psychopathology exam 3

• a diffuse, unpleasant, vague sense of apprehension
• often accompanied by autonomic symptoms
• headache
• perspiration
• stomach pains, , etc..

• distress with a minimal realation to an external cause
• highlevel of dicomfort and severity of symptoms
• persistence of symptoms over time
• development of disabling behavioral strategies (avoidant or compulsive behaviors)

• CBT is most effective
• event better than drugs alone, but when combined is best
• Focus on instruction about false beliefs
• info about panic epsiodes

• cognitive retraining
• desensitization
• rehearsal during sessions
• homework assignments
• CBT

• behavior therapy as effective as drugs
• exposure and resposne prevention
• desensitization
• thought stopping
• flooding
• implosions therapy
• aversive conditioning

patient exposed serially to a predetermined lsit of anxiety provoking stiumuli

graded in a hierarchy from least to most frightening

• patien tries to relax muscles via:
• hypnosis
• anti-anxiety drugs
• instruction

taught how to mentally and and pysically induce the state

taught to induce state when faced with each stimuli.

socail and specific phobias

• regression uncovers early modes of thought - not impulses
• ego and id functions are affected by regression

Freud's theory for OCD behavior

• omnipotence of thinking
• believe that thinking about event in external world will cause event to occur w/o physical action

may fear having aggressive though - believe thought is equal to deed.

Xanex and Paxil

SSRIs and Anafranil are best in effectiveness and tolerance of side affects

SSRI's and benzodiazepines

SSRI or anafranil

• most rapid action against panic (even in 1st week)
• potenetial for:
• Dependence
• impariment
• abuse
• (especially after long term use)

is a TCA that offers best selective uptake of serotonin and not norepinephine.

dosing titrated upward over 2-3wks to avoid GI issues and orthostatic hypotension

best to combine drug with behavioral therapy

• worry
• apprehension
• obsessions
• thought about emotional or bodily damage

• diarrhea
• dizziness
• restlessness
• syncope
• tachycarida
• termors
• upset stomach
• tingling in extremities

• both anxiety and depressive symptoms but don't meet criteria for a d/o.
• combo of symptoms causees significant funcitonal impairment

GABA - calmer downer. lack of it causes you not to be calm.

• may be casued by strep (OCD)
• area allows us to react quickly.
• message may get stick like broken record

norepinephrine

survivors of trauma have braing changes related to norep.

chronic symptoms of people w/ anxiety d/o - panic attacks, insomnia, startle, hyperarousal - all caused by increased norepinephrine.

occasional bursts of activity

serotonin

right hemisphere - cerebral assymmetty may cause anxiety do

amygdale - ptsd

temperal lobes- pathology (esp in hippocampus and amygale) with panic d/o

• increased activity in:
• frontal lobes
• basal ganglia
• cingulum

• recurrent and intrusive thought
• feeling
• idea
• sensation

mental event

conscious, standardized, recurrent behavior

act in attempt to reduce anxiety associated with obsession

but doesn't affect anxiety and may increase it

unexpected - occur at any time - not associated w/ any identifiable situation stimulus - but not always unexepcted

not a codeable disorder by itself, but can go under another disorder

• discrete fear or discomfort
• 4 or more symptoms develop rapidly
• reach a peak witing 10 minutes
• palpitations
• swearting
• trebling
• shortness of breath
• feeling of choking
• chest pain
• nausea
• dizziness

acute intense attack of anxiety accompanies by feelings of impending door.

• 2 Diagnotistic criteria:
• w/ agoraphobia
• w/o agoraphobia

differentiated from medical and mental d/o (hypoglycemia, endocrine d/o, MS, or anxiety d/o)

• course and prognsis
• onset in late adolescence/early adulthood
• increased risk for suicide and substance dependence

fear of being in places or situaitons from which escape might be difficult, embarassing, or help may be unavailable in event of a panic attack.

avoidance of feared places or situaitons.

interferes w/ ability to function in work and social situations outside home.

not a codeable d/o - goes in another.

• beahvioral therapy - reduces symptoms
• CBT and drugs are most affective

developmetnally inapproritate and excessive anxiety concerning seeparation from home or attachment figure

• 3 or more recurrent and excessive: distress when separation anticipted
• worry a.f. will be lost or harmed
• worry event will lead to separation
• fear of being along w/o a.f.
• reluctance or refusal to sleep away from home or w/o being near to af
• at least 4 weeks
• onset before 18
• distress and impairmine in funcitoing
• pysical symptoms

• marked and persistent fear of socail or performace situaitons.
• concerned about negative eval or scrutiny of others.
• fears humilation or embarassment, even by manifesting anxiety symptoms
• feared situations are avoided or endured w/ intesne anxiety or distress

• blushings
• muscle twitching
• anxiety about scrutiny

• different than major depressive d/o
• scizoid personality d/o
• other anxiety do

onset in late childhood or early adolescence. tends to be chrnoic

best tx is behvaior therapy

• development of symptoms after exposure to traumatic life events.
• reaction of fear and helplessness, persistentely relives event, tries to avoid being reminded of it.
• feelings of guild, rejection, and humiliation.
• dissociateve staets and panic attacks
• illusions and hallucinations may be present.
• Imparied memoy and attention.

• time
• ASD must be at least 2 days and max of 4 weeks and occurs w/i 4 weeks of event
• PTSD lasts more than a month

• persons seen as dramatizing and emotionally shallw.
• may be labled as histrionic
• behave like anxious adolescents
• expose self to exciting dangers to erase anxiety

denoting aspects of a personality that are viewed as acceptable and consistent with that person's total personality.

personality traits are susually ego-syntonic. also acceptable to the ego

• aka ego alien
• denoting aspects of a person's personality that are viewed as repugnant, unacceptable or inconsistent with the rest of the personality

• seen in persons labeled schizoid
• seek solace and satisfaction w/i themselves by creating imaginary lives, especially imaginary friends.

• characteristic of the overly controlled persons who are often labeled OCPD.
• under stress show intensified self restraint, overly formal social behavior and obstinacy.

• displaces outward all that becomes troublesome from within.
• externalization of an internal menace
• attributing their own unacknowleged feelings to others

• a person's feelings are directed out as all good or all bad
• paited may idealize some people while disparaging others.

• more inward and predominatnly male
• eccentric in bad way
• don't want friends/relationships
• don't have interpersonal needs
• no psychotherapies seem to work
• will not come in willingly
• suspicious
• expression of self is odd and reclusive

• attentions seeking
• dramatic
• want to be linked and impressive
• act out and throw tantrum
• excessive emotionality
• self-injurious behavior
• grandiose behaviors
• angry outbursts

• low selfesteem
• lack self confidence and assertiveness but want it
• good followers
• responsibly and conscientous
• both male/female
• turned in - shy and anxious

• passive aggressive
• depressive
• personality changes due to a GMC

• procrastinate
• resist demand for adequate performance
• excuses for delays
• find fault with those they depend on
• refuse to remove self from dependent relationships
• expect others to do their errands and carry out routine responsibilities

supportive psychotherapy

• constantly down
• negative
• pessimistic
• may be dysthymic
• may lack insight into the problem
• chronic and lifelon

doesn't respond to meds b/c it's a way they look at life, not a brain problem.

• insight oriented therapy
• group
• interpersonal
• cognitive
• (long term treatment)

• depressed as long as they remember
• metaphoical language - shades of grey
• mood d/o characterized by greater influcitaitons in mood and may be epsiodic
• can occur anytime and usually has a precipitation stressor

• not an offical diagnostic catefory
• but NOS
• desire to cause pain to toehrs by being some form of abusive

• not included in the DSM
• pervasice aggressive pattern of cruel demeaning and aggrtessive behavior that is directed towards others.

• head trauma
• cerebrovascular diseases
• cerebral tumos
• epilepsy
• huntington's disease
• MS
• endocrine do
• heavy metal poisoning
• neurosyphilis
• AIDS

change in personality from previous patterns of habiro or an exacerbation of pervious personality characterisists is notable

impaired control of expression of emotions and impulses

have a clear sensorium

• often are co-morbid.
• practically always have mroe than one together, and also mixed with depression

GAD w/ depressive features

Mixed Anxiety and Depression

anxios depression

anxious dysthymia

• anticipatory anxiety
• cognitive misperceptions
• socially cued panic
• degree of avoidance behavior
• substance misuse

• Distraction - journaling
• Breathing
• psychoeducaiton
• supportive counseling
• problem solving
• desensitization
• meditation
• graduated exposures
• social training

benzos or lyrica

• ephixor
• paxil
• lexapro

welbutrin

• paxil
• prozac

• betta blockers
• cardiac meds like
• enderol
• naterol

EMDR

• must be more than 6 months
• albercarnil
• sluzole

• 1. rule out GMC
• 2. rulte out substance abuse
• 3. chose which d/o it is

• low quality of life
• 3-5% of pop. only 1/3 seek tx
• feel they are being follished/ashamed
• go to MD or specialist
• highest use of ER's.
• often can't drive or work

• Dirt or contamination
• checking things
• belief that thoughts are unnacceptable

• picture
• cognition
• physical sensations
• behavior
• emotions

• animals
• biofeedback
• CBT
• meds
• desensitation
• visual kinesthetic dissociation
• Thought-feel therapy
• EMDR