114 terms

DTS Abnormal Behavior

Abnormal Behavior Final Exam Terms
Mental Disorder
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
Apathy, Lack of Motivation and seeming Absence of Interest or Inability in what are usually routine activities
Significant Reduction in Amount of Speech
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)
Inability to experience pleasure
Schizophreniform Disorder
Schizophrenia characteristic symptoms met
* Episode of Disorder lasts at least 1 month but less than 6 months
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
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)
- comes from Tyrosine - which is involved in reward
- Ventral Tegmental area of the midbrain
- Substantia Nigra
comes from Dopamine, which comes from Tyrosine
- Made in Locus Coeruleus in brainstem
Synthesized from Tryptophan
- Raphe Nucleus in brainstem
Norepinephrine Deficiency Syndrome
Decreased Attention
Decreased Concentration
Impaired Working Memory
Information Processing Speed (Slowed)
Psychomotor Retardation
Serotonin Deficiency Syndrome
Depressed Mood
Obsessions and Compulsions
Food Craving
Bulimic Behavior
Serotonin and Norepinephrine Reuptake Inhibitors
- Useful for Improving Energy and fighting Depression
- Do not give to someone with hypertension (high blood pressure)
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
Symptoms or evidence of disease are INTENTIONALLY induced or produced solely for personal benefit (External incentives)
- NOT a psychiatric disorder
- NOT DSM IV diagnosis
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 *
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
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
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:
Decreased Need for Sleep
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
* 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
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)
(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)
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
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
Paranoid, Schizotypal, Schizoid
Cluster B Personality Disorders
Narcissistic, Anti-Social, Historionic, Borderline
Cluster C Personality Disorders
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
Deterioration of cognitive functioning
- Progresses over time
- Begins with difficulty remembering recent events
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
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