Adult Psychopathology Final

  1. What are the criteria for a manic episode
    for at least one week 

    • abnormal elevated, expansive (all encompassing) or irritable mood
    • increase goal directed activity or energy 

    presence of three or more symptoms

    • pressured speech
    • flight of ideas
    • distractability 
    • psychomotor agitation 
    • Excessive involvement in things that could have painful consequences
    • grandiosity 
    • decreased need for sleep

    severe enough to cause marked impairment in function or require hospitalization
  2. what is the difference between bipolar 1 and 2?
    bipolar 1 has full blown manic episodes
  3. what are the criteria for a hypomanic episode?
    for at least four consecutive days

    • abnormal elevated, expansive (all encompassing) or irritable mood
    • increase goal directed activity or energy 

    presence of three or more symptoms

    • pressured speech
    • flight of ideas
    • distractability 
    • psychomotor agitation 
    • Excessive involvement in things that could have painful consequences
    • grandiosity 
    • decreased need for sleep

    Not severe enough to cause marked impairment in function or require hospitalization

    If there is a history of a full manic episode then diagnose a full manic episode
  4. What is necessary for a depressive episode?
    For a two week period, five or more of the following

    • depressed mood
    • anhedonia
    • significant weight loss or gain
    • sleep disturbance
    • psychomotor agitation or retardation
    • fatigue
    • worthlessness or inappropriate guilt 
    • diminished ability to concentrate 
    • recurrent suicidal ideation/suicide attempt
  5. What is needed for a Bipolar 1 Disorder diagnosis?
    • manic episode (1 in history)
    • depressive episode is not needed
    • average age is 18
    • not caused by drug addiction capable of producing symptoms
  6. Bipolar specifier: with anxious distress
    • restless and have a hard time concentrating
    • afraid some awful might happen or they might loose control of themselves
  7. Bipolar specifier: with rapid cycling
    at least 4 manic episodes in the past 12 months
  8. Bipolar specifier: with melancholic features
    • a loss of pleasure
    • depression is worse in the morning
    • feel guilty
    • weight loss
    • loss of sleep
  9. Bipolar specifier: with atypical features
    • mood is very reactive (can actually cheer up in conversation)
    • excessively sleepy 
    • sensitive to rejection
    • weight gain
  10. Bipolar specifier: with mood-congruent psychotic features
    • consistent with the mood the person is presenting 
    • if person is manic, the delusions are cheerful.  If person is depressed, so are the delusions
  11. Bipolar specifier: with mood-incongruent psychotic features
    delusions are not persistent with presenting mood
  12. Bipolar specifier: with catatonia
    psycho-motor hyper activity or inactivity
  13. Bipolar specifier: with peripartum onset
    symptoms happen during or 1 month after pregnancy
  14. Bipolar specifier: with seasonal onset
    mood changes with seasons or with absence of light
  15. Criteria for Bipolar II Disorder
    • Hypomanic episode + major depressive episode
    • no previous manic episode 
    • onset is usually in 20's
    • treatment is usually about the depressive episode 
    • do not usually see flight of ideas or pressured speech 
    • will not require hospitalization for manic episode
  16. requirements of Cyclothymic Disorder
    • symptoms do not qualify for manic, depressive, or hypomanic episodes
    • onset is usually early adulthood
    • 15-50% go on to develop Bipolar I or II
  17. Criteria for substance/medication induced Bipolar and Related Disorder
    disturbed mood symptoms develop during or soon after

    • substance intoxication
    • substance withdrawal
    • exposure to medication 

    substance/medication is capable of producing disturbed mood symptoms
  18. Criteria for Bipolar and Related Disorder due to Another Medical Condition
    prominent, persistent abnormally elevated, expansive, or irritable mood

    • evidence that disturbance is direct consequence of another medical condition
    • clinically significant distress or social, occupational impairment
  19. Bipolar Disorder risk factors: Gender
    • women are more like to manifest depressive symptoms, more rapid cycling, and more Bipolar II diagnosis
    • Men and women are equally diagnosed with Bipolar I
  20. Bipolar Disorder risk factors: culture
    • African Americans are more likely to attempt suicide 
    • more likely to be prescribed antipsychotics 
    • shows cultural bias in psychiatry 
    • African Americans adolescents tend to be in treatment longer
    • less likely to have follow up treatment
  21. Bipolar Disorder risk factors: age-related
    • 1/2-2/3 develop by age 18
    • the earlier the onset, the worse the prognosis
  22. Bipolar Disorder risk factors: suicide
    • rates of suicide or 12-15 times higher than general population and 4 times higher than people with recurrent depression 
    • 50% will attempt suicide in their lifetime 
    • comorbid with substance abuse elevates risk
  23. Bipolar Disorder risk factors: recurrence
    • almost all will have recurrent episodes
    • there is a biological component
  24. Bipolar Disorders treatment
    • Needs to be stabilized with mood stabilizers 
    • atypical antipsychotics and antidepressents are used sometimes 
    • problems with people staying on meds
    • abrupt cessation of meds can lead to suicide attempts 
    • High EE contributes to relapse rates 
    • CBT is used sometimes to work on problem solving skills and cognitive restructuring
    • Interpersonal and social rhythm therapy -- sleep/wake cycles are targeted as well as daily routines  
    • taught to avoid drugs and alcohol
    • always target compliance with meds
  25. Criteria for Major Depressive Disorder
    Have to have a history of at least 1 major depressive episode
  26. Criteria for Persistent Depressive Disorder
    chronic depressive symptoms for at least 2 years

    Depressed mood for most of the day + two of the following

    • poor appetite
    • insomnia/hypersomnia 
    • low energy
    • low self-esteem
    • difficulty concentrating or making decisions 
    • feelings of hoplessness
  27. criteria for substance/medication-induced depressive disorder
    prominent, persistent depressive mood disturbance and symptoms develop during or soon after

    • Substance intoxication
    • substance withdrawal
    • exposure to medication
  28. Criteria for Depressive Disorder due to Another Medical Condition
    Prominent, persistent depressed mood or diminished interest or pleasure

    • evidence that disturbance is direct consequence of another medical condition 
    • clinically significant distress or social, occupational impairment
  29. Criteria for Other Specified Depressive Disorder
    does not meet full criteria for any of the disorders in the depressive disorders class
  30. Criteria for Unspecified Depressive Disorder
    To be used in situations

    • in which the clinician chooses not to specify the reason criteria are not met for a specific disorder 
    • in which there is insufficient information to make a more specific diagnosis (emergency rooms)
  31. suicide attempters vs. completers: gender
    • attempt: majority female
    • complete:  majority male
  32. suicide attempters vs. completers: age
    • attempt:  mostly young
    • complete: risk increases with age
  33. suicide attempters vs. completers: method
    • attempt: low lethality (pills, cutting)
    • complete: more violent (guns, jumping)
  34. suicide attempters vs. completers: common Dx
    • attempt:  dysthymic disorder, borderline, schizophrenia
    • complete: major mood disorder, alcoholism
  35. suicide attempters vs. completers: dominant emotion
    • attempt: depression with anger
    • complete: depression with hoplessness
  36. suicide attempters vs. completers: motivation
    • attempt: change in situation/cry for help
    • complete: death
  37. What is the single best predictor of a suicide attempt?
    previous attempts
  38. Suicide risk assessment: Ideation
    just thinking about it
  39. Suicide risk assessment: plans/means
    person has thought about it in some detail
  40. Suicide risk assessment: history of attempts
    best single indicator
  41. Suicide risk assessment: impulse control
    • have to evaluate through behavior 
    • use of drugs and alcohol are a bad sign
  42. Suicide risk assessment: hoplessness
    • life will not be better in the future
    • common in depression
    • can elevate risk by up to 4 times
  43. What is the negativistic thinking triad?
    negative thinking about the self, future, and world
  44. Depression subtype:  typical (melancholic or endogenous)
    tends to be more responsive to medications and might be a biochemical issue
  45. depression subtype: Atypical
    • sometimes caused by a stressful event
    • see a temporary brightness in mood
    • can see hypersomnia and weight gain
    • heaviness in arms and legs
    • highly sensitive to rejection
    • more responsive to psychotherapy
  46. Effects of CBT on depression
    • very effective 
    • depression sits on three points -- negative views of self, world, and future
    • targets distortions in people's thinking 
    • taught new ways to think in specific situations
  47. When are depressive actions more prevalent?
    summer and spring because of increased energy levels
  48. Define fear
    emotional and physiological response to recognized external threat
  49. define anxiety
    • unpleasant emotional state -- source is less readily defined; frequently accompanied by physiological symptoms 
    • not always recognizable
  50. define a specific phobia
    • marked fear of specific object or situation 
    • provokes immediate fear or anxiety
    • is actively avoided 
    • fear is out of proportion to actual danger 
    • last longer than 6 months
  51. What is an effective treatment for a most phobias?
  52. Define Social Anxiety Disorder
    • marked fear or anxiety in social situations where a person is exposed to scrutiny by others
    • fear of negative evaluations
    • almost always provokes anxiety 
    • avoided or endured with great fear/anxiety 
    • fear/anxiety is out of proportion 
    • persists over time
  53. What is the 3rd most common disorder in the US?
    Social Anxiety Disorder
  54. Define derealization
    • the sense of things around seeming unreal/different 
    • sometimes things feel like they are slowed down
  55. define depersonalization
    the odd sense of being detached from yourself
  56. Define agoraphobia
    marked fear or anxiety about two or more 

    • using public transportation 
    • open spaces
    • enclosed spaces
    • standing in line, being in a crowd
    • being outside of the home alone 

    fear and avoidance of these situations 

    • escape might be difficult
    • help might not be available
  57. Define Generalized Anxiety Disorder
    • excessive anxiety and worry about a number of events or activities 
    • difficult to control worry 

    with three or more of the following 

    • restlessness
    • easily fatigued
    • difficulty concentrating, mind going blank
    • irritability
    • muscle tension
    • sleep disturbance

    Sometimes have a history of traumatic experiences
  58. Anxiety Disorders treatment approaches: psychological treatments
    • confronting fear is central 
    • cognitive-behavioral approaches have been found helpful
  59. Anxiety Disorders treatment approaches: medications
    • Benzodiazepines 
    • Anti-depressants -- SSRI's currently treatment of choice
  60. Define obession
    A thought, urge, or image that is persistent and recurrent that is unwanted causing the person a great deal of distress or anxiety
  61. Define compulsion
    • a behavior that is repetitive that a person is DRIVEN to perform in response to an obsession
    • the action is intended to reduce stress or prevent disaster 
    • not realistically connected to the obsession
  62. Define ego-syntonic
    something is comfortable to the self
  63. define ego-dystonic
    when something is uncomfortable to the self (OCD Disorder)
  64. Define Body Dysmorphic Disorder
    • preoccupation with perceived deficits or flaws in physical appearance that are not observable or appear slight to others
    • person has performed repetitive behaviors or mental acts in response to the appearance concerns
    • a possible link to depression
    • generally a poor quality of life
  65. Define Hoarding Disorder
    • persistent difficulty discarding possessions, regardless of their actual value 
    • difficulty due to perceived need to save items and to the distress associated with discarding them
    • results in accumulation of possessions that congest and clutter active living areas and compromises their intended use
  66. What are the characteristics of hoarders
    • Core vulnerabilities: depression, anxiety, family history and high levels of perfectionism 
    • difficulties processing information: attention, memory, categorization, and decision making
    • intense emotional control to objects 
    • beliefs about necessity of not wasting objects
  67. define trichotillomania
    • repeated pulling out one's hair
    • repeated attempts to decrease or stop hair pulling
  68. Define Excoriation Disorder
    • recurrent skin picking -- resulting in skin lesions
    • repeated attempts to decrease of stop skin picking
  69. Criteria for PTSD
    Exposure to traumatic event (that terrifies the person)

    One or more intrusion symptom

    • recurrent, involuntary, intrusive distressing memory of event
    • recurrent distressing dreams
    • dissociative reactions (flash backs)
    • distress when exposed to internal/external cues
    • physiological reactions

    Avoidance symptoms (one or both)

    • avoidance of distressing memories related to the event
    • avoidance of external reminders related to the event

    Negative alterations in cognitions and mood (at least 1)

    • issues with recalling aspects of event
    • negative beliefs/expectations of others
    • persistent negative emotional state
    • inability to experience positive emotions
    • etc...

    • Arousal and reactivity
    • symptoms (at least 1)

    • irritability/angry outbusrts
    • hypervigilance
    • sleep disturbance 
    • reckless behavior 
    • etc...
  70. What is the difference between PTSD and Complex PTSD?
    • associated with long-term trauma in which an individual is held in captivity
    • kept under control of the perpetrator without escape options
    • additional symptoms make diagnosis and treatment more difficult
    • involves dysregulation: inability to regulate emotionality or be preoccupied with revenge, sometimes develop personality disorders
    • much more chronic than PTSD
  71. Non-combat PTSD vs. combat PTSD
    evidence shows that combat PTSD had 

    • more severe symptoms
    • less apt to experience remission of symptoms
    • less likely to seek mental health treatment
  72. Treatment of PTSD: goals
    • regaining a sense of control over one's life
    • developing and maintaining coping strategies
  73. Treatment of PTSD: medications
    • antipsychotics 
    • antidepressants
    • anti-anxiety meds
    • prazosin -- helpful with insomnia and nightmare
  74. Treatment of PTSD: psychological
    • trauma focused CBT: cognitive restructuring, stress inoculation therapy, exposure therapy 
    • Family therapy
    • EMDR
  75. Things to keep in mind about PTSD
    • powerful biochemical process occurs
    • Brain damage can occur with trauma 
    • its not just an issue of the mind
  76. Criteria for Acute Stress Disorder
    • Same as PTSD but symptoms pattern must happen within a month of the traumatic event
    • 9 or more symptoms needed from the remaining categories 
    • dissociative is a symptom, not a specifier
  77. Criteria for Adjustment Disorder
    • development of emotional or behavioral symptoms in response to an identifiable stressor (within 3 months)
    • distress out of proportion to the severity or intensity pf the stressor
    • significant impairment 
    • not life threatening
    • must rule out other diagnoses first
Card Set
Adult Psychopathology Final
Adult Psychopathology Final