Adult Psychopathology Final

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

bipolar 1 has full blown manic episodes

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

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

• manic episode (1 in history)
• depressive episode is not needed
• average age is 18
• not caused by drug addiction capable of producing symptoms

• restless and have a hard time concentrating
• afraid some awful might happen or they might loose control of themselves

at least 4 manic episodes in the past 12 months

• a loss of pleasure
• depression is worse in the morning
• feel guilty
• weight loss
• loss of sleep

• mood is very reactive (can actually cheer up in conversation)
• excessively sleepy 
• sensitive to rejection
• weight gain

• consistent with the mood the person is presenting 
• if person is manic, the delusions are cheerful.  If person is depressed, so are the delusions

delusions are not persistent with presenting mood

psycho-motor hyper activity or inactivity

symptoms happen during or 1 month after pregnancy

mood changes with seasons or with absence of light

• 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

• 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

disturbed mood symptoms develop during or soon after

• substance intoxication
• substance withdrawal
• exposure to medication 

substance/medication is capable of producing disturbed mood symptoms

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

• 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

• 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

• 1/2-2/3 develop by age 18
• the earlier the onset, the worse the prognosis

• 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

• almost all will have recurrent episodes
• there is a biological component

• 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

Have to have a history of at least 1 major depressive episode

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

prominent, persistent depressive mood disturbance and symptoms develop during or soon after

• Substance intoxication
• substance withdrawal
• exposure to medication

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

does not meet full criteria for any of the disorders in the depressive disorders class

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)

• attempt: majority female
• complete:  majority male

• attempt:  mostly young
• complete: risk increases with age

• attempt: low lethality (pills, cutting)
• complete: more violent (guns, jumping)

• attempt:  dysthymic disorder, borderline, schizophrenia
• complete: major mood disorder, alcoholism

• attempt: depression with anger
• complete: depression with hoplessness

• attempt: change in situation/cry for help
• complete: death

previous attempts

just thinking about it

person has thought about it in some detail

best single indicator

• have to evaluate through behavior 
• use of drugs and alcohol are a bad sign

• life will not be better in the future
• common in depression
• can elevate risk by up to 4 times

negative thinking about the self, future, and world

tends to be more responsive to medications and might be a biochemical issue

• 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

• 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

summer and spring because of increased energy levels

emotional and physiological response to recognized external threat

• unpleasant emotional state -- source is less readily defined; frequently accompanied by physiological symptoms 
• not always recognizable

• 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

CBT

• 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

Social Anxiety Disorder

• the sense of things around seeming unreal/different 
• sometimes things feel like they are slowed down

the odd sense of being detached from yourself

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

• 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

• confronting fear is central 
• cognitive-behavioral approaches have been found helpful

• Benzodiazepines 
• Anti-depressants -- SSRI's currently treatment of choice

A thought, urge, or image that is persistent and recurrent that is unwanted causing the person a great deal of distress or anxiety

• 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

something is comfortable to the self

when something is uncomfortable to the self (OCD 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

• 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

• 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

• repeated pulling out one's hair
• repeated attempts to decrease or stop hair pulling

• recurrent skin picking -- resulting in skin lesions
• repeated attempts to decrease of stop skin picking

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...

• 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

evidence shows that combat PTSD had 

• more severe symptoms
• less apt to experience remission of symptoms
• less likely to seek mental health treatment

• regaining a sense of control over one's life
• developing and maintaining coping strategies

• antipsychotics 
• antidepressants
• anti-anxiety meds
• prazosin -- helpful with insomnia and nightmare

• trauma focused CBT: cognitive restructuring, stress inoculation therapy, exposure therapy 
• Family therapy
• EMDR

• powerful biochemical process occurs
• Brain damage can occur with trauma 
• its not just an issue of the mind

• 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

• 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