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103 Cards in this Set
- Front
- Back
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Obsessive-compulsive Disorder
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debilitating, unwanted obsessions- intrusive thoughts, impulses, images and compulsions-repetitive behavior to ward off anxiety or an unwanted impulse
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Risk factors- OCD
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80% have coexisting major depression, mostly male childhood prevalence
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signs/symptoms OCD
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Recognition that one’s obsessions and compulsions are excessive or unreasonable. Significant distress or impairment for over one hr per day.
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treatments- OCD
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antidepressant therapy w/ serotonin-boosting meds- SSRI, Tricyclics
Behavior therapy Psychosurgery- cingulotomy |
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Brain areas involved in OCD
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Overreactive basal ganglia and orbito-frontal cortex
High orbital glucose metabolism |
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PANDAS : pediatric autoimmune neuropsychiatric disorder
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Associated with streptococcal infections
Sudden onset of tics, OCD (germs/handwashing) associated with patients who develop strep throat, rash, etc Remission with antibiotics |
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Body integrity identity disorder
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belief that one or more limbs (usually limbs) do not belong to body and amputation will achieve wholeness
Pretend amputation state in public, self amputation Belief one should be deaf, blind, paralyzed, disfigured |
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HOCD
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a form of OCD that a person has when they have a fear of unwanted thoughts that they might somehow be attracted to the same sex
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tourettes
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an inherited neuropsychiatric disorder with onset in childhood, characterized by multiple physical (motor) tics and at least one vocal (phonic) tic
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Acute Stress Disorder and PTSD
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intrusive recollections and acute distress upon cues suggestive of the trauma
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symptoms of stress disorders
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emotional detachment
being in a daze dropping out of usual activities avoidance of talking about trauma fogginess or forgetting tauma derealization depersonalization chronic hyperarousal irritability and aggresiveness survival guilt |
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acute stress
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greater than two days and less than a month
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PTSD
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greater or equal to a month
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risk factors of stress disorders
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o Family history of depression, anxiety disorders, or PTSD – perhaps these reflect common inheritance
o Depression or anxiety disorder at the time of the trauma o Early (prenatal?) traumatic conditioning (Meaney Effect) o Severity and chronicity of trauma o Poor social support |
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Treatment of stress disorders
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Anxiolytics for anxiety and panic attacks (Bezos for short term)
Antidepressants (SSRIs) for depression, irritability Antipsychotics for paranoia social estrangement Sleep medications for insomnia Unproven: propranolol |
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Critical Incident Stress Debriefing: Basic steps
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• Fact phase: Ask victims to tell their story
• Reaction phase: Ask victims to report their thoughts and feelings about the incident • Symptom phase: Solicit symptomatology and suggest coping strategies • Teaching phase: Educate victim regarding traumas and typical reactions to trauma • Reentry phase: Wrap-up, answer Q’s, provide referrals, develop plan of action |
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Depersonalization
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feeling of being outside of one’s body
• Own voice/sound not their own |
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Jamais vu
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familiar things feel unfamiliar
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Dissociative amnesia
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• Inability to recall important personal information @ a level exceeding normal forgetfulness
• More in women than men • Associated with PTSD • Confined to a period after a stressful event • Failure in memory encoding/retrievel • Mostly restricted to personal episodes • Recur in 40% more in those w hx of trauma • Ends often w/in hours or days • Treatment: anxiolytics, supportive psychotherapy (sedative hypnotic meds) |
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Dissociative amnesia w/fugue
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o sudden, unexpected travel away from home or usual workplace, with amnesia for one’s past
o confusion about one’s identity or adoption of a new ID o Dx retroactively, after episode is over memories return o Occurs after personal trauma, common in war etc o May last hours to months, usually short lived o Can result from medication side effects (ambien) o Must rule out complex partial seizure disorder with repeated states o Treatment: anxiolytics and supportive psychotherapy (sedative-hypnotic meds) |
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Depersonalization / derealization disorder
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o Experience of being outside of one’s own body
o Intact reality testing during episode- pt is not psychotic o Significant distress or impairment o NOT due to schizophrenia, drugs, meds, etc o Basic facts • Common- 50% • Early emotional abuse and recent intense stressors risk factors • 2x more in women • peaceful, dreamy, affect • near-death experiences • rarely last long enough to dx |
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Dissociative identity disorder
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• presence of two or more distinct identities or personality states (parts/fragments separated by dissociative barriers)
NOT schizo • 80% carry a secondary dx of PTSD |
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Treatment of Dissociative identity disorder
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o pyschotherapy
• Hypnosis with sodium amytal • Long, average of 4 years • Goal: reintegration of personalities, removal of dissociative barriers between them o Psychodynamic: group therapy for personalities o Cognitive-behavioral: isolation and strengthening of dominant personality o Antianxiety and antidepressants |
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View of DID as an iatrogenic illness
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elicit an alter personality
assumes there is another personality split the personalities asking names etc |
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False Memory Syndrome and Memory Recovernment
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• recovered memories of abuse
• likely confabulation (false memory syndrome) • tales of ritual satanic abuse etc • many failures |
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Preferred treatments for DID.
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o pyschotherapy
• Hypnosis with sodium amytal • Long, average of 4 years • Goal: reintegration of personalities, removal of dissociative barriers between them o Psychodynamic: group therapy for personalities o Cognitive-behavioral: isolation and strengthening of dominant personality o Antianxiety and antidepressants |
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Paranoid Personality Disorder
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• Pervasive, unwarranted suspiciousness and mistrust
• Hypersensitivity • Restricted emotion • Often moralistic and grandiose • Sometimes, charismatic • Are frequently drawn to marginal groups and identities • Rarely seen in psychotherapy or medical settings |
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Schizoid Personality Disorder
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• Defects in ability to form close relationships
• Cold, aloof, absence of interpersonal warmth • Indifference to praise or criticism • Close friendships with only 1-2 people • “Loners,” most often referred for treatment by others • May be weak form of “schizotype” |
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Treatment Schizoid Personality Disorder
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antipsychotics, antidepressants, therapy
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Schizotypal Personality Disorder
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• Odd thinking
• “Magical thinking” • Ideas of reference • Eccentric speech • Paranoia • Aloof, cold, socially isolated • Undue social anxiety, hypersensitivy • Under stress: hallucination / delusions • High suicide risk • May be moderate form of “schizotype” |
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Treatment Schizotypal Personality Disorder
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antipsychotics, therapy
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Histrionic Personality Disorder
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• More common in 1st-degree relatives, probable genetic component
• Attention-seeking; person plays to an “imaginary stage” • Overly dramatic, reactive, intense • Interpersonal difficulties • Shallow, transient relationships • Egocentric, self-indulgent, inconsiderate • Vain and demanding • Dependent, “helpless” • Prone to manipulative suicidal threats / gestures • Sexually promiscuous, or withholding and manipulative • Frequent health complaints |
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Treatment Histrionic Personality Disorder
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antidepressants, therapy
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Narcissistic Personality Disorder
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Grandiose sense of self-importance or uniqueness
• Fantasies of unlimited success, power, brilliance, ideal love • Continual demands for approval and agreement • Reacts to criticism with rage or indifference • Disturbed interpersonal relationships • Sense of entitlement • Exploitiveness for self-advancement • Others seen as either allies or obstacles • Splitting: idealization / devaluation • Lack of empathy • Rarely seek treatment, usually drop out of therapy |
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Psychoanalytic explanation of Narcissistic Personality Disorder
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little boy forced to grow up too fast, develops defensive shell
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Borderline Personality Disorder
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o Unstable, chaotic and intense relationships
o Self-damaging behavior (sex, ETOH / drugs, gambling, overeating) o Inappropriate intense anger and marked mood shifts (“transient psychotic episodes”) o “Splitting” – idealization / devaluation • either see people as wonderful or horrible o Intolerance of being alone w/ deep abandonment depressions o Feelings of internal emptiness and “void.” o Repeated suicidal gestures, self-mutilation |
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Risk factors Borderline Personality Disorder
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early physical or sexual abuse, borderline parents make borderline babies, PTSD
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Psychoanalytic theory Borderline Personality Disorder
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failure to master separation/individuation
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transient psychotic episodes
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inappropriate intense anger and marked mood shifts, anger that flares up out of no good reason
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splitting
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idealization/devaluation
either see people as wonderful or horrible |
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Medication Borderline
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antimanics, antidepressants, and or anxiolytics (benzos dangerous b/c of suicidality), sometimes antipsychotics
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Long term therapy Borderline
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highly structure, psychodynamic therapy or dialectical behavior therapy
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Dialetical therapy Borderline
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Look at life, relationships, discover deficiencies and fill them in life
For parasuicidal patients, manualized therapy Four modules: mindfulness, distress tolerance, emotion regulation, interpersonal effectiveness Structure to therapist on how to handle difficult patients Preliminary evidence promising |
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Antisocial Personality Disorder
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• Continual violation of the rights of others
• Deficient in guilt and remorse • Concrete morality • Strong genetic contribution (heritability ~ 0.6) • Linked to deprivation, incompetent parenting • so bad at manipulations that they cause people to bring them into therapy |
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Risk factors Antisocial Personality Disorder
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Common preceding diagnoses: ADHD, conduct disorder
Cortical immaturity: prefrontal area dysfunction |
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Treatment Antisocial Personality Disorder
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incarceration
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Childhood Antisocial Personality Disorder
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lying, stealing truancy, resisting authority, early psychopathic triad (firesetting, enuresis, cruelty to animals)
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Adolescence Antisocial Personality Disorder
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unusually early aggressive or sexual behavior, excessive drinking or illicit drug use
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Adult Antisocial Personality Disorder
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persistence of adolescent behavior, failure to hold a job, irresponsible parents, frank law breaking, no close relationships, manipulative, charming and intelligent, Somatization or Munchausens by proxy
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Avoidant Personality Disorder
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Hypersensitive to rejection or ridicule
Strong desire for relationships, but extreme skittishness about them Social withdrawal, retreat to secondary social roles Overriding desire for acceptance, affection Low self-esteem Devalues personal strengths Overvalues personal shortcomings |
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Treatment Avoidant Personality Disorder
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Medication for anxiety, depressive symptoms
Therapy Social skills and assertiveness training Supportive individual therapy Group therapy |
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Dependent Personality Disorder
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Allows life to be run by others
Defers to others on major decisions Subordinates own needs to others (e.g., tolerates abusive spouse) Sees self as helpless, stupid Does not make demands on others for fear of jeopardizing relationships “Thankful” for friendships Typically, appears selfless and bland Sometimes precipitated by chronic physical illness |
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Treatment Dependent Personality Disorder
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Medication for symptoms
Group, family or couples therapy |
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Obsessive-Compulsive Personality Disorder
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Not OCD, all OCPD symptoms are ego-syntonic.
“Cold fish”: Restricted in expressing warmth or tenderness Perfectionistic Extremely moralistic, judgmental about self and others Preoccupied with small details, lists, rules, schedules Insist that others conform to person’s way of doing things Workaholic, preoccupied with productivity Oversensitive to criticism by authority figures Indecisive Fear of making mistakes > procrastination Rumination about priorities |
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Treatment Obsessive-Compulsive Personality Disorder
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Psychotherapy
Antidepressants |
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Passive-Aggressive (Negativistic) Personality Disorder
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Provisional Disorder (in DSM-IV appendix)
Continuous pattern of negative attitudes (“hostile compliance,” “begrudging agreement”) that usually beings in early adulthood. Passive resistance to demands for adequate performance in social and occupational situations. Expressed as: Procrastination Intentional inefficiency and obstructionism “Forgetting” obligations, always arriving late, repeated evasion and excuse-making Sulking or arguing when asked to do something unpleasant Stubbornness / Resentment of useful suggestions Complaining about “unreasonable” demands, making unreasonable criticisms of authority figures, manipulating others into assuming their obligations Caustic joking, unacknowledged hostility |
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Treatment of Passive-Aggressive Personality Disorder
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Supportive psychotherapy
Build self-confidence Teach assertiveness instead of sulking, manipulativeness Medication (e.g., SSRI’s) for any associated depression or anxiety |
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Dementia praecox
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Dementia praecox (a "premature dementia" or "precocious madness") refers to a chronic, deteriorating psychotic disorder characterized by rapid cognitive disintegration, usually beginning in the late teens or early adulthood.
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General manifestations of Schizo
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• Loss of previous level of functioning
• Disturbances of language and communication • “Formal thought disorder” • Disordered emotionality: “flat,” “paranoid,” or “silly” affect • Disturbances of the will • Social withdrawal and autistic thinking • Motor abnormalities |
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"Formal thought disorder”
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o Altered thought boundaries (thought broadcasting, insertion, removal)
o Hallucinations (usually auditory- almost always) • Hearing voices o Delusional experiences o Delusional beliefs |
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Odds of a child becoming schizophrenic are
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• 15 % if one parent is schizophrenic (vs. 1 % base rate)
• 46 % if both parents are schizophrenic (vs. 1 % base rate) |
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Genetic Risk Factors schizo
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• Not child-rearing
• Genetic relatedness (consanguinity) • Twin concordances ( MZ = ~.55, DZ = ~.15) |
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Nongenetic Risk Factors in Schizophrenia
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• Birth complications (e.g., protracted labors, forceps deliveries)
• Maternal malnutrition • Seasonality of birth • Geographic clusters of 4-6% incidence |
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• Maternal exposure to influenza virus
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o Risk greatest at 6th month of gestation
o Viral exposure may explain MZ / DZ difference |
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Other infectious agents involved with Schizo
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o Rubella (German measles)
o Toxoplasmosis spores: greater prevalence of cat ownership among parents of schizophrenics o Endogenous retroviruses (e.g., herpes simplex II) • Use of street drugs, especially cannabis – risk is enhanced with certain genotypes |
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Old sperm in schizo
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o About 1 in 200 if father is 25
o About 1 in 120 if father is 40 o About 1 in 70 if father is 50 |
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Maximal Schizophrenia Risk from Maternal Viral Infection
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6th Month Gestational Age
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One placenta MZ twins (share 100% genes)
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monochorionic twins
o Common blood supply o .85% • related to something supplied in blood |
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Two placentas
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dichorionic twins
o If they split into 2 early they develop their own placenta o .81% |
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Positive Symptom shizo symptoms- Type 1
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• Hallucinations
• Delusions • Paranoid or silly affect • Bizarre or disorganized behavior • Disordered thought processes |
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Negative-symptom schizophrenia symptoms-type II
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• Flat affect
• Psychomotor retardation • Mutism and blocking • Poor grooming • Social withdrawal |
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Positive Symptom Schizo
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• Childhood oddity, irritability, aggressiveness
• Later age of diagnosis (20-25) • Females > Males • Better prognosis • DA abnormalities • Responds to classical antipsychotic meds • Less chance of observable brain damage |
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Negative Symptom Schizo
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• Childhood withdrawal, passivity
• Earlier age of diagnosis (16-18) • Males > Females • Worse prognosis • No DA abnormalities • Poor response to classical antipsychotic meds • Greater chance of observable brain damage |
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Classical Antipsychotics
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• (Rarely Used Currently; Treat Mainly + Symptoms)
o Thorazine, Haldol, Prolixin, Stelazine |
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Some Atypical (2nd Generation) Antipsychotics
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• (Treat Both + and – Symptoms)
o Abilify, Zyprexa, Clozaril, Invega, Risperdal, Seroquel, Geodon o Note: Abilify and Geodon are weight-neutral. |
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Side Effects of Antipsychotic Medications
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• Drowsiness / sedation (can be useful in agitated patients)
• “Metabolic syndrome” • Motor side effects ( |
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Metabolic syndrome
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o Weight gain (especially in abdomen)
o Elevated blood lipids (cholesterol & triglycerides) o Type 2 Diabetes (blood glucose dysregulation) |
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Motor side effects
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much greater with classical antipsychotics like Thorazine and Haldol
Akathisia Pseudoparkinsonism Tardive Dyskinesia |
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Akathisia
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(“cruel restlessness”), e.g., rocking, “Thorazine shuffle”
Acute dystonias (lock-jaw, oculogyric crisis) |
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Pseudoparkinsonism
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• Resting Tremor
• Slowness of movements • Muscular rigidity |
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Tardive dyskinesia
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(rare with 2nd-generation medications)
• Early “rabbit sign” • Eventually, tongue and limb writhing |
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Psychotherapy in Schizo
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o Adjustment to illness
• Family • Friends • Work • Love o Deal with secondary depression, anxiety o Symptom self-monitoring o Building compliance with medication |
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Other disorders often treated with antipsychotic medications
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• Major Depression
• Bipolar Disorder (several antipsychotic medications such as Abilify are FDA-approved for both schizophrenia and bipolar disorder) • Paranoid, Schizoid and Schizotypal Personality Disorders • Borderline Personality Disorder • Post-traumatic Stress Disorder • Intense anxiety with psychotic features (e.g., Brief Psychotic Episodes, encephalopathies, etc.) • Agitation in the elderly (especially at nightfall: “sundowner’s syndrome”) |
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“Rule of thirds”
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• 1/3 improve, 1/3 stay same, 1/3 deteriorate
• rule probably reflects misdiagnosed bipolar disorder |
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New outlook prognosis of schizo
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• Now, outlook is considered more dismal. On 30-year follow-up:
o 20 % show good adjustment o 35 % show fair adjustment o 45 % incapacitated |
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Worldwide trend of schizo
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• Incidence of schizophrenia appears to be declining world-wide, perhaps due to better infant nutrition and childbirth methods.
o Don’t know why o Less fetal distress, better birthing practices o Better flu vaccinations |
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Why Are Eating Disorders Overwhelmingly Female?
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• Across Western cultures, males are more likely to be obese, but are less likely to care.
• Mass media • Gay men in the gay social scene • Men in sports that emphasize thin-ness or weight control |
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Anorexia nervosa
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self-starvation to precariously low body weight
• Refusal to maintain adequate weight, defined as less than 85% of ideal body weight |
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Bulimia nervosa
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recurrent binge eating accompanied by compensatory behavior (“purging” via vomiting, laxatives, emetics, or non-purging behavior such as fasting and/or exercise)
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Binge-eating disorder
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Recurrent binge eating without compensatory behavior
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Eating Disorder NOS
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(not otherwise specified): disorders that do not fit either category
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Body-image distortion
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person “feels fat” even when obviously underweight (confirmed with trick-lens studies)
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Who Gets Anorexia Nervosa?
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Relatively rare: Lifetime prevalence of .25% to .6% in the general female population (in males, about 1/10 as prevalent).
• May be frequent (rates from 15% to 60%) in woman athletes and dancers (e.g. ballet) • Most cases begin in adolescence (peak ages 13 to 20) • Runs in families |
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How Does Anorexia Nervosa Begin?
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• Often develops in adolescents who, as children, were “picky eaters” and generally perfectionistic, and also socially avoidant.
• Typically begins with a period of dietary restriction after a period of weight gain and negative comments about the person’s weight. • Sometimes, begins after a stressful life event. |
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Altered Eating Habits in Anorexia Nervosa
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• Development of obsessive thinking about food
• Establishing irrational rules about food • Food rituals • ½ of all anorexics binge and “purge,” although the binges are usually small, and the “purging” is most often via excessive exercise. Up to 70% of patients with anorexia nervosa also have OCD, |
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“Two P‘s of Anorexia Nervosa"
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• Powerlessness
• Perfectionism • “If can control my body, then I can have a “perfect body” and a “perfect life.” |
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How is Anorexia Nervosa Treated?
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• Medical management of any physical illnesses that may have resulted from starvation
• Hospital re-feeding if necessary 9under 75%) • Inpatient → Outpatient family therapy o Reassert parents’ control of eating o Begin a program of re-feeding. Medication so for ineffective but maybe Zyprexa |
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Treatment Effectiveness in Anorexia Nervosa
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Mortality Rate in 10-25%,
Fewer than 50% of people with anorexia nervosa ever achieve a normal weight, and among those who have “recovered,” their social and occupational functioning is often poor. |
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Purging
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Self-induced vomiting (manual or with emetic medications), laxatives, or diuretics
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Non-purging
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exercise and/or temporary fasting
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Who Gets Bulimia Nervosa?
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Adolescents and young adults, 90% female. Peak ages 15 to 18 in females, and 18 to 26 years for males.• Among college students, point prevalence of bulimia nervosa may be 10% (freshman 15)
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What Is the Damage in Bulimia Nervosa?
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• Most of the damage is from repeated vomiting:
o Rupture of stomach or esophagus o Heart damage from loss of electrolytes (mainly, potassium) o Erosion of teeth, gums and fingernails o Broken blood vessels in the eyes o Swollen salivary glands (“chipmunk faces”) o Menstrual irregularities and higher risk of pregnancy complications • Also associated with: o high (30 to 70%) rates of ETOH and/or drug abuse o smoking (in order to maintain weight) o other impulsive behavior (sexual promiscuity, cutting, kleptomania). |
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How Is Bulimia Treated?
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• 1st line treatment: high doses of SSRI’s (such as Prozac), which have been shown to reduce bingeing by up to 70% and vomiting by up to 60%.
• Therapy is also indicated: o Support groups o Cognitive-behavior therapy o Focus is on resisting impulses to binge or purge, healthy eating, and developing positive alternatives to food-centered behavior • Treatment over several years is usually successful (70-90%), but relapse is common |
