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Abnormal Psych Chapters 5, 6

Terms in this set (72)

Somatic Symptom Disorders
-Illness anxiety disorder
-Somatic symptom disorder
-Conversion disorder (functional neurological symptom disorder)
-Factitious disorder
-Psychological factors affecting medical conditions
Dissociative Disorders
-Depersonalization/derealization disorder
-Dissociative amnesia
-Dissociative trance disorder
-Dissociative identity disorder
Soma
Soma - meaning "body"
Preoccupation with health and/or body appearance and functioning
No identifiable medical condition causing the physical complaints
Somatic Symptom Disorder: Clinical Description
Presence of one or more medically unexplained symptoms
Substantial impairment in social or occupational functioning
Concern about the symptoms
In severe cases, symptoms become the person's identity
Somatic Symptom Disorder with Predominant Pain
Type of somatic symptom disorder, previously classified as "pain disorder"
Clear physical pain that is medically unexplained
Little is known about origin
-May include:
--Familial history of illness
--Stressful life events
--Sensitivity to physical sensations
--Experience suggesting that there are benefits to illness (e.g., attention)
5% to 8% of the population my have this disorder
Somatic Symptom Disorder: Treatments
Treatment
CBT is the best treatment
Reduce the tendency to visit numerous medical specialists "doctor shopping"
Assign "gatekeeper" physician
Reduce supportive consequences of talk about physical symptoms
Illness Anxiety Disorder
Clinical description:
Physical complaints without a clear cause
Severe anxiety about the possibility of having a serious disease
Strong disease conviction
Medical reassurance does not seem to help
Very similar to DSM-IV hypochondriasis
Culturally specific disorders similar to illness anxiety disorder
Koro = Fear in some Asian cultures of genitals retracting into the abdomen.
Dhat = Symptoms like dizziness, weakness and fatigue are attributed to semen loss in some Indian cultures.
Kyol goeu = "Wind overload." A syndrome among Khmer people of Cambodia. Anxiety that the vessels allowing for proper circulation of "wind" in the body are blocked, which is thought to cause death. Dizziness, weakness, fatigue and trembling are seen as signs of this illness, and these symptoms lead to great anxiety.
Illness Anxiety Disorder: Causes and Treatments
Causes:
Cognitive perceptual distortions
Familial history of illness
Treatment:
Challenge illness-related misinterpretations
Provide more substantial and sensitive reassurance and education
Stress management and coping strategies
CBT is generally effective
Antidepressants offer some help
Conversion Disorder (Functional Neurological Symptom Disorder)
Clinical description
Physical malfunctioning of sensory or motor functioning
E.g., blindness or difficulty speaking (aphonia)
Lack physical or organic pathology
Persons may show "la belle indifference"
Retain most normal functions, but lack awareness
Conversion Disorder: Causes
Not well understood
Freudian psychodynamic view is still common, though unsubstantiated
Past trauma or unconscious conflict is "converted" to a more acceptable manifestation, i.e., physical symptoms
Primary/secondary gains
Freud thought primary gain was the escape from dealing with a conflict
Secondary gains: Attention, sympathy, etc.
Conversion Disorder: Treatment
Similar to somatic symptom disorder
If onset after a trauma, may need to process trauma or treat posttraumatic symptoms
Remove sources of secondary gain
Reduce supportive consequences of talk about physical symptoms
Factitious Disorders
Clinical description
Purposely faking physical symptoms
May actually induce physical symptoms or just pretend to have them
No obvious external gains
Distinguished from "malingering", in which physical symptoms are faked for the purpose of achieving a concrete objective (e.g., getting paid time off, avoiding military service)
Factitious Disorder Imposed on Another
Type of factitious disorder
More commonly known as Muchausen syndrome by proxy
Inducing symptoms in another person
Typically a caregiver induces symptoms in a dependent (e.g. child)
Purpose = receive attention or sympathy
Psychological Factors Affecting Medical Condition
Diagnostic label useful for clinicians
Indicates that psychological variables may be impacting a generam medical issue
Examples:
Chronic anxiety attacks worsening asthma
Needle phobia making it impossible to get important bloodwork done
Overview of Dissociative Disorders
Involve severe alterations or detachments from reality
Affect identity, memory, or consciousness
Depersonalization - distortion in perception of one's own body or experience (e.g., feeling like you own body isn't real)
Derealization - losing a sense of the external world (e.g., sense of living in a dream)
Depersonalization/Derealization Disorder: An Overview
Overview and defining features:
Recurrent episodes in which a person has sensations of unreality of one's own body or surroundings
Feelings dominate and interfere with life functioning
Only diagnosed if primary problem involves depersonalization and derealization
Similar symptoms may occur in the context of other disorders, including panic disorder and PTSD
Depersonalization/Derealization Disorder: Causes and Treatment
Risk factors:
Cognitive deficits in attention, short-term memory, spatial reasoning
Deficits related to tunnel vision and mind emptiness
Such persons are easily distracted
Treatment:
Little is known due to limited research
Dissociative Amnesia: An Overview
Dissociative amnesia
Includes several forms of psychogenic memory loss
Generalized vs. localized or selective type
May involve dissociative fugue
During the amnestic episode, person travels or wanders, sometimes assuming a new identity in a different place
Unable to remember how or why one has ended up in a new place
Dissociative Amnesia and Fugue: Causes
Statistics:
Usually begin in adulthood
Show rapid onset and dissipation
Causes:
Little is known
Trauma and stress can serve as triggers
Dissociative Amnesia and Fugue: Treatment
Most get better without treatment
Most remember what they have forgotten
Dissociative Trance Disorder: An Overview
Clinical description
Symptoms resemble other dissociative disorders
Dissociative symptoms and sudden changes in personality
Changes often attributed to possession by a spirit
Presentation varies across cultures
Nigeria - called vinvusa
Thailand - called phii pob
Only considered a disorder if leads to distress or impairment
Dissociative Trance Disorder: Causes and Treatments
Causes:
Often attributable to a life stressor or trauma
Treatment:
Little is known
May need to address stressor/trauma
Dissociative Identity Disorder (DID): An Overview
Clinical description
Formerly known as multiple personality disorder
Defining feature is dissociation of personality
Adoption of several new identities (as many
as 100; may be just a few; average is 15)
Identities display unique behaviors, voice, and postures
Unique aspects of DID
Alters - different identities or personalities
Host - the identity that keeps other identities together
Switch - quick transition from one personality to another
Dissociative Identity Disorder (DID): Causes
Causes:
Typically linked to a history of severe, chronic trauma, often abuse in childhood
Closely related to PTSD, possibly an extreme subtype
Mechanism to escape from the impact of trauma
Biological vulnerability possible
Dissociative Identity Disorder (DID): Treatments
Treatment:
Focus is on reintegration of identities
Identify and neutralize cues/triggers that provoke memories of trauma/dissociation
Patient may have to relive and confront the early trauma
Some achieve through hypnosis
False Memories
Fairly easy to create false memories through suggestibility
Interest in repressed memories has led to some patients thinking they have repressed memories of abuse which are later shown to be false, but can be very damaging to patients and their families
Therapists need to be well trained in memory function and be careful not to suggest an untrue history by mistake
Summary of Somatic Symptom Disorders and Dissociative Disorders
Features of somatic symptom disorders
-Physical problems without on organic cause
Features of dissociative disorders
-Extreme distortions in perception and memory
Well established treatments are generally lacking
An Overview of Depression and Mania
Mood disorders = gross deviations in mood
Composed of different types of mood "episodes": periods of depressed or elevated mood lasting days or weeks, including:
Major depressive episodes
Persistent depression
Manic and hypomanic episodes
Depressive Disorders
Major Depressive Disorder
Persistent Depressive Disorder
Bipolar Disorders
Bipolar I disorder
Bipolar II disorder
Cyclothymic disorder
Types of Mood Disorders
Major depressive episode
Extremely depressed mood and/or loss of pleasure (anhedonia)
Lasts most of the day, nearly every day for at least two weeks
At least 4 additional physical or cognitive symptoms:
E.g., indecisiveness, feelings of worthlessness, fatigue, appetite change, restlessness or feeling slowed down, sleep disturbance
Manic Episodes
Elevated, expansive mood for at least one week
Inflated self-esteem, decreased need for sleep, excessive talkativeness, flight of ideas or sense that thoughts are racing, easy distractibility, increase in goal-directed activity or psychomotor agitation, excessive involvement in pleasurable but risky behaviors
Impairment in normal functioning
Hypomanic Episodes
Shorter, less severe version of manic episodes
"Mixed Features"
"Mixed features" = term for a mood episode with some elements reflecting the opposite valence of mood
Example: Depressive episode with some manic features
Example: Manic episode with some depressed/anxious features
Major Depressive Disorder: An Overview
Clinical features
One or more major depressive episodes separated by periods of remission
Single episode - highly unusual
Recurrent episodes - more common
From grief to depression
Previously could not be diagnosed during periods of mourning
Now recognized that major depression may occur as part of the grieving process
Persistent Depressive Disorder: An Overview
At least two years of depressive symptoms
Depressed mood most of the day on more than 50% of days
No more than two months symptom free
Symptoms can persist unchanged over long periods (≥ 20 years)
May include periods of more severe major depressive symptoms
Major depressive symptoms may be intermittent or last for the majority or entirety of the time period
Bipolar I Disorder: An Overview
Overview and defining features
Alternations between full manic episodes and major depressive episodes
Facts and statistics
Average age of onset is 15-18 years
Can begin in childhood
Tends to be chronic
Suicide is a common consequence
Bipolar II Disorder: An Overview
Overview and defining features
Alternations between major depressive and hypomanic episodes
Facts and statistics
Average age of onset is 19-22 years
Can begin in childhood
10% to 25% of cases progress to full bipolar I disorder
Tends to be chronic
Cyclothymic Disorder: An Overview
Overview and defining features
Chronic version of bipolar disorder
Alternating between periods of mild depressive symptoms and mild hypomanic symptoms
Episodes do not meet criteria for full major depressive episode, full hypomanic episode or full manic episode
Hypomanic or depressive mood states may persist for long periods
Must last for at least two years (one year for children and adolescents)
Prevalence of Mood Disorders
Worldwide lifetime prevalence
16% for major depression
6% have experienced major depression in last year
Sex differences
Females are twice as likely to have major depression
Bipolar disorders approximately equally affect males and females
Women more likely to experience rapid cycling
Women more likely to be in depressive period
Prevalence of Mood Disorders pt 2
Occurs less often in prepubertal children
Rapid rise in adolescents
Adults over 65 have about 50% less prevalence than general population
Bipolar same in childhood, adolescence and adults
Prevalence of depression seems to be similar across subcultures
Life Span Developmental Influences on Mood Disorders
Three-month-olds can show depressive symptoms
Young children typically don't show classic mania or bipolar symptoms
Mood disorder may be misdiagnosed as ADHD
Children are being diagnosed with bipolar at increasingly high rates
Live Span Developmental Influences on Mood Disorders
Depression in elderly between 14% and 42%
Co-occurance with anxiety disorders
Less gender imbalance after 65 years of age
Cultural differences exist
Hopi say they are "heartbroken"
Native American population have four times the rate of depressive disorders as the general population
Mood Disorders: Familial and Genetic Influences
Twin studies
Concordance rates are high in identical twins
two to three times more likely to present with mood disorders than a fraternal twin of a depressed co-twin
Severe mood disorders have a strong genetic contribution
Heritability rates are higher for females compared to males
Vulnerability for unipolar or bipolar disorder
Appears to be inherited separately
Some genetic factors are common for mood and anxiety disorders
Mood Disorders: Neurobiological Influences
Neurotransmitter systems
Serotonin and its relation to other neurotransmitters
Serotonin regulates norepinephrine and dopamine
Mood disorders are related to low levels of serotonin
Permissive hypothesis: Low serotonin "permits" other neurotransmitters to vary more widely, increasing vulnerability to depression
Mood Disorders: Neurobiological Influences pt 2
The endocrine system
Elevated cortisol
Stress hormones decrease neurogenesis in the hippocampus > less able to make new neurons
Sleep disturbance
Hallmark of most mood disorders
Depressed patients have quicker and more intense REM sleep
Sleep deprivation may temporarily improve depressive symptoms in bipolar patients
Mood Disorders: Psychological Dimensions (stress)
Stressful life events
Stress is strongly related to mood disorders
Poorer response to treatment
Longer time before remission
Context of life events matters
Gene-environment correlation: People who are vulnerable to depression might be more likely to enter situations that will lead to stress
The relationship between stress and bipolar is also strong
Mood Disorders: Psychological Dimensions (Learned Helplessness)
The learned helplessness theory of depression
Lack of perceived control over life events leads to decreased attempts to improve own situation
First demonstrated in research by Martin Seligman
Negative cognitive styles are a risk factor for depression
Mood Disorders: Depressive Attributional Style
Internal attributions
Negative outcomes are one's own fault
Stable attributions
Believing future negative outcomes will be one's fault
Global attribution
Believing negative events will disrupt many life activities
All three domains contribute to a sense of hopelessness
Mood Disorders: Psychological Dimensions (Cognitive Theory)
Negative coping styles
Depressed persons engage in cognitive errors
Tendency to interpret life events negatively
Types of cognitive errors
Arbitrary inference - overemphasize the negative aspects of a mixed situation
Overgeneralization - negatives apply to all situations
Cognitive errors and the depressive cognitive triad
Think negatively about oneself
Think negatively about the world
Think negatively about the future
Mood Disorders: Social and Cultural Dimensions
Marital relations
Marital dissatisfaction is strongly related to depression
This relation is particularly strong in males
Gender Differences in Mood Disorders
Women account for 7 out of 10 cases of major depressive disorder
Recall that women also have higher rates of anxiety disorders
Possible explanations for gender disparity
Women socialized to have stronger perception of uncontrollability
Parenting style makes girls less independent
Women more sensitive to relationship disruptions (e.g., breakups, tension in friendships)
Women ruminate more than men
Mood Disorders: Social and Cultural Dimensions pt 2
Social support
Extent of social support is related to depression
Lack of social support predicts late onset depression
Substantial social support predicts recovery from depression
An Integrative Theory
Shared biological vulnerability
Overactive neurobiological response to stress
Inadequate coping and depressive cognitive style
Diathesis-stress model
Biological, psychological and social factors all influence the development of mood disorders
Exposure to stress
Treatment of Mood Disorders: Medication
Antidepressants
Selective serotonin reuptake inhibitors
tricyclic antidepressants
monoamine oxidase inhibitors
Mixed reuptake inhibitors (e.g., serotonin/norepinephrine reuptake inhibitors)
Approximately equally effective
Only 50% of patients benefit;
Only 25% achieve normal functioning
Selective Serotonin Reuptake Inhibitors
Called SSRIs
Specifically block reuptake of serotonin so more serotonin is available in the brain
Fluoxetine (Prozac) is the most popular SSRI
SSRIs pose some risk of suicide particularly in teenagers
Negative side effects are common
Tricyclic Antidepressants
Include Tofranil, Elavil
Mechanisms not well understood
Block reuptake orepinephrine and other neurotransmitters
Negative side effects are common (e.g., drowsiness, weight gain)
Discontinuation is common
May be lethal in excessive doses
Mixed Reuptake Inhibitors
Block reuptake of norepinephrine as well as serotonin
Best known is venlafaxine (Effexor)
Have fewer side effects than SSRIs
Monoamine Oxidase (MAO) Inhibitors
Block monoamine oxidase
This enzyme breaks down serotonin/norepinephrine
As effective as tricyclics, with fewer side effects
Dangerous in combination with certain foods
Beer, red wine, cheese cannot be consumed; patients dislike dietary restrictions
Also dangerous in combination with cold medicine
Treatment of Mood Disorders: Lithium
Lithium carbonate = a common salt
Treatment of choice for bipolar disorder
Considered a mood stabilizer because it treats depressive and manic symptoms
Toxic in large amounts
Dose must be carefully monitored
Effective for 50% of patients
Why lithium works remains unclear
Treatment of Mood Disorders: Electroconvulsive Therapy (ECT)
Effective for medication-resistant depression
The nature of ECT
Brief electrical current applied to the brain
Results in temporary seizures
Usually 6-10 outpatient treatments are required
Side effects:
Short-term memory loss which is usually restord
Some patients suffer long-term memory loss
Mechanism is unclear
Treatment of Mood Disorders: Transcranial Magnetic Stimulation
Uses magnets to generate a precise localized electromagnetic pulse
Few side effects; occasional headaches
Less effective than ECT for medication-resistant depression
May be combined with medication
Psychosocial Treatments for Depression
Cognitive-behavioral therapy
Addresses cognitive errors in thinking
Also includes behavioral components
Interpersonal psychotherapy
Focus: Improving problematic relationships
Prevention
Preemptive psychosocial care for people at risk
Has longer-lasting effectiveness than medication
Psychosocial Treatments for Bipolar Disorder
Medication (usually Lithium) is still first line of defense
Psychotherapy helpful in managing the problems (e.g., interpersonal, occupational) that accompany bipolar disorder
Family therapy can be helpful
Suicide: Facts and Statistics
11th leading cause of death in USA
Underreported; actual rate may be 2-3x higher
Most common among white and native Americans
Particularly prevalent in young adults
Third leading cause of death among teenagers
Second leading cause of death in college students
12% of college students consider suicide in a given year
Gender differences:Th
Males complete more suicides than females
Females attempt suicide more often than males
Disparity is due to males using more lethal methods
Exception: Suicide more common among women in China
May reflect cultural acceptability; suicide is seen as an honorable solution to problems
The Nature of Suicide: Risk Factors
Risk factors
Suicide in the family
Low serotonin levels
Preexisting psychological disorder
Alcohol use and abuse
Stressful life event, especially humiliation
Past suicidal behavior
Plan and access to lethal methods
Suicide Contagion
Some research indicates that a person is more likely to commit suicide after hearing about someone else committing suicide
Media accounts may worsen the problem by
Sensationalizing/romanticizing suicide
Describing lethal methods of committing suicide
Suicide Prevention
In professional mental health:
-Clinician does risk assessment (ideation, plans, intent, means, etc.)
-Clinician and patient develop safety plan (e.g., who to call, strategies for coping with suicidal thoughts)
-In some cases, sign no-suicide contract
-Preventative programs for at-risk groups
-Important: removing access to lethal methods
-If you think someone is at risk, talk to them and ensure they're getting needed support
-Talking to someone about suicide is not likely place them at greater risk or "plant the idea"
-In contrast, the risk of not providing support to someone who may be in need is huge
Suicide Support Line:
1-800-273-TALK
(1-800-273-8255)
Summary of Mood Disorders
All mood disorders share:
Gross deviations in mood
Common biological and psychological vulnerability
Occur in children, adults, and the elderly
Onset, maintenance, and treatment are affected by
Stressful life events
Social support
Differential response to medication
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