II:* Personality disorders & Mental Retardation.

Axis III:* General Medical Conditions

Axis IV:* ​Psychosocial and Environmental Problems

Axis V:* Global Assessment of Functioning (GAF scale) a scale used to rank the individuals psychological, social, and occupational functioning on a scale that ranges from 0 to 100.

To ensure that consideration will be given to the possible presence of Personality Disorders & Mental Retardation, NOT because pathogenis or range of appropriate Tx is fundamentally different than Axis I

In the DSM-IV-TR, diagnostic uncertainty about the indivs. condition is indicated by coding on Axis I or II:

Dx (or Condition) Deferred - coded when there is not enough info. to make a definite Dx.

Specific Dx (Provisional) - used when there is sufficient info. for a tentative, but not firm, Dx.

(Class of D/O) Not Otherwise Specified - Class of Dx’s used when there is adequate info. to know that a D/O belongs to a particular category but not enough info. to make a more specific Dx or when features of the D/O do not meet the criteria for a more specific Dx.

The Outline for Cultural Formulation recommends that clinicians consider five elements:

The client’s cultural identity;

The cultural explanation for the CT’s illness;

Cultural factors relevant to the CT’s psychosocial environment & level of Fx;

Cultural factors relevant to the relationship between the client and therapist; and

How cultural factors may impact the client’s Dx & care.

Developmental D/O involving:

Significantly subaverage intellectual Fx (IQ = 7O or below on IQ test)

Impaired adaptive Fx in 2 Areas (Does not meet expected standard of personal Independence for culture/age in at least 2 areas of Fx: communication, self-care, self-direction, social skills, Fx academic skills, work or safety, etc.)

An onset prior to age 18.

Correct Dx: if ppl w/IQ of 71-75 & level of adaptive Fx is subtantially impaired.
4 degrees of severity are:

Mild Mental Retardation (IQ 50-55 to 70):

Moderate Mental Retardation (IQ 35-40 to 50-55);

Severe Mental Retardation (IQ 20-25 to 35-40);

Profound Mental Retardation (IQ below 20-25).

4 degrees of severity are:

1. Mild Mental Retardation (IQ 50-55 to 70): 6th grade level & Adults live independently w/min. sup.;

2. Moderate Mental Retardation (IQ 35-40 to 50-55): 2nd grade level & Adult perform skilled/semi-skilled work w/reg. sup.;

3. Severe Mental Retardation (IQ 20-25 to 35-40): Basic self-care skills & Adults perform simple tasks while closely supervised;

4. Profound Mental Retardation (IQ below 20-25): Need highly structured env. & Indiv. sup.

Delays in motor development

Lack of age appropriate interest in environmental stimuli

a. Lack of eye contact during feeding

b. Less responsive to voice & movement than would be expected

Heredity Causes - 5% (Tay-sachs, Fragile X Syndrome, PKU)

Early alterations of embryonic development - 30% (Down Syndrome, Damage due to toxins)

Pregnancy & perinatal probs - 10% (Fetal malnutrition, anoxia, HIV)

General medical conditions during infancy or childhood - 5% (lead poisoning, encephalitis, malnutrition)

Environmental factors and other mental D/O’s - 15-20% (deprivation of nurturance or stimulation, Autistic Dx)

Unknown causes (Approx. 30-40%)

A rare recessive gene syndrome due to an inability to metabolize the amino acid phenylalanine, found in high-protein foods.

If untreated, produces:

irreversible moderate to profound retardation,

impaired motor & language devel., &

unpredictable, erratic behaviors.

​Sx’s include:

Mental retardation

Microcephaly (condition in which a person’s head is significantly smaller than normal for their age and sex)

Vomiting & Diarrhea

Movement D/O’s

Seizures

D/O can be detected at birth by a blood test & its Sx prevented by a diet low in phenylalanine (milk/dairy,meat, fish)

Due to the presence of an extra 21st chromosome & is estimated to be the cause of 10-30% of all cases of moderate to severe retardation.

Characterized by:

Moderate to severe Mental Retardation

Delayed motor devel. & physical growth

Assoc. w/physical abnormalities including:

Slanted, almond-shaped eyes,

Broad flat face

Cataracts,

Respiratory defects

Tend to age more rapidly than other ppl,

Life expectancy below normal,

At higher risk for Alzheimer‘s disease/dementia, leukemia & heart defects/lesions.

Approp. Dx for people with IQ’s in the 71-84 range.

Persons who fall into this categorization have:

A relatively normal expression of affect for their age, though their ability to think abstractly is rather limited.

Reasoning displays a preference for concrete thinking.

Others may describe such a person as “simple” or “a little slow”.

They are usually able to Fx day to day w/out assistance, including holding down a simple job & the basic responsibilities of maintaining a dwelling

If s/he has substantial deficits in adaptive functioning.

Due to a deletion on chromosome 15

Sx’s include:

Mental Retardation

Decreased muscle tone

Short stature

Insatiable appetite

Morbit obesity

(Etiology of MR)

Dx when a person’s:

Score on a measure of academic achievement is substantially below (usually 2 SD’s or more) his/ her score on a(n) IQ test & the discrepancy cannot be fully explained by a sensory deficit.

The most common co-diagnosis is ADHD (20-30%); evidence that LD associated w/high risk for antisocial behavior & arrest/conviction for antisocial behaviors.

More common in Boys.

(Communication D/O) is characterized by:

Disturbance in normal fluency and

Time patterning of speech that is inapprop. for the individual’s age;

Connot be completely explained by a speech-motor or sensory deficit.

Onset:* Btwn ages of 2-7

Effective Tx*: Habit reversal, which combines regulated breathing, awareness training, & social support.

Etiology:* 3 times more common in males, & in 60% of cases it remits spontaneously by 16 y.o.

Reduction of psychological stress at home, stop reprimanding child for stuttering & teach coping strategies for frustration

Regulated breathing:

Involves reassuring the individual that s/he can speak without stuttering

Incorporates breathing & vocalization exercises & graded speech assignments

Habit reversal, which combines regulated breathing, vocal exercises, awareness training (aware of situations words that evoke stuttering), & social support (parents encourage & reinforce childs efforts to speak w/out stuttering)

Involve severe & pervasive impairments in communication & social interaction &/or the presence of stereotyped behaviors & activities.

Included in this category are:

Autistic Disorder,

Rett's Disorder,

Childhood Disintegrative Disorder,

Asperger‘s Disorder.

Autistic Disorder is a pervasive developmental disorder with onset by age 3, characterized by:

1. Impaired social interaction (e.g., poor eye contact, limited facial expressions, difficulty with peer relationships),

2. Impaired communication (e.g., delayed speech, echolalia, pronoun reversal), and

3. Restricted, repetitive behaviors or interests (e.g., narrow interests, hand-flapping, rocking).

Prognosis is better for those with verbal communication by age 5–6, IQ >70, and later onset of symptoms.

Etiology involves genetic and CNS abnormalities, neurotransmitter irregularities, and it is 4–5 times more common in males.

Most effective are:

Behavioral techniques (e.g., shaping & discrimination training for communication) by Lovaas.

improving daily living, communication, and social skills

Reducing undesirable behaviors

Used behavioral technique for Autism, one found to be most effective:

Shaping & discrimination training to teach non-speaking children to immitate others verbally & improve communication skills.

Originally described by Lovaas (1960) & continue to be used to improve communication skills.

(Pervasive Devel D/O) Characteristic devel. pattern of multiple Sx following a period of normal devel. for 5 + mos. Sx's include:

Head growth deceleration;

Loss of previously acquired purposeful hand skills

Loss of expressive language

Devel. of stereotypical movements (e.g., hand-wringing);

Impairments in the coordination of gait or trunk movements; -

Loss of interest in the social environment;

Severely impaired language development; and

Psychomotor retardation.

DSM-IV-TR states that this D/O “has been reported only in females"; yet is evidence it's occasionally occurs in males but that males w/this D/O often die shortly after birth (e.g., Kerr, 2002).

(Pervasive Developmental D/O) is characterized by distinct pattern of developmental regression after 2 yrs. of normal devel. in at least 2 areas of Fx. Sympotms include:

Loss of previously acuired language (expressive or receptive), motor, social skills, play, self-help skills & bowel or bladder control

Characteristic abnormalities in social interactions, communication & adaptive behaviors

(Pervasive Developmental Disorder) Essential features include:

Severe impairment in social interactions

Restrictive, repetative paterns of behavior, interests & activity, w/no substantial delays in cognitive, language, or self-help skills.

ADHD is a disruptive behavior disorder with onset before age 7, symptoms in at least two settings (e.g., home and school), and persistence for 6+ months.
Symptoms include inattention (e.g., forgetfulness, distractibility) and/or hyperactivity-impulsivity (e.g., fidgeting, excessive talking, interrupting).
Three subtypes: Predominantly Inattentive, Predominantly Hyperactive-Impulsive, and Combined Type.

At least 60% of children w/ADHD continue to have some Sx as adults.

For most adults, inattention is the predominant Sx & includes inconsistency in the ability to concentrate, difficulty establishing and maintaining routines, and an inability to prioritize and complete important tasks & activities.

Hyperactivity is less apparent & manifests itself as fidgiting & restlesness.

Similar associated Sx's as child/adolesc. related to social relations & ED & Occupational Fx

Prevalence of ADHD in Adults 1-5%

conduct disorder (30 to 90%)

learning disorder (up to 50%)

oppositional defiant disorder

anxiety disorder

major depression

Conduct Disorder is characterized by a persistent pattern of violating the rights of others or age-appropriate social rules, with at least 3 symptoms in the past 12 months.

Symptoms include theft/deceit, serious rule violations, aggression, and property destruction.

Other features: lack of remorse, blaming others, little concern for others’ well-being, and misinterpreting others’ actions as hostile.

Two subtypes: Childhood-Onset (before age 10; higher aggression, risk for antisocial personality) and Adolescent-Onset (age 10 or later).

Associated with persistent antisocial behavior and increased risk of later substance use or personality disorders.

Life-Course Persistent: Begins early (~age 3), involves escalating antisocial behavior due to neurological deficits, difficult temperament, and adverse environment, with a wide range of crimes, including victim-oriented offenses.

Adolescence-Limited: Temporary antisocial behavior during adolescence caused by a “maturity gap”, limited to acts that mimic adult privileges or autonomy.

The distinction highlights differences in onset, severity, and underlying causes of antisocial behavior.

Essential features are a recurrent pattern of:

Negativistic, defiant, & hostile behaviors toward authority figures.

Sx include (Min. 4 Sx's - BAD AVATAR):

Blames others for own mistakes or misbehaviors;

Argues with adults;

Deliberately annoys people;

Angry & resentful

Vindictive or spiteful

Actively defies or challenges the rules or requests of adults;

Temper; often losses temper;

Antagonistic

Rule Refusal

(Tic D/O) Characterized by at least:

1 vocal tic (Clicks, grunts or barks) &

Multiple motor tics (Deep knee bends, facial grimaces & eye blinks).

Onset of Sx's before 18

Duration of Sx's 1yr. +

Onset:* 6-7 years old; more common in males

Etiology:*

May share a genetic basis w/OCD & abnorm. in the basal ganglia & frontal lobes.

Linked to abnorm. (elevated) levels of dopamine.

Comorbidity:

Most common assoc. Sx are obsessions & compulsions

Sx of ADHD, reason they often do poorly in school.

Tx:*

Antipsychotic drugs - Haloperidol & compliance a problem due to adverse side effects.

Transient Tic Disorder

Sx's began before age 18

An individual w/tics that do not meet the criteria for a specific Tic disorder & onset after 18 w/ a duration less than 4 weeks.

Enuresis is an elimination disorder involving repeated involuntary urination in a child who has reached an age where continence is expected.
It can occur during the day or night and is not caused by a medical condition or substance use.
Treatment includes behavioral therapy, especially the bell-and-pad (night alarm) method, which is most effective long-term.
Pharmacotherapy options include imipramine (reduces wetting; high relapse after discontinuation) and desmopressin (short-term benefit, poor long-term outcome).
Research shows behavioral interventions are more effective than drugs for sustained results.

Bell-and-pad (aka night alarm) effective in up to 80% of cases; -causes a bell to ring when the sleeping child begins to urinate

1/3 of kids exhibit some degree of relapse within six months of the initial treatment

effectiveness increased when combined with other behavioral techniques (e.g., behavioral rehearsal or overcorrection)

Separation Anxiety Disorder is a childhood anxiety disorder with developmentally inappropriate, excessive fear of separation from home or attachment figures.
Symptoms persist for at least 4 weeks with onset before age 18.
Children show distress during separation, fear for caregiver’s safety, nightmares, and reluctance to be alone.
Physical complaints such as headaches or stomachaches often occur when separation is anticipated.
Common manifestations include school refusal or difficulty sleeping alone, often triggered by a stressful life event.

Reactive Attachment Disorder is an early childhood disorder caused by pathogenic care, resulting in developmentally inappropriate social behavior.
Symptoms begin before age 5 and are directly linked to inadequate caregiving.
There are two subtypes:
Inhibited: persistent failure to initiate or respond to social interactions; overly inhibited or ambivalent.
Disinhibited: indiscriminate sociability; no preference for familiar caregivers and overly familiar with strangers.

Disclosure - Open communication w/child about illness; cope better if told early on in Devel. appropriate way.

Hospitalization - Hospitalized children are at increased risk for emotional & behavioral problems (Dependency, disrputive behaviors, anxiety, depression or severe withdrawl).

Physical Disabilities - Children with physical disabilities are at increased risk for emotional & behavioral problems.

School-Related Problems - Children & adolescents with chronic medical conditions have higher rates of school-related problems (e.g., CNS irradiation & intrathecal chemotherapy for leukemia have been linked to impaired neurocognitive functioning and learning disabilities).

Compliance - with medical regimens is a particular difficulty for adolescents.

Involves:

Persistent eating of nonnutritive substances (e.g., paint, plaster, insects, and clay) for at least 1 month w/out an aversion to food.

Behavior is inappropriate for the person‘s developmental level &

Is not part of a culturally-sanctioned practice.

Onset: Btwn ages of 12-24 months; occasionally found in pregnant women.

Adjustment Disorders involve a maladaptive reaction to one or more stressors that is excessive compared to the expected response.
Symptoms develop within 3 months of the stressor and do not persist beyond 6 months after its resolution.
Types include with anxiety, depressed mood, disturbance of conduct, mixed anxiety and depressed mood, or mixed disturbance of emotions and conduct.
Specifiers categorize the disorder as acute (<6 months) or chronic (≥6 months).
The disorder reflects emotional or behavioral difficulties in response to identifiable stressors.

Delirium is characterized by a disturbance in consciousness with reduced awareness, distractibility, and impaired attention, often accompanied by cognitive and perceptual changes.

Cognitive changes include memory and language impairment, disorientation, while perceptual disturbances include illusions and hallucinations.

It has a rapid onset with fluctuating course, commonly triggered by fever, head injury, nutritional deficiencies, medical illness, or substance use/withdrawal.

Most affected populations are children and older adults, especially when medical conditions or medication changes are present.

Treatment focuses on addressing the underlying cause and reducing agitation through environmental, psychosocial interventions, and sometimes antipsychotic medications.

Involves:

Disturbance in consciousness & other Cog. Fx

Autonomic Hyperactivity

Tremors

Insomnia

Nausea & vomiting

Confusion

Vivid Hallucinations & Delusions

Seizures potentially fatal form

Following a period of prolonged heavy use.

Dementia is a progressive cognitive disorder with insidious onset, characterized by memory impairment (anterograde and retrograde amnesia) and denial of cognitive deficits.

It involves at least one other cognitive impairment, such as aphasia, apraxia, agnosia, or impaired executive functioning.

Causes include general medical conditions or substance use, with multiple subtypes.

Cortical dementias (e.g., Alzheimer’s) show early anterograde amnesia, while subcortical dementias (e.g., Huntington’s, Parkinson’s) show early retrograde amnesia.

Vascular dementia results from arteriosclerosis or cerebrovascular disease, often with stepwise progression.

Major Depressive Disorder that involves prominent cognitive Sx that may be mistaken for Dementia (especially in older adults) & is referred to as pseudodementia.

Onset:

Usually abrupt,

Exaggeration of cognitive problems

Person is concerned about his/her impairments,

Greater impairment in recall & procedural memory (vs. declarative) but intact recognition memory

Person is likely to emphasize failures & be uncooperative during testing.

.

Alzheimer’s dementia is a cortical dementia with gradual onset and slow, progressive decline in memory and cognitive function, occurring in three stages: early (anterograde amnesia, personality changes), middle (retrograde amnesia, agitation, delusions, apraxia), and late (severe cognitive deterioration, incontinence, rigidity).

Caused by degeneration of medial temporal lobe structures (hippocampus, amygdala, entorhinal cortex) and associated with low acetylcholine levels.

More common in females, usually late-onset (>65 yrs), with average duration of 8–10 years.

Vascular dementia results from cognitive impairments caused by cerebrovascular disease such as arteriosclerosis or stroke.

It has an abrupt onset with stepwise or fluctuating decline and a patchy pattern depending on brain lesion location.

Cognitive deficits often include focal neurological signs like weakness, abnormal reflexes, or sensory deficits.

Diagnosis is supported by CT or MRI showing cortical or subcortical lesions.

Recovery and prognosis depend on the underlying cause, with risk factors including hypertension, diabetes, smoking, and atrial fibrillation.

(Subcortical Dementia)

Includes:

Retrograde Amnesia initally prominent

Parkinsonism

Hallucinations

Frontal & visospatial deficits

Fluctuating course

Sx depend on location & extent of brain injury.

Usually the subcortical type & likely to involve:

Changes in personality,

Deficits in executive cognitive Fx,

Altered experience &

Expression of emotion (Frank, 2005).

If Head Trauma is cause of a single brain injury, it is usually non-progressive; yet, repeated injury (e.g., from boxing) can result in a progressive form of dementia referred to as dementia pugilistica.

HIV-related dementia involves cognitive impairment (forgetfulness, poor attention, problem-solving difficulties) and psychomotor slowing, along with psychiatric symptoms (depression, anxiety), motor deficits (ataxia, tremors), apathy, and social withdrawal.

Early signs include subtle forgetfulness and slowed movements, progressing through six stages from normal to end-stage vegetative state.

Stage progression ranges from subclinical/mild impairment to moderate/severe functional disability, eventually leading to loss of speech, mobility, and continence.

Dx criteria:

Memory impairment w/some degree of Anterograde amnesia (Inability to acquire & recall new info.) w/or w/out Retrograde amnesia (impairment in the ability to recall previously acquired info.

Appropriate Dx when memory loss is known to be due to a general medical condition or substance use & usually has no difficulty learning new info. or recalling personal info. from prior to the occurrence of the trauma/stressor.

Does not occur exclusively during the course of Delirium or Dementia

Alcohol-Induced Persisting Amnestic Disorder (Korsakoff Syndrome) is characterized by:

Due to alcohol/sibstance abuse

Retrograde amnesia,

Anterograde amnesia, and

Confabulation (Fill in memory gaps w/inaccurate or imagined info & believe it's real)

Effects recent long-term memory more than remote memory (trouble recalling events that happened before D/O than events earlier in life)

Believed to be due to a thiamine deficiency.

involves 1 or more episodes of an inability to recall important personal info. that cannot be attributed to ordinary forgetfulness

The gaps in memory are often related to a traumatic event

Most common types are localized & selective

Retrospective gaps in the recall of aspects of the indiv. past often related to a trauma/stressor

Alcohol withdrawal involves:

Autonomic hyperactivity,

Hand tremor,

Insomnia,

Nausea or vomiting,

Anxiety,

Transient illusions or hallucinations, and

Grand mal seizures following cessation of prolonged or heavy alcohol use.

Alcohol-Induced Sleep Disorder is usually of the Insomnia Type and can be the result of Alcohol Intoxication or Withdrawal.

Substance dependence involves continued use despite significant substance-related problems over a 12-month period.

Key symptoms include taking larger amounts than intended, unsuccessful attempts to cut down, and spending excessive time using or obtaining the substance.

It leads to neglect of social, occupational, or recreational activities and persistent use despite physical or psychological harm.

Tolerance and withdrawal may occur, indicating physiological dependence.

The condition is often referred to as addiction, reflecting compulsion, tolerance, and withdrawal.

Conger (1956) Proposed that alcohol reduces anxiety, fear & other states of tension & ppl drink alcohol to reduce tension which leads to addiction. Thus, the addiction is the result of negative reinforcement.

RPT views addiction as an overlearned maladaptive habit and focuses on preventing relapse.

Relapse often triggers an “abstinence violation effect” involving self-blame, guilt, anxiety, and depression, increasing vulnerability to further use.

Relapse risk is reduced when lapses are seen as mistakes due to specific, controllable factors rather than personal failure.

Therapy involves identifying high-risk situations (negative emotions, cues, or social pressure) that may trigger relapse.

Behavioral and cognitive strategies, such as coping skills training, cognitive restructuring, self-efficacy enhancement, and lapse management, are taught to prevent or manage relapses.

Predictors of successful smoking cessation attempts include:

Male gender,

Older age (35+)

Later age at the initiation of smoking, and

Low nicotine dependence.

Live in girfriend or Married

Interventions are most effective when they include a combo of:

Nicotine replacement therapy;

Multicomponent behavior therapy; and

Support & assistance from a clinician.

Sx include:

Resemble a moderate-severe case of the flu (e.g., sweating, nausea, abdominal cramps, and fever)

Occur following cessation of or a substantial reduction in the use of an opioid following prolonged or heavy use.

Sx occur following abrupt cessation of or reduction in the use of nicotine after daily use for at least several weeks and include:

Depressed mood,

Insomnia,

Irritability,

Anxiety,

Restlessness,

Impaired concentration,

Decreased heart rate, and

Increased appetite.

Schizophrenia requires ≥6 months of disturbance, including ≥1 month of active-phase symptoms with 2+ symptoms.

Positive symptoms (THREAD): Delusions, Hallucinations (auditory), Disorganized speech/behavior.

Negative symptoms (LESS): Flat affect, Alogia, Avolition.

Subtypes: Paranoid, Disorganized, Catatonic, plus Undifferentiated and Residual.

Onset: 18–25 (males), 25–35 (females); prevalence 0.5–1.5%.

Causes: Genetic, brain abnormalities, dopamine dysregulation.

Treatment: Antipsychotics, CBT, family therapy; misdiagnosis higher in African Americans.

Sx's (Type 1) - Excess of Normal Fx includes:

Thinking may become disturbed (Delusions)

Hallucinations (usually Auditory)

Reduced contact w/reality

Emotional control affected (Incongruent Affect)

Arousal may lead to worsening Sx's

Disorganized Speech (word salad) & Behavior

Appears to reflect an excess/distortion of normal Fx including delusions, hallucinations, disorganized speech, and grossly disorganized or catatonic behavior. (Type I)

THREAD

Sx's (Type 2) - Restriction in ramge & intensity of emotions & other Fx's:

Loss of volition (Avolition: reduction in goal directed behavior)

Emotionally Flat (Affective flattening)

Speech Reduced

Slowness in movement & thought; psychomotor agitation (Alogia: poverty of thought/speech)

Involve a restriction in the range & intensity of emotions & other Fx & includes affective flattening, alogia (poverty of thought & speech), and avolition (restricted initiation of goal directed behavior). (Type II)

LESS

Rates of Schizophrenia are higher among those with genetic similarity,

more similarity = higher concordance rates.

Bio. siblings 10%

Identical twins 48%

Fraternal twins 17%

A better prognosis for Schizophrenia is associated with:

Later age at onset

Presence of a precipitating event

Good premorbid adjustment

An acute & late onset,

Female gender,

Absence of structural brain abnormalities

Brief duration of active-phase symptoms,

Insight into the illness,

A family Hx of a Mood Disorder, and

No family Hx of Schizophrenia

Prognosis better when indiv. is aware of thier illness

Attribute Schizophrenia to elevated levels/oversensitivity in dopamine receptors.

Also can be abnormalities on other neurotransmitters such as elevated dopamine, norepinepherine &/or serotonin

High levels of expressed emotions by family members (open criticism and hostility toward the patient, or alternatively, overprotective, symbiotic relationships) are associated with a high risk for relapse and rehospitalization for individuals with Schizophrenia.

From best (1) to worst (5) prognosis:

SchizoiD Personality D/O = Distant (Avoids)

SchizoTypal Personality D/O = Magical Thinking (Not your Typical)-ME PECULIAR

SchizophreniFORM D/O = Form from stress (1-6mos.; 6+ mos. Schizophrenia)

Schizophrenia D/O = +(THREAD)/-(LESS) (6+ mos. w/1 mo. 2 active phase Sx's)

Schizoaffective D/O = Schizophrenia(psychotic) + Mood D/O (Except 2 weeks w/psychotic; no mood Sx's)

(Psychotic D/O) identical to Sx of Schizophrenia except for:

Involving active-phase psychotic Sx with

A duration of symptoms for at least 1 month but less than 6 months.

Involves delusions, hallucinations, disorganized speech, &/or grossly disorganized behavior that has:

a duration btwn 1 day to 1 month &

Eventually returns to premorbid Fx.

Onset follows an overwhelming stressor.

Characterized by:

An uninterrupted period of active phase illness involving (Psychotic & Mood Sx)

Concurrent Sx of Schizophrenia & symptoms of Major Depressive, Manic, or Mixed Episode that includes:

A period of at least 2 weeks w/out prominent mood Sx

Onset:* Early adulthood

Prognosis:* Somewhat better than for Schizophrenia, but worse than a Mood D/O.

Schizophrenic + Mood D/O

Involves 1 or more nonbizarre delusions that last for at least 1 month & do not substantially impair functioning.

2 types:

Erotomanic (belief that someone is in love with the individual of higher status) and

Unspecified (which is appropriate when the indiv. dominant delusions do not clearly fit the criteria for a specific type; delusions of reference).

Other Types:

Grandiose (inflated sense of self worth, power, knowledge)

Jealous

Persecutory (belief one is being attacked, harrased, persecuted, etc)

Somatic

MDD involves one or more major depressive episodes without history of manic, hypomanic, or mixed episodes.

Key symptoms (DEAD SWAMP) include Depressed mood, Energy loss, Anhedonia, Death/Suicidal thoughts, Sleep/appetite changes, Worthlessness, Attention/concentration problems, and Psychomotor changes.

Symptoms last at least 2 weeks and may present differently by age (irritability in children, aggression in adolescents, cognitive/physical issues in older adults).

Etiology involves neurotransmitter abnormalities (low norepinephrine and serotonin) and a strong genetic component.

Treatment typically includes antidepressants, CBT, or interpersonal therapy.

Depression has been linked to a number of alterations in sleep quality & quantity:

Assoc. w/ decreased sleep continuity

Reduced slow-wave sleep

Shortened/Decreased REM Latency (Earlier onset of REM sleep)

Increased REM Density (Increased frequency of rapid eye movements)

Requires the presence of characteristic symptoms:

Depressed mood and/or

Loss of interest or enjoyment in customary activities

For at least 2 weeks

That represents a change from previous functioning w/sufficently severe impaired Fx

Episode can last 3-6 months, Sx's remit at 6 months & may or may not return

Prior to puberty, rates are about equal for males and females

In adolescence, the rate for females is about 2x the rate for males and continues into adulthood

Lifetime risk of D/O in community samples ranges from 10-25% for women & 5-12% for men.

Strong genetic component:

Twin Studies Identical .50 & Fraternal .20

1.5 to 3 times more common in 1st degree bio. relatives

Dx Criteria (DIG FAST):

Involves a period of 1 week or longer w/psychotic features w/significantly impaired functioning (occupational/social) or need for hospitalization:

The prevailing mood is abnormally & persistently elevated, expansive or irritable.

Distractibility

Indiscrection (excessive involvement in pleasurable activities)

Grandiosity

Flight od Ideas

Activity Increases

Sleep Deficit (Decreased need for sleep)

Talkativness (Pressured Speech)

Dx Criteria (TAD HIGH):

Characterized by a distinct period of abnormally & persistently elevated, expansive or irritable that:

lasts for 4 days &

Accompanied by 3 Sx of a Manic Episode.

There is a clear change in mood & Fx but not severe enough to cause marked impairment in (occupational/social) Fx or require hospitalization & absence of psychotic Sx.

Talkative

Attention Deficit

Decreased need for sleep

High self-esteem/Grandiosity

Ideas the race

Goal directed activity increased

High-risk activity

Dx Criteria: Lasts for 1 week and involves rapidly alternating Sx of Manic & Major Depressive Episodes. * Disturbance is severe enough to cause marked impairment in social & occupational Fx or requires hospitalization or alternatively includes psychotic Sx.

The specifier with Postpartum Onset is applied to Major Depressive D/O, Bipolar I Disorder, Bipolar II Disorder, or Brief Psychotic Disorder when:

Onset of Sx is w/in 4 weeks postpartum.

10-20% of women experience Sx that are sufficiently severe to meet the Dx criteria for Major Depressive D/O &

Addl. Sx's include preoccupation w/infant's weel-being that can range from excessive concern to unplesant fears & thoughts about harming the child

Up to 70%-85% experience milder symptoms ("baby blues").

In Northern Hemisphere, Major Depressive D/O is linked to winter mos. for some CT's.

Sx include:

Decreased activity

Hypersomnia (Sleep disturbances)

Loss of libido,

Increased appetite & weight gain, and

Cravings for carbohydrates.

Tx: Phototherapy - exposure to bright light that mimics sunlight is an effective.

Seligman's original (1970) model proposes that:

Depression is due to repeated exposure to uncontrollable negative life events &

attributions of the negative events are internal, stable, & global (Attribution theory - believe his/her own fault).

Abramson, Metalsky, and Alloy (1980) revised the original theory to:

emphasize the role of hopelessness

predicts that exposure to negative life events leads to depression and attributions of those events to internal, stable & global factors contribute to a sense of helplessness and an inability to control those events.

(Beck) Depression is related to a negative cognitive triad that consist of negative beliefs about:

onself,

the world (situation), &

the future

that devel. during childhood as the result of negative life experiences.

Ex: A Dep. person may believe that she is a failure, that no one can do anything to help her suceed & nothing is going to change in the future.

Dx criteria (HES 2 SAD):

presence of a chronically depressed mood present most of the time

that is not severe enought to meet the criteria for a Major Dep. Episode &

lasts for at least 2 years in adults or 1 year in children/adolescents.

Hopelessness

Energy loss or fatige

Self-esteem low

2 years min. of Depressed mood most of day for more days than not

Sleep (increased/decreased)

Appetite (increased/decreased)

Decision-making or concentration impaired

Tx: Interpersonal therapy & CBT are both useful but may be less effective than for Major Dep. D/O. Outcome improve when CT goes for maintenence session & Tx combined w/antidepressants.

Lewinsohn (1974) operant conditioning.

Attributes Dep. to a low rate of response-contingent reinforcement for social & other behaviors (e.g. as the result of the death of a partner or change in social environment), which results in:

extinction of those behaviors as well as

pessimism,

low self-esteem,

social isolation, &

other features of depression that tend to reduce the likelihood of positive reinforcement in the future

Compared 3 Tx types:

CBT,

Interpersonal therapy (IPT), &

The tricyclic imipramine for depression.

Inital res. results found all 3 were effective & their effects did not differ significantly overall, but imipramine was somewhat better for CT's w/severe Sx.

A follow up study indicated that only 30% of CT's receiving CBT remained Sx free 18 mos. later compared to:

26% receiving IPT,

19% receiving imipramine, and

20% in the placebo group

Bipolar I involves ≥1 manic or mixed episode, with or without a major depressive episode.

Symptoms include impulsivity, mood liability, hyperthymic premorbid personality, overeating/oversleeping, and abrupt onset with agitation.

Often comorbid with anxiety or substance use disorders and shows family history of bipolar or schizophrenia.

Onset typically in early 20s, equally common in males and females, and genetically influenced.

Treatment usually involves lithium or anticonvulsants to manage mania/hypomania.

Bipolar II involves ≥1 major depressive episode and ≥1 hypomanic episode, without any full manic or mixed episodes.

Symptoms include impulsivity, mood liability, hyperthymic premorbid personality, overeating/oversleeping, and abrupt behavioral changes.

Often comorbid with anxiety or substance use disorders and shows family history of bipolar or schizophrenia.

Onset typically in early 20s, more common in females, and genetically influenced.

Treatment usually involves lithium or anticonvulsants to manage hypomania and mood instability.

Dx criteria:

Periods of fluctuating hypomanic Sx (periods) &

numerous periods of depressive Sx for

at least 2 years in adults or 1 year in children/adolescence.

High risk for suicide is associated with:

A warning,

Previous attempts,

A plan (especially involving a lethal weapon),

Male gender,

Being divorced/separate and

Feelings of hopelessness

Rates are highest for Whites, an exception is for American-Indian/Alaskan Native adolescents & young adults

Related to mental D/O's the highest risk is associated w/Major Dep.

Suicide attempters (vs. completers) are most likely to be female & under the age of 35

Panic disorder involves ≥2 unexpected panic attacks with at least 1 month of persistent worry or behavioral change related to attacks.

Symptoms (PANICS) peak within ~10 minutes and include Palpitations, Apprehension, Nausea, Intense fear, Choking/chest pain, Shortness of breath/sweating/shaking.

Attacks must not be due to a medical condition and may mimic heart attack or hyperthyroidism.

Three types: unexpected (uncued), situationally bound (cued), situationally predisposed.

Treatment: in vivo exposure with response prevention, sometimes combined with SSRIs, TCAs, or benzodiazepines.

Dx Criteria:

Involves excessive anxiety about being in situations or places from which escape might be difficult or embarrassing or in which help might not be available in case of panic attack or if other Sx's occur

If a panic attack or other symptoms occur - it can occur with or without panic attacks

Indiv. restrict places willing to go & eventually wont leave the house

More common in females

Tx of choice:

in vivo exposure with response prevention - involves exposing the person to the feared stimulus while preventing usual avoidance response

Exposure can be gradual or can involve flooding - whic involves initally exposing the person to stimuli that produce maximal anxiety

Indiv. may want a friend to accompany them in order to help alleviate anxiety

Characterized by:

Persistent fear of of being in social/performance situations that may cause embarrassment or humiliation as the result of scrutiny or evaluation by others

In adults, there is a realization that the fear is excessive and unreasonable

Situations commonly associated w/Social Phobia include:

public speaking,

attending parties,

initiating conversations, and

speaking to authority figures

Tx:

In-vivo exposure, enhanced w/social skills training

Cognitive techniques

Characterized by:

A marked & persistent fear of a specific object or situation other than those associated w/Agoraphobia or Social Phobia

In adults, there is recognition that the fear is unreasonable or excessive

5 Types

Blood-Injection-Injury Type differs from the other types in terms of physical reaction to feared stimuli.

For ppl w/this type, feared stimuli produce an initial increase in heart rate & blood pressure that is immediately followed by a drop in both &, as a consequence, fainting

Other Specific Phobias experience only an increase in heart rate and blood pressure

Animal

Natural Environment

Situational