DTS Abnormal Behavior

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Abnormal Behavior Final Exam Terms

Mental Disorder

Characteristics:
1. Occurs within the individual
2. Causes personal distress or disability
3. Not a culturally specific reaction to an event
4. Not primarily result of social deviance or conflict with society

Schizophrenia Characteristic Symptoms

2 or more of following present during 1 month period: (D,D,H,G,N)
1. Delusions
2. Disorganized Speech
3. Hallucinations
4. Grossly disorganized or catatonic behavior
5. Negative Symptoms (i.e. Affective flattening)

Schizophrenia Duration Requirements

Continuous Signs of Disturbance persist for at least 6 months
At least 1 Month of Criterion A Symptoms (Characteristics)

Schizophrenia Negative Symptoms

Behavioral Deficits: Avolition, Asociality, Anhedonia, Blunted Affect, Alogia

Schizophrenia Positive Symptoms

Hallucinations
Delusions

Avolition

Apathy, Lack of Motivation and seeming Absence of Interest or Inability in what are usually routine activities

Alogia

Significant Reduction in Amount of Speech

Asociality

Severe impairment in social relationships
- Few friends, poor social skills, little interest being with other people

Blunted Affect

Lack of Outward Expression of Emotion
- Refers only to outward expression of emotion, not inner experience, which is not impoverished all all)

Anhedonia

Inability to experience pleasure

Schizophreniform Disorder

Schizophrenia characteristic symptoms met
* Episode of Disorder lasts at least 1 month but less than 6 months

Catatonia

Motor abnormalities:
- Repetitive, complex gestures
- Excitable, wild flailing of limbs

Brief Psychotic Disorder

Presence of 1 or more of following: (D,D,H,G)
1. Delusions 2. Disorganized Speech 3. Hallucinations 4. Grossly Disorganized or Catatonic Behavior
Episode at least 1 day but less than 1 month

Shared Psychotic Disorder

(Folie a Deux)
Delusion develops in individual in context of relationship with another person with established delusion

Paranoid Type

*Most common type
- Preoccupation with one or more delusions or frequent auditory hallucinations
- None of following are present: disorganized speech, disorganized or catatonic behavior, or flat or inappropriate affect

Catatonic Type

At least 2 of the following:
1. Motoric Immobility
2. Excessive Motor Activity (purposeless)
3. Extreme Negativism
4. Peculiarities of voluntary movement by posturing
5. Echolalia or Echopraxia

Disorganized Type

All of following are prominent:
1. Disorganized Speech
2. Disorganized Behavior
3. Flat or Inappropriate Affect
- Criteria not met for Catatonic Type

Delusional Disorder

A. Non-bizarre delusion of at least 1 month
B. Schizo Characteristic Symptoms never met
C. Functioning not markedly impaired and behavior not odd or bizarre

Schizoaffective Disorder

Schizophrenia + Affective Disorder at same time
Either:
MDD for 2 weeks
Manic Episode for 1 week
Mixed Episode for 1 week

Excess of Dopamine Looks Like

Psychosis - hallucinations, delusions
Cognitive Blunting - slowing and processing difficulty

Dopamine Pathways

1) Mesolimbic - overactive pathway leads to psychosis
2) Mesocortical - under-active with too dopamine causing cognitive problems
3) Nigrostriatal - movement control (Parkinsons is from too little dopamine to this area)
4) Tuberoinfundibular - secretes prolactin
(prolactin = makes women lactate, dopamine suppresses secretion)

Dopamine

- comes from Tyrosine - which is involved in reward
- Ventral Tegmental area of the midbrain
- Substantia Nigra

Norepinephrine

comes from Dopamine, which comes from Tyrosine
- Made in Locus Coeruleus in brainstem

Serotonin

Synthesized from Tryptophan
- Raphe Nucleus in brainstem

Norepinephrine Deficiency Syndrome

DD, II, F, PD
Decreased Attention
Decreased Concentration
Impaired Working Memory
Information Processing Speed (Slowed)
Fatigue
Psychomotor Retardation
Depression

Serotonin Deficiency Syndrome

DAPPO FB
Depressed Mood
Anxiety
Panic
Phobia
Obsessions and Compulsions
Food Craving
Bulimic Behavior

SNRI

Serotonin and Norepinephrine Reuptake Inhibitors
- Useful for Improving Energy and fighting Depression
- Do not give to someone with hypertension (high blood pressure)

SSRI

Selective Serotonin Reuptake Inhibitors
- blocks reuptake pump, increases amount of serotonin in the cleft to bind to post-synaptic receptor
- Can cause sexual dysfunction in all stages

First Gen Antipsychotics block

Strictly dopamine

Second Gen Antipsychotics block

Serotonin and Dopamine Blockers
Side Effect - Weight gain and increased risk of diabetes

Malingering

Symptoms or evidence of disease are INTENTIONALLY induced or produced solely for personal benefit (External incentives)
- NOT a psychiatric disorder
- NOT DSM IV diagnosis

Hypochondriasis

Preoccupation with, fear of having a particular disease that doctors are missing
- Misinterpretation of bodily symptoms and functions as further proof of their conviction
- Production of symptoms NOT conscious or intentional
- Causes distress and impairment
* Male cases = Female cases *

Somatization

Psychological distress that manifests as physical symptom

Factitious Disorder

Symptoms or evidence of disease are INTENTIONALLY induced or produced for privileges of SICK role
- External motives are absent

Pain Disorder

Pain is focus of attention and not fully accounted for by a medical condition
- Psychological factors associated with initiation, exacerbation, and/ or maintenance of pain symptoms
- Symptoms NOT imaginary
- Causes stress and or impairment

Dissociative Identity Disorder

Two or more distinct and fully developed personalities (alters)
* Most severe of dissociative disorders
* Typical onset in childhood

Post traumatic Model for DID

DID from severe psychological and / or sexual abuse in childhood

Socio-Cognitive Model for DID

DID is form of role-play in suggestive individuals
- Occurs in response to prompting by therapists or media

Tardive Dyskinesia

Chronic involuntary mouth movements
Result from prolonged First Gen. Antipsychotics

Depersonalization Disorder

Perception of self is altered
- Lost sense of self
- Unusual sensory experiences
- Limbs feel deformed or enlarged
- Voices sound different
- Feelings of detachment or disconnection
- watching self from outside
- floating above one's body

Dissociative Amnesia

Inability to recall important personal information
- Usually about a traumatic experience
- Not ordinary forgetting
- Not due to physical injury
- May last hours or years
Usually remits spontaneously

Dissociative Fugue

Amnesia, flight and new identity - Unexpected travel with inability to recall one's past

Somatization Disorder Treatment

1) Regularly scheduled visits with one PCP (Primary Care Physician)
2) Goal is management of symptoms, not necessarily resolution of symptoms
3) Psychiatric referral should happen only once

Bodily Dysmorphic Disorder

Preoccupations with having some profound bodily deformity
* Exception - Does Not Apply To WEIGHT
- Either no deformity exists or is minor
- Causes distress and or impairment

Somatization Benefits

Rewards
1) Primary Gain - avoidance of inciting psychological conflict
2) Secondary Gain - attaining sick role
3) External Incentives
a. Financial Assistance / disability
b. Avoidance of legal charges or duty
c. Obtaining drugs for abuse

Conversion Disorder

Motor and or sensory symptoms not from neurological problem (ex: paralysis, blindness, mutism, seizures,etc.)
* Psychological factors associated with initiation and or exacerbation
* Production of symptoms NOT conscious

Somatization Disorder

Remember 4,2,1,1
4 pain symptoms
2 GI symptoms (gastrointestinal)
1 sexual
1 pseudo-neurological (false)
* Production of symptoms NOT conscious or intentional

Major Depressive Disorder

- One or more major depressive episodes
- No history of manic, mixed or hypomanic episodes

Substance Induced Mood Disorder

Mood disorder related to physiological effects of a substance
- causes impairment

Hypomanic Episode

Syndrome of persistently Elevated, Expansive, or Irritable mood lasting at least 4 days, and including 3 of the following:
G, D, D, F, P, P
Grandiosity
Distractibility
Decreased need for sleep
Flight of ideas
Pressured speech
Psychomotor Agitation
* Does NOT cause marked functional impairment

Major Depressive Episode

At least 5 of following symptoms lasting 2 weeks (One symptom must be dysphoria or decreased interest):
Remember SIGECAPSS **
Sadness (Dysphoria)
Interest Decreased (Decreased Interest)
Guilt / Worthlessness
Energy Change
Concentration Impairment
Appetite Change
Psychomotor Retardation
Sleep Disturbance
Suicidal Thoughts

Mood Disorder due to General Medical Condition

Mood disturbance related to physiological effects of a medical illness
- NOT merely emotional reaction to diagnosis
- Causes impairment

Manic Episode

Period of abnormally and persistently Elevated, Expansive, or Irritable Mood lasting at least 1 Week and include at least 3 of the following:
G,D,D,F,P,P,H*
Grandiosity
Decreased Need for Sleep
Distractibility
Flight of ideas (racing thoughts)
Pressured Speech
Psychomotor Agitation
High Risk Activities *
* Causes Marked Impairment *

Psychological Treatment of Mood Disorders

1) Interpersonal Psychotherapy (IPT)
2) Cognitive Therapy
3) Mindfulness based Cognitive Therapy (MBCT)
4) Behavioral Couples Counseling

Dysthymic Disorder

Depressed mood lasting at least 2 years and including at least 2 of the following:
(Remember D,D,D,L,P,H)
Decreased sleep
Decreased appetite
Decreased energy
Low self-esteem
Problems concentrating
Hopelessness
* NO MDE, Manic, Mixed or Hypomanic Episodes *

Cyclothymic Disorder

Numerous Hypomanic episodes & Depressive episodes for at least 2 years
No MDE, Manic or Mixed episodes in first 2 years of disturbance

Mixed Episode

Syndrome involving concurrent symptoms of MDE and Manic episode for at least 1 week
- a.k.a. Dysphoric Mania

Bipolar I Disorder

One or more Manic or Mixed Episodes
- MDE not required

Bipolar II Disorder

At least 1 MDE and at least 1 Hypomanic Episode
- NO Manic or Mixed episodes

Generalized Anxiety Disorder

Characterized by at least 6 months of persistent and excessive worry about everything

Agoraphobia

Anxiety about, or avoidance of, places or situations where escape might be difficult or embarrassing - OR - help may not be available in event of panic attack

Multi-Axial Assessment

1. Clinical Disorders
2. Personality Disorders & Mental Retardation
3. General Medical Conditions
4. Psycho-social and environmental problems
5. GAF (Global Assessment of Functioning)

Panic Attack

Discrete period when sudden impact of intense apprehension, fearfulness, or terror, feelings of impending doom

Acute Stress Disorder

Characterized by symptoms similar to PTSD that occur immediately in aftermath of extremely traumatic event

Obsessive Compulsive Disorder

Characterized by Obsessions (which cause anxiety or stress) and / or Compulsions (serve to neutralize stress)

Autism

(Remember 3, 2, 1, 1)
Social/communication/play problems before age "3"
2 "Social" criteria
1 "Communication" criterion
1 "Behavior problems" criterion

Autism Social Criteria

Remember PRN'S
P-Peer relationships fail to develop normally
R-Reciprocity, social or emotional, is lacking
N-Non-verbal behaviors are impaired
S-Spontaneously seeking to share with others is lacking

Autism Communication Criteria

Remember LISP
L-Language delayed or lacking
I -Initiating/Sustaining conversation is impaired
S-Stereotyped, repetitive, or idiosyncratic language
P-Play is lacking or not developmentally appropriate

Autism Behavior Patterns Criteria

Remember PIMP
P-Patterns of interest are stereotyped/restricted
I-Inflexible adherence to specific nonfunctional routines and/or rituals
M-Motor mannerisms that are stereotyped/repetitive
P-Parts of objects is persistent preoccupation

ADHD criteria

(Remember 6,6,7)
A. Either 1 or 2:
1) 6 or more inattention symptoms that are maladaptive for 6 months or more
2) 6 or more hyperactivity/impulsive symptoms that are maladaptive for 6 months or more
B. Some hyperactive-impulsive or inattentive symptoms that caused impairment were present before age 7

Medical treatment of ADHD

Stimulants (Concerta, Vyvanse, Adderrall,etc) or
Non-Stimulants (Strattera, Intuniv, Kapvay, Wellbutrin)
- Stimulants Most Commonly Used
- Side Effects - headache, stomach ache, loss of appetite

Psychosocial treatment of ADHD

Parent Training*
-Behavioral interventions at school/home
-Structure/routine (bedtime)
- Classroom accommodations

Oppositional Defiant Disorder

Negative, hostile, defiant behavior lasting at least 6 months with at least 4 present:
-Often loses temper
-Often argues with adults
-Often actively defies or refuses to comply with adults requests or rules
- Often deliberately annoys people
- Often blames others for his or her mistakes or misbehavior
- Often touchy or easily annoyed by others
- Often angry and resentful
- Often spiteful or vindictive

Conduct Disorder

3 or more of the following lasting past 6 months:
- Aggression to people animals
- Destruction of property
- Deceitfulness of property
- Deceitfulness or theft
- Serious violation of rules

Anorexia Nervosa

- Refusal to maintain normal body weight
(Less than 85% of ideal body weight)
- Intense fear of gaining weight and being fat
- Distorted body image
- Amenorrhea - loss of menstrual period

Anorexia Nervosa

Young women disease
Women 10x as likely to develop disorder as men
Suicide rates very high
- 20% attempting
- 5% completing

Bulimia Nervosa

Uncontrollable eating binges followed by compensatory behavior to prevent weight gain
- At or above normal body weight
- Two types: Purging (vomiting, laxatives)
Non-purging (fasting, excessive exercise)

Binge

An excessive amount of food consumed in under 2 hours
- Occur at least 2x per week for 3 months

Russell's Sign

Possible physical change of bulimia
- calloused knuckles from purging

Implicit memory

underlies behaviors based on experiences that cannot be consciously recalled
(Skills) e.g. playing tennis, writing a check

Explicit memory

Involves conscious recall of experiences
facts, b-day's, dates

Electroconvulsive Therapy

Mood disorder treatment reserved for:
- Severe depression with high risk of suicide
- Depression with psychotic features
- Treatment non-responders
Side Effects
- Memory loss

Panic Disorder

Recurrent, uncued panic attacks
- At least 1 month of concern or worry about possibility of future attacks

Phobia

Irrational, excessive, persistent fear triggered by objects or situations
- Lasts at least 6 months

Social Anxiety Disorder

a.k.a. Social Phobia
- Causes more life disruption than other phobias
- Fear of: being in presence of other people, being embarrassed, sweating, blushing, negatively evaluated, scrutinized, etc.

Personality Disorders General Diagnostic Criteria

Manifests in at least 2 of following areas:
1.Cognition 2. Affectivity 3. Interpersonal Functioning 4. Impulse Control

Cluster A Personality Disorders

WEIRD (P,S,S)
Paranoid, Schizotypal, Schizoid

Cluster B Personality Disorders

WILD (N,A,H,B)
Narcissistic, Anti-Social, Historionic, Borderline

Cluster C Personality Disorders

WORRIED (D,O,A)
Dependent, Obsessive Compulsive, Avoidant

Paranoid Personality Disorder

4 or more of the following:
1. Suspects without evidence, others are exploiting, harming or deceiving him,
2. Preoccupied with unjustified doubts about loyalty or trustworthiness of friends
3. Unwarranted fear that info he gives will be used against him
4. Reads hidden demeaning or threatening meanings into benign remarks
5. Persistently bears grudges

Schizotypal Personality Disorder

Begins in early adulthood and present in variety of contexts, indicated by 5 or more of the following:
1. Ideas of reference
2. Odd beliefs or magical thinking
3. Unusual perceptual experiences (including bodily illusions)
4. Odd thinking or speech
5. Suspiciousness or paranoid ideation
6. Inappropriate or constricted affect
7. Odd, eccentric, or peculiar behavior or appearance
8. lacks close friends
9. excessive social anxiety tends to be associated with paranoid fears

Schizoid Personality Disorder

Begins in early adulthood and present in variety of contexts, indicated by 4 or more of the following:
1. Neither desires nor enjoys close relationships (including family)
2. Prefers solitary activities
3. Little or no interest in sexual experiences
4. Takes pleasure in few if any activities
5. Lacks close friends
6. Indifferent to praise or criticism
7. Shows emotional coldness, detachment, or flattened affect

Narcissistic Personality Disorder

Begins in early adulthood and present in variety of contexts, indicated by 5 or more of the following:
1. Grandiose sense of self-importance
2. Preoccupied with fantasies of unlimited success, power, beauty, brilliance or ideal love
3. Believes to be special and unique can only be understand or associate with high-status people or institutions
4. Requires excessive admiration
5. Sense of entitlement
6. Interpersonally exploitative (takes advantage of others for his own ends)
7. Lacks empathy**
8. Often envious of others or believes that others are envious of him
9. Shows arrogant, haughty behaviors or attitudes

Antisocial Personality Disorder

Occurring since age 15 years, indicated by 3 or more of the following:
1. Fails to conform to social norms with lawful behaviors
2. deceitfulness, repeated lying, conning others
3. impulsive or failures to plan ahead
4. Irritable and aggressive, by repeated fights or assaults
5. Reckless disregard for personal safety or safety of others
6. Consistently fails to keep jobs or honor financial obligations
7. Lacks remorse or indifferent when hurting, mistreating, or stealing from others
- At least 18 years of age
- Evidence of Conduct Disorder with onset before 15 years

Histrionic Personality Disorder

Begins in early adulthood and present in variety of contexts, indicated by 5 or more of the following:
1. Uncomfortable when he or she is not center of attention
2. Interaction with others often inappropriate sexually seductive or provocative behavior
3. Displays rapidly shifting and shallow expression of emotions
4. Uses physical appearance to draw attention to self
5. Style of speech that is excessively impressionistic and lacking in detail
6. Theatrical, and exaggerates expression of emotion
7. Easily influenced by others or circumstances
8. Considers relationships to be more intimate than they are

Borderline Personality Disorder

Begins in early adulthood and present in variety of contexts, indicated by 5 or more of the following:
1. Frantic efforts to avoid abandonment * (real or imagined)
2. Unstable interpersonal relationships characterized by alternating between extremes of idealization and devaluation
3. Persistently unstable self-image or sense of self
4. Risky or self-damaging impulsive behaviors
5. Recurrent suicidal or self-mutilating behaviors
6. Affective instability
7. Chronic feelings of emptiness
8. Inappropriate anger or difficulty controlling anger
9. Transient, stress-related paranoid ideation or severe dissociative symptoms

Dependent Personality Disorder

Begins in early adulthood and present in variety of contexts, indicated by 5 or more of the following:
1. Difficulty making decisions without excessive amount of advice and reassurance from others
2. Needs others to assume responsibility for most major areas of his life
3. Difficulty expressing disagreement with others because he fears loss of support or approval
4. Difficulty starting projects or doing things on his own
5. Goes to excessive lengths to receive nurturance and support from others
6. Feels uncomfortable or helpless being alone because fear of being unable to care for himself
7. Urgently seeks another relationship as a source of care when close relationship ends
8. Unrealistically preoccupied with fears of being able to take care of himself

Obsessive Compulsive Personality Disorder

Begins in early adulthood and present in variety of contexts, indicated by 4 or more of the following:
1. Preoccupied with rules, details, lists, order, organization, or schedules
2. Shows perfectionism that interferes with task completion
3. Excessively devoted to work and productivity to the exclusion of friendships and leisure
4. Overconscientious, scrupulous and inflexible about matters of morality, ethics, or values
5. Unable to discard worn-out or worthless objects even if there is no sentimental value
6. Reluctant to delegate tasks or work with others unless they have complete control
7. Adopts miserly spending style both toward self and others
8. Shows rigidity and stubborness

Avoidant Personality Disorder

Begins in early adulthood and present in variety of contexts, indicated by 4 or more of the following:
1. Avoids job activities that involve significant interpersonal contact, because of fear of criticism, disapproval, or rejection
2. Unwilling to get involved with people unless certain of being liked
3. Shows restraint with intimate relationships because of fear of being shamed or ridiculed
4. Preoccupied with being criticized or rejected in social situations
5. Inhibited in new interpersonal situations because of feelings of inadequacy
6. Views self as socially inept, personally unappealing or inferior to others
7. Unusually reluctant to take personal risks or try new activities because they may be embarrassed

Dementia

Deterioration of cognitive functioning
- Progresses over time
- Begins with difficulty remembering recent events

Dementia

Multiple cognitive impairments including 1+ of the following:
1. Aphasia - language impairment (naming, speech)
2. Apraxia - can't execute motor activities
3. Agnosia - can't recognize / identify objects or faces
4. Disturbance is executive functioning (planning, initiating, sequencing)

Alzheimer's Disease

80% of Dementia Cases
- Irreversible brain deterioration
- Death usually occurs within 12 years

Vascular Dementia

May or may not involve neurological impairment
- Weakness in limb or abnormal reflexes
Typically result from stroke
Risk factors: Smoking, high LDL cholesterol, high BP

Frontal-Temporal Dementia

-Impairment of executive functions (planning, problem solving, goal directed behavior)
- Begins in mid to late 50's
- Memory not severely disrupted

Dementia with Lewy Bodies

Symptoms similar to Parkinson's and Alzheimer's diseases
- Shuffling gait
- Loss of memory
Symptoms differ in that patients have:
- Fluctuating cognitive symptoms
- Prominent visual hallucinations
- Intense dreams involving movement and vocalizing

Delirium

Clouded State of Consciousness
- State of mental confusion
- Secondary to underlying medical condition
- Beyond treating underlying medical conditions, most common treatment is atypical antipsychotics

Aspergers Disorder

Less severe than Autism (2,1)
2 Social Interaction Impairments PRN'S
-Peer relationships not normal
-Reciprocity decreased; social/emotional
-Non-verbal behaviors abnormal
-Limited sharing of interests with others
0 Communication Problems Unlike Autism
-No language delay
1 Behavioral Symptoms PIMP
-Preoccupation with stereotyped/restricted interests
-Inflexible adherence to routines or rituals
-Mannerisms - stereotyped or repetitive
-Preoccupation with parts of objects

Process of becoming a Drug Abuser

Positive Attitude -> Experimentation -> Regular Use -> Heavy Use -> Abuse or Dependence

Early Remission

After 1 month, less than 12 months

Sustained Remission

After 12 months

Full Course Specifier

No criteria for dependence or abuse met during period of remission

Partial Course Specifier

at least one criteria met during period of remission

Substance Abuse

Maladaptive pattern of use leading to significant clinical impairment: At least 1 of the following in same 12-month period:
1. Failure to fulfill major obligations at work, home, or school
2. Use in situations which is physically hazardous
3. Recurrent substance related legal problems
4. Continued use despite persistent social or interpersonal problems caused by it

Substance Dependence

Maladaptive pattern of use leading to clinical impairment: At least 3 of the following in same 12-month period:
1. Tolerance
2. Withdrawal
3. Substance taken in large amounts over longer period of time than intended
4. Persistent desire or efforts to cut down
5. Great deal of time used to obtain, use, or recover from substance
6. Social/Occupational/Recreational Activities given up
7. Use continued despite knowledge of problem

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