1
Q
What is anxiety?
A
A mood state characterised by marked negative affect and bodily symptoms of tension in which a person apprehensively anticipates future danger or misfortune: ‘Shadow of Intelligence’.
2
Q
What is the Evolutionary Perspective of fear?
A
The fear response is geared to enhance an animal’s survival advantage in the face of threat. The animal enters a state of physical readiness to avoid harm, avoid pain and avert danger.
3
Q
Examples of Archetypal threats and their pathological response.
A
- Smothering: Panic attack, panic disorder
- Animals, environment: Specific phobia
- Social rejection: Social anxiety
- Dirt, disorganisation: OCD
- Future: GAD
4
Q
What is fear?
A
An immediate emotional reaction to a current threat geared towards averting danger.
5
Q
What is a Panic Attack?
A
An abrupt experience of intense fear or discomfort accompanied by a number of physical symptoms, such as dizziness or heart palpitation.
6
Q
Two types of panic attacks.
A
- Expected (cued) panic attack: If you know that you are afraid of high places, you might have a panic attack in that situation but not anywhere else.
- Unexpected (uncued) panic attack: If you are assailed by an attack for no good reason, out of the blue.
7
Q
What are the two types of symptoms of panic attacks?
A
- Physical symptoms: palpitations, sweating, trembling, shortness of breath, dizziness, chest pain.
- Cognitive symptoms: fear of losing control, dying or going crazy.
8
Q
What are the Biological Contributions to the causes of anxiety and related disorders?
A
- Biological Vulnerability: The tendency to panic seems to run in families and probably has a genetic component that differs from genetic contributors to anxiety.
- Corticotropin-releasing factor (CRF): the expression of anxiety and the groups of genes that increase the likelihood that this system will be turned on.
- The Behavioural Inhibition System (BIS): activated by signals from the brain stem of unexpected events, such as major changes in body functioning that might signal danger.
- Fight/Flight System (FFS): a brain circuit in animals that, when stimulated, causes an immediate alarm and escape response resembling human panic. Also known as ‘fight, flight and freeze’.
- Brain circuits are shaped by environment: Factors in the environment can change the sensitivity of these neural systems, directly affecting susceptibility to anxiety and the emergence of anxiety disorder.
9
Q
What are the Social Contributions to the causes of anxiety and related disorders?
A
- Stressful Events: Stressful life events trigger our biological and psychological vulnerabilities to anxiety.
- An Integrated Model: Triple Vulnerability Theory: a theory of the development of anxiety by putting the factors together.
10
Q
What are the Psychological Contributions to the causes of anxiety and related disorders?
A
- Generalized Psychological Vulnerability: A general ‘sense of uncontrollability’ may develop early as a function of upbringing and other disruptive or traumatic environmental factors.
- Behavioural Theorists (Bandura): panic invoke conditioning and cognitive explanation that are difficult to separate. Thus, a string fear response initially occurs during extreme stress. This emotional response then becomes associated with a variety of external and internal cues. These cues, or conditioned stimuli, provoke the fear response and assumption of danger, even if the danger is not actually present, so it is really a learnt or false alarm.
- Psychoanalytic Theorists (Freud): You might not be aware of the cues or triggers of severe fear, that is, they are unconscious. This is most likely because these cues or triggers may travel from the eyes directly to the amygdala in the emotional brain without going through the cortex, the source of awareness.
11
Q
What is Anxiety Sensitivity?
A
The general tendency to respond fearfully to anxiety symptoms.
12
Q
What are External Cues?
A
Places or situations similar to the one where an initial panic attack occurred.
13
Q
What are Internal Cues?
A
Increases in heart rate, that were associated with the initial panic attack, even if they are now the result of normal circumstances, such as exercise.
14
Q
Outline the Triple Vulnerability Theory.
A
- Generalised Biological Vulnerability: we can see that the tendency to be uptight might be inherited. But GBV for anxiety is not sufficient to produce anxiety itself.
- Generalised Psychological Vulnerability: that is, you might also grow up believing the world is dangerous and out of control and you might not be able to cope when things go wrong based on your early experiences.
- Specific Psychological Vulnerability: you learn from early experience, such as being taught that some situations or objects are filled with danger (even if they are not).
15
Q
Comorbidity of Anxiety and Related Disorders.
A
- Before describing the specific disorders, it is important to note that the disorders often occur together.
- Additional diagnosis for all anxiety disorders is minor depression. This is important when discussing the relationship of anxiety and depression.
16
Q
Comorbidity with Physical Conditions.
A
- The presence of anxiety disorder was uniquely and significantly associated with thyroid disease, respiratory disease, gastrointestinal disease, arthritis, migraine and allergic conditions.
- Comorbid anxiety and physical disease cause greater morbidity and poorer quality of life.
17
Q
Suicide in anxiety and related disorders.
A
Having an anxiety or related disorder, not just PD, uniquely increases the chances of having thought about suicide, or making suicidal attempts. However, the relationship is strongest with PD and PTSD.
18
Q
What is Generalised Anxiety Disorder (GAD)?
A
An anxiety disorder characterised by intense, uncontrollable, unfocused, chronic and continuous worry that is distressing and unproductive, accompanied by physical symptoms of tenseness, irritability and restlessness.
19
Q
The DSM-5 diagnostic criteria for Generalised Anxiety Disorder (GAD)
A
A. Excessive anxiety and worry, occurring more days than not for at least 6 months, about a number of events or activities.
B. The individual finds it difficult to control the worry.
C. The anxiety and worry are associated with at least 3 (or more) of the following 6 symptoms (with at least some symptoms present for more days than not for the past 6 months):
1. Restlessness or feeling on the edge.
2. Being easily fatigued.
3. Difficulty concentrating or mind going blank.
4. Irritability.
5. Muscle tension.
6. Sleep disturbances.
D. The anxiety, worry or physical symptoms cause clinically significant distress or impairment in social, occupational or other important areas of functioning.
E. The disturbances are not attributable to the physiological effects of a substance (e.g. drug abuse, medication).
F. The disturbance is not better explained by another mental disorder (e.g. anxiety or worry about having panic attacks in panic disorder).
20
Q
What are the Causes of GAD?
A
- A genetic contribution to GAD confirmed that what seems to be inherited is the tendency to become anxious rather than GAD itself.
- Many people with GAD also inherit a tendency to be tense (generalised biological vulnerability) and proceed to develop a sense early on of the uncontrollability of adverse events (generalised psychological vulnerability).
21
Q
The Management of GAD.
A
- The most prudent approach to management would involve the exclusion of physical causes to the anxiety symptoms.
- Acute Symptomatic Relief can be achieved with the time-limited use of anxiolytic agents like the Benzodiazepines.
- The long-term management is strong evidence for the usefulness of antidepressants agents such as Serotonin Noradrenergic Reuptake Inhibitors (SSRIs).
- Cognitive Behavioural Therapy (CBT): patients learn to use cognitive therapy and other coping techniques to counteract and control the worry process.
22
Q
What is Panic Disorder?
A
The recurrent, unexpected panic attacks accompanied by concern about future attacks and/or a lifestyle change to avoid future attacks.
23
Q
What is Agoraphobia?
A
An anxiety disorder characterised by anxiety about being in places or situations from which escape might be difficult in the event of panic symptoms.
24
Q
A list of typical situations commonly avoided by individuals with agoraphobia.
A
- Shopping malls.
- Buses.
- Shops.
- Movies.
- Lifts.
25
Agoraphobia without the presence of a panic attack?
An individual who has not had a panic attack for years may still have strong agoraphobic avoidance. Avoidance is determined by the extent to which you think or expect you might have another attack rather than by how many attacks you have.
26
What is Interoceptive Avoidance?
The avoidance of physical sensations. These behaviours involve removing yourself from situations or activities that might produce the physiological arousal that somehow resembles the beginnings of a panic attack. These include:
1. Running up the stairs.
2. Hot, stuffy rooms.
3. Hot, stuffy cars.
4. Dancing.
5. Sexual relations
27
The DSM-5 diagnostic criteria for Panic Disorder (PD)
A. Recurrent unexpected panic attacks are present.
B. At least one of the attacks has been followed by 1 or more of one of the following: (a) Persistent concern or worry about additional panic attacks (e.g. losing control, having a heart attack, ‘ging crazy’ or (b) A significant maladaptive change in behaviour related to the attacks.
C. The disturbance is not attributable to the physiological effects of a substance (e.g. a drug of abuse, medication) or another medical condition (e.g. hyperthyroidism).
D. The disturbance is not better explained by another mental disorder (e.g. the panic attacks do not occur only in response to feared social situations, as in social anxiety disorder).
28
The DSM-5 diagnostic criteria for Agoraphobia
A. Marked by fear or anxiety about two or more of the following 5 situations:
1. Using public transportation.
2. Being in open spaces.
3. Being in enclosed places.
4. Standing in line or being in a crowd.
5. Being outside the home alone.
B. The individual fears or avoids these situations due to thoughts that escape might be difficult or help might not be available in the event of developing panic-like symptoms.
C. The agoraphobia situations almost always provoke fear or anxiety.
D. The agoraphobic situations are actively avoided, require the presence of a companion or are endured with intense fear or anxiety.
E. The fear or anxiety is not proportionate to the actual danger posed by the agoraphobic situations or to the sociocultural context.
F. The fear, anxiety or avoidance is persistent, typically lasting for 6 months or more.
G. The fear, anxiety or avoidance causes clinically significant distress is social, occupational or other important areas of functioning.
H. If another medical disorder is present, the fear, anxiety or voidance is excessive.
I. The fear, anxiety or avoidance is not better explained by the symptoms of another mental disorder (e.g. the symptoms are not confined to specific phobia).
29
What are the Cultural Influences of PD?
1. Somatic symptoms of anxiety may be emphasised in non-Western societies.
2. Subjective feelings of dread may be foreign to some cultures, meaning individuals in these cultures do not attend to their feelings.
3. ‘Brain Fag Syndrome’ it is considered a ‘reactive’ form of anxiety and includes symptoms such as conversion. Sensory disturbances include itchiness of the scalp, some limitation of memory and concentration.
30
What are the Causes of PD and Agoraphobia?
1. Agoraphobia often develops after a person has unexpected panic attacks, but whether it develops and how severe it becomes seems to be socially and culturally determined.
2. PD and panic attacks seem to be related most strongly to biological and psychological factors and their interactions.
31
What is Separation Anxiety?
What a child might feel at the threat of separation from an important caregiver.
32
The Management of PD and Agoraphobia.
1. Medication: SSRIs are the preferred medication for PD.
2. Psychological Intervention: the strategy of exposure-based treatments is to arrange conditions in which the patient can gradually face the feared situations and learn there is nothing to fear. Patients are taught relaxation or breathing retraining to help them reduce anxiety and excess arousal.
3. Combined Psychological and Pharmacological Treatment: ‘Stepped Care’ approach is when the clinician begins with one treatment and then adds another if needed.
33
What is Panic Control Treatment (PCT)?
Panic Control Treatment (PCT) concentrates on exposing patients with PD to the cluster of their panic attacks. The therapist attempts to create ‘mini’ panic attacks.
34
What is Specific Phobia?
The unreasonable fear of a specific object or situation that markedly interferes with daily life functioning.
35
The DSM-5 diagnostic criteria for Specific Phobia.
A. Marked fear or anxiety about a specific object or situation (e.g. flying, heights). *In children, the fear may be expressed by crying, tantrums).
B. The phobic object or situation almost always provokes immediate fear and anxiety.
C. The phobic object or situation is actively avoided or endured with intense fear or anxiety.
D. The fear or anxiety is out of proportion to the actual danger posed by the specific object or situation.
E. The fear, anxiety or avoidance is persistent, typically lasting for 6 months or more.
F. The fear, anxiety or avoidance causes clinically significant distress or impairment in important areas of functioning.
G. The disturbance is not better explained by symptoms of another medical disorder, including panic-like symptoms, objects or situations related to obsessions, reminders of traumatic events, separation from home or attachment figures.
35
What is Blood-Injection-Injury Phobia?
The unreasonable fear and avoidance of exposure to blood, injury or the possibility of an injection.
36
What is Situational Phobia?
Anxiety involving enclosed places or public transportation.
37
What are the subgroups of Specific Phobia?
1. Blood-Injection-Injury phobia.
2. Situational Phobia.
3. Natural Environment Phobia.
4. Animal Phobia.
38
What is Claustrophobia?
The fear of small, enclosed places. It is a situational phobia.
39
What is Natural Environment Phobia?
The fear of situations or events in nature, especially heights, storms and water.
40
What is Animal Phobia?
The unreasonable, enduring fear of animals or insects that usually develops early in life.
41
What are the Causes of Specific Phobia?
1. Direct experience, where real danger or pain results and raises a true alarm.
2. Experiencing a false alarm in a specific situation, observing someone else experience severe fear, or, under the right conditions, being told about danger.
3. Information transmission.
41
What is Information Transmission?
Being warned repeatedly about a potential danger is enough for someone to develop a phobia.
42
The Management of Specific Phobia.
1. Psychological treatment: require structured and consistent exposure-based approaches. The patient can practice approaching the phobic situation or object at home, checking in occasionally with the therapist.
2. Medications: anxiolytics agents are useful to acutely contain overwhelming distress. They may also be useful as an emergency contingency measure.
43
What is Social Anxiety Disorder (SAD)?
The extreme, enduring, irrational fear and avoidance of social or performance situations.
44
The DSM-5 diagnostic criteria for Social Anxiety Disorder.
A. Marked fear or anxiety about one or more social situations in which the person is exposed to possible scrutiny by others. Examples include having a conversation, eating or drinking, giving a speech.
B. The individual fears that he/she will act in a way, or show anxiety symptoms, that will be negatively evaluated.
C. The social situations are avoided or endured with intense fear or anxiety.
D. The fear or anxiety is out of proportions to the actual threat posed by the social situation, and to the sociocultural context.
E. The fear, anxiety or avoidance is persistent, typically lasting for 6 months or more.
F. The fear, anxiety, or avoidance causes clinically significant distress or impairment in important areas of functioning.
G. The fear, anxiety or avoidance is not attributed to the effects of a substance or another medical condition.
H. The fear, anxiety, or avoidance is not better explained by the symptoms of another mental disorder.
I. If another medical condition is present, the fear, anxiety or avoidance is clearly unrelated.
J. The social situations almost always provoke fear or anxiety.
45
What are the Causes of Social Anxiety Disorder?
1. Prepared by evolution to fear certain wild animals and dangerous situations in the natural environment.
2. Some infants are born with a temperamental profile or trait of inhibition or shyness.
3. Someone could inherit a generalised biological vulnerability to develop anxiety, a biological tendency to be socially inhibited, or both.
4. The vulnerable individual who had stressful experiences may harbour the thought that social evaluation can be dangerous.
46
The Management of Social Anxiety Disorder.
1. Psychological treatments: Social mishap exposures directly target the patients’ beliefs by confronting them with the actual consequences of such mishaps.
2. Family-based treatments appear to outperform individual treatment when the child’s parents also have an anxiety disorder.
47
What is Post-Traumatic Stress Disorder (PTSD)?
An enduring, distressing emotional disorder that follows exposure to severe helplessness. The victim relives the trauma, avoids stimuli associated with it and develops a numbing of responsiveness and an increased vigilance and arousal.
48
The DSM-5 diagnostic criteria for PTSD.
A. Exposure to actual or threatened death, serious injury, or sexual violence in 1 or more of the following:
1. Directly experiencing the traumatic event.
2. Learning that the event occurred to a close relative or close friend.
3. Witnessing, in person, the event as they occurred to others.
4. Experiencing repeated or extreme exposure to aversive details of the traumatic event.
B. Presence of 1 or more of the following intrusion symptoms associated with the traumatic events, beginning after the event occurred:
1. Recurrent, involuntary and intrusive distressing memories of the traumatic event.
2. Recurrent distressing dreams in which the content and effect of the dream are related to the traumatic event.
3. Dissociative reactions (flashbacks) in which the individual feels as if the traumatic event were recurring.
4. Intense or prolonged psychological distress at exposure to internal or external cues that resemble an aspect of the event.
5. Marked psychological reactions to internal or external cues that resemble an aspect of the event.
C. Persistent avoidance of stimuli associated with the traumatic event, beginning after the event occurred as evidenced by 1 or both of the following:
1. Avoidance of external reminders (people, places) that arouse distressing memories, thoughts.
2. Avoidance to distressing memories, thoughts, feelings.
D. Negative alterations in cognitions and mood associated with the traumatic event, beginning or worsening after the event occurred, as evidenced by 2 or more of the following:
1. Inability to remember an important aspect of the event.
2. Persistent and exaggerated negative beliefs about oneself, others or the world (“the world is completely dangerous).
3. Persistent distorted cognitions about the cause or consequences of the event that lead the individual to blame oneself.
4. Persistent negative emotional state.
5. Markedly diminished interest in significant activities.
6. Feelings of detachment from others.
7. Persistent inability to experience positive emotions.
E. Marked alterations in arousal and reactivity associated with the event, beginning or worsening after the event occurred, as evidence by 2 or more of the following:
1. Irritable behaviour and angry outbursts.
2. Reckless or self-destructive behaviour.
3. Hypervigilance.
4. Exaggerated startle response.
5. Problems with concentration.
6. Sleep disturbances.
F. Duration of the disturbances is more than 1 month.
G. The disturbances cause clinically significant impairment in important areas of functioning.
H. The disturbance is not attributed to the physiological effects of a substance.
I. Specifiers
1. Depersonalisation: persistent or recurrent experiences of feeling detached from one’s mental processes or body.
2. Derealisation: persistent or recurrent experiences of unreality of surroundings.
48
What are the Causes of PTSD?
1. Generalised biological vulnerability: genetic factors predispose individuals to be easily stressed and anxious, which then may make it more likely that a traumatic experience will result in PTSD.
2. Generalised psychological vulnerability: family instability was found to be a risk factor for the development of PTSD.
3. Social factors: Social factors like having a strong support group around you make it less likely to develop PTSD.
49
The Management of PTSD.
1. Psychological treatment: face original trauma, process the intense emotions and develop effective coping procedures in order to overcome the effects of the disorder. Cognitive therapy to correct negative assumptions about the trauma, such as feeling guilty.
2. Medications: antidepressants such as SSRIs. Anticonvulsant mood stabilising agents reduce flashbacks and irritability, alleviating depression.
50
What is Catharsis?
Reliving emotional trauma to relieve emotional suffering.
51
What is Prolonged Grief Disorder (PGD)?
A disorder in which a bereaved person experiences intense longing for and preoccupation with the deceased and a range of symptoms that make it difficult to move on with life.
52
What is Obsessive-Compulsive Disorder (OCD)?
A disorder involving unwanted, persistent, intrusive impulses, as well as repetitive actions intended to suppress them.
53
What are the 4 subgroups of Prolong Grief Disorder?
1. Adjustment disorders: describe anxious or depressive reactions to life stress that impair work and academic performance and quality of life.
2. Attachment disorders: refer to disturbed and developmentally inappropriate behaviours in children, in which the child is unable or unwilling to form normal attachment relationships with caregiving adults.
3. Reactive Attachment Disorder: the child will seldom seek out a caregiver for protection, support and nurturing and will seldom respond to offer from caregivers to provide this kind of care.
4. Disinhibited Social Engagement Disorder: a similar set of child-rearing circumstance would result in a pattern of behaviour in which the child shows no inhibitions to approaching adults.
54
The DSM-5 diagnostic criteria for Obsessive-Compulsive Disorder.
A. Presence of obsession, compulsion or both.
Obsessions are defined by:
1. Recurrent and persistent thoughts, urges, or images that are experienced during the disturbance, as intrusive and inappropriate and cause anxiety.
2. The individual attempts to ignore such thoughts, impulses, or images.
Compulsions are defined by:
1. Repetitive behaviours (washing hands) or mental acts (counting) that the individual feels driven to perform in response to an obsession.
2. The behaviours or mental acts are aimed at preventing or reducing distress. However, they are not connected in a realistic way with what they are designed to prevent.
B. The obsessions or compulsions are time-consuming or cause impairment in important areas of functioning.
C. The obsessive-compulsive symptoms are not attributable to the physiological effects of a substance.
D. The disturbance is not better explained by the symptoms of another mental disorder.
54
The DSM-5 diagnostic criteria for Prolonged Grief Disorder.
A. The death, at least 12 months ago, of a person who was close to the bereaved individual.
B. Since death, the development of a persistent grief response characterised by one/both of the following symptoms. The symptom(s) have occurred nearly every day for at least the last month:
1. Intense yearning/longing for the deceased person.
2. Preoccupation with memories of the deceased person.
C. Since the death, at least 3 of the following symptoms have been present most days and have occurred nearly every day for at least the last month:
1. Identity disruption since death.
2. Marked sense of disbelief about the death.
3. Avoidance of reminders that the person is dead.
4. Intense emotional pain (anger, bitterness) related to the death.
5. Difficulty reintegrating into one’s relationships and activities after the death.
6. Emotional numbness as a result of the death.
7. Feeling that life is meaningless as a result of the death.
8. Intense loneliness as a result of the death.
D. The disturbance causes clinically significant distress in important areas of functioning.
E. The duration and severity of the bereavement reaction clearly exceed expected social, cultural, or religious norms of the individual’s culture and context.
F. The symptoms are not better explained by MDD, PTSD, or the physiological effects of a substance.
55
Types of obsessions and associated compulsions
1. Symmetry/exactness/just right (needing things to be symmetrical; urges to do things over and over until they feel ‘just right’): putting things in a certain order. Repeating rituals.
2. Forbidden thoughts or action (fears, urges to harm self or others; fears of offending God): Checking. Repeated requests for reassurance.
3. Cleaning/contamination (germs; fears of contamination): Repetitive/excessive washing.
Using gloves, masks to do daily tasks.
4. Hoarding (fears of throwing anything away): Collecting/saving objects with little/no actual value.
56
What are the Causes of OCD?
1. Generalised biological & psychological vulnerability: early experiences conditioned patients with OCD that some thoughts are dangerous and unacceptable because the terrible things that they are thinking might happen and they would be responsible.
56
What is a Tic?
A semi-purposeful muscular behaviour, usually a sudden jerk of a limb, neck movement, grimace, tight closure to the eye, grunt or other simple vocalisation.
57
What is Thought-action fusion?
When patients with OCD equate thoughts with the specific actions represented by the thoughts, may be caused by attitudes of excessive responsibility and resulting guilt developed during childhood.
58
The Management of OCD.
1. Medications: most effective are SSRIs such as the tricyclic antidepressant, but relapse often occurs when the medication is discontinued.
2. Psychological treatments: Exposure and Ritual Prevention (ERP) is a process whereby the rituals are actively prevented, and the patient is systematically and gradually exposed to the feared thoughts or situations. Cognitive treatments with a focus on the overestimation of threat, the importance and control of intrusive thoughts.
59
What is Body Dysmorphic Disorder (BDD)?
A disorder featuring a disruptive preoccupation with some imagined defect in appearance.
60
What are the features of Body Dysmorphic Disorder?
1. Many people with this order become fixated on mirrors, others avoid mirrors to an almost phobic extent.
2. Suicidal ideation, suicide attempts and suicide itself are typical consequences of BDD.
3. ‘Ideas of reference’ which means that they think everything that goes on in their world is somehow related to them.
4. Depression and substance abuse are common comorbid conditions.
61
The DSM-5 diagnostic criteria for Body Dysmorphic Disorder.
A. Preoccupation with one/more defects or flaws in physical appearance that are not observable to others.
B. At some point during the course of the disorder, the individual has performed repetitive behaviours or mental acts in response to the appearance concerns.
C. The occupation causes clinically significant impairment in important areas of functioning.
D. The appearance preoccupation is not better explained by concerns with body fat or weight in an individual whose symptoms meet criteria for an eating disorder.
62
What are the Causes of Body Dysmorphic Disorder?
1. There is no information on biological or psychological predisposing vulnerabilities, nor genetic contributions to BDD.
2. The psychopathology of BDD lies in their reacting to a ‘deformity’ that others cannot perceive. Social and cultural determinants of beauty and body image largely define what is ‘deformed’.
63
The Management of Body Dysmorphic Disorder.
1. Medication: SSRIs provide relief for some people.
2. Psychological treatment: exposure and response prevention has also been successful with BDD.
64
What are the features of Hoarding Disorder?
1. These individuals usually begin acquiring things during their teenage years and often experience great pleasure from collecting various items.
2. They experience strong anxiety and distress about throwing anything away, because everything has either some potential value in their minds
3. Their homes may become almost impossible to live in.
4. Cognitive and emotional abnormalities include strong emotional attachment to possessions, an exaggerated desire for control over possessions, marked deficits in deciding whether a possession is worth keeping or not.
65
What are the 3 major characteristics of Hoarding Disorder?
1. Excessive acquisition of things.
2. Difficulty discarding anything.
3. Living with excessive clutter under gross disorganisations.
66
The Management of Hoarding Disorder.
1. Cognitive-behavioural therapy is a promising treatment for HD.
2. Teach people to assign different values to objects and to reduce anxiety about throwing away items that are somewhat less valued.
67
What is Trichotillomania?
People’s urge to pull out their own hair from anywhere on the body, including the scalp, eyebrows and arm.
68
What is Excoriation?
The recurrent, difficult-to-control picking of your skin leading to significant impairment and scarring.
69
The Management of Trichotillomania and Excoriation.
1. Psychological treatments: Habit reversal training has the most evidence for success with both disorders. Patients are carefully taught to be more aware of their repetitive behaviour, and to then substitute a different behaviour, such as chewing gum.
70
What is a Clinical Assessment?
The systematic evaluation and measurement of psychological, biological and social factors in an individual presenting with a possible psychological disorder.
70
What is Diagnosis?
A process of determining whether a presenting problem meets the established criteria for a psychological disorder.
71
What are the key concepts in assessment and diagnosis?
1. Reliability: the degree to which a measurement is consistent, for example over time and among different raters.
2. Validity: the degree to which a technique measures what it is designed to measure
3. Standardisation: the process of establishing specific norms and requirements for a measurement technique to ensure it is used consistently across measurement occasions.
72
Outline Reliability as a key concept in assessment and diagnosis.
1. One way psychologists improve their reliability is by carefully designing their assessment devices and then conducting research on them to ensure that two or more raters will get the same answer (called Inter-Rater Reliability).
2. They also determine whether these assessment techniques are stable across time. For instance, all things being equal, such as attention span, should remain stable from one assessment to the next (called Test-Retest Reliability).
73
Outline Validity as a key concept in assessment and diagnosis.
1. Comparing the results of others that are better known allows you to begin to determine the validity of the first measure. This comparison is called Concurrent or Descriptive Validity.
2. Predictive Validity is how well your assessment tells you what will happen in the future.
74
Outline Standardisation as a key concept in assessment and diagnosis.
1. The standards might apply to procedures of testing, scoring and evaluating data. For example, the assessment might be given to large numbers of people who differ in age, race, gender, socioeconomic status and diagnosis, their scores would be pooled with other individuals like them and then be used as a standard, or norm, for comparison purposes.
75
What are the types of Assessment Techniques?
1. The Clinical Encounter.
2. Physical Examination.
3. Semi-structured Clinical Interviews.
4. Behavioural Assessment.
5. Psychological Testing.
76
What are the features of a Clinical Encounter?
1. Clinical History.
2. Mental State Examination.
77
What are the characteristics of a Clinical Encounter/Consultation/Interview?
1. Such an approach is stilted and will impede the free flow of information that is essential to get to the bottom of any presentation.
2. Although systematised, structured, goal-directed and rooted in scientific understanding, the encounter must be as natural and unthreatening as possible.
3. Leading questions or questions that are closed must be avoided.
4. Allow the patient to speak, which will reveal the most.
78
What are the 6 features of the Clinical History?
1. Demographic information: name; age; language.
2. Primary & presenting problem: nature; severity; onset, course & development.
3. Systematic inquiry: anxiety; mood, emotions, feelings; obsessions & compulsions.
4. Medical history: onset, course, severity; past & current psychiatric disorders, stress, medical conditions.
5. Habits: substance abuse; intoxication; withdrawal & tolerance.
6. Psychological adaptation & functioning: early development; adolescence; relationships.
79
What is a Mental State Examination (MSE)?
A brief, but systematic overview of global mental functioning across the domains of consciousness, cognitive functions, emotions, reality testing and behaviour.
80
What are the characteristics of a Mental State Examination?
1. It is not a set of features that are checked on a tick-box.
2. It is the product of observation, using all our sense, that is reported in a systematic way.
3. This interaction occurs when one person interacts with another.
4. Performed relatively quickly by experienced clinicians in the course of interviewing or observing a patient.
81
What are the 6 features of a Mental State Examination?
1. General Appearance: mobility; injuries; neatness; hygiene.
2. Cognition: arousal; attention; language; speech.
3. Mood and Affect: mood; affect; motivation.
4. Reality Testing: thinking; thoughts; apperceptions.
5. Motoric & other Behaviours: intensity; compulsion.
6. Other Observations: interactions with relatives; reliability, judgement.
82
What is Praxis?
The performance of previously learned complex motor tasks.
83
What is Gnosis?
The recognition of things across all sensory modalities (faces, numbers).
84
What are the characteristics of a Physical Examination?
1. It is prudent for all patients presenting for the first time with a psychological problem to undergo physical examination.
2. Failure to recognise an underlying physical cause for a psychological presentation may have devastating consequences.
3. A good physical examination requires the understanding and co-operation of the patient.
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What does Behavioural Assessment refer to?
Measuring, observing and systematically evaluating the client’s thoughts, feelings and behaviour in the actual problem situation or context.
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What are the features of a Physical Examination?
1. History: physical symptoms and enquiries into physical systems in the systematic enquiry.
2. Physical examination: vital signs (blood pressure, pulse, respiration); general observations (distress, colour, oedema (swelling), injuries); eyes; Ear, nose & throat; abdominal (observe)
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What are the characteristics of Semi-structured Clinical Interviews?
1. Made up of questions that have been carefully phrased and tested to elicit useful information in a consistent manner so that clinicians can be sure they have enquired about the most important aspects of particular disorders.
2. The disadvantage is that it robs the interview some of the spontaneous quality of two people talking about a problem.
88
What are the 2 types of Behavioural assessments?
1. The ABCs of Observation.
2. Self-Monitoring (self-observation)
89
What are the characteristics of Behavioural Assessments?
1. BAs may be appropriate than an interview when assessing individuals who are not old enough or skilled enough to report their problems and experiences.
2. Other clinicians go to the person’s home or workplace or even into the local community to observe the person and the reported problems directly.
3. Role-play simulations in a clinical setting to see how people might behave in similar situations in their daily lives.
4. Target behaviours are identified and observed with the goal of determining the factors that seem to influence them.
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What are the characteristics of the ABCs of Observation?
1. The clinician’s attention is usually directed to the immediate behaviour, its antecedents (what happened before the behaviour), and its consequences (what happened after the behaviour).
2. Informal observation relies on the observer’s recollection, as well as interpretation, of the events.
3. Formal observation involves identifying specific behaviours that are observable and measurable, referred to as an operational definition.
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What is Self-Monitoring (self-observation)?
The action by which clients observe and record their own behaviours as either an assessment of a problem and its change or a treatment procedure that makes them more aware of their responses.
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What are the characteristics of Self-Monitoring (self-observation)?
1. When the behaviours occur only in private (such as purging by people with bulimia), self-monitoring is essential.
2. A more formal and structured way to observe behaviours is through checklists and behaviour rating scales.
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What is the problem of Reactivity?
Simply observing a behaviour may cause it to change due to the individual’s knowledge of being observed.
94
What do Psychological Tests include?
1. Specific tools to determine cognitive, emotional or behavioural responses that might be associated with a specific disorder.
2. General tools that assess long-standing personality features.
95
What are Projective Tests?
Psychoanalytically based measures that present ambiguous stimuli to clients on the assumptions that their responses will reveal their unconscious conflicts.
96
What are the types of Projective Tests?
1. The Rorschach Inkblot Test.
2. The Thematic Apperception Test (TAT).
3. Personality Inventories.
4. Intelligence testing.
5. Neuropsychological Testing.
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What are the characteristics of The Rorschach Inkblot Test?
1. The examiner presents the inkblots one by one to the person being assessed, and they respond by telling what they see.
2. To respond to the concerns about reliability and validity, a standardised version of the Rorschach inkblot test, called the Comprehensive System was developed by John Exner. It specifies how the cards should be presented, what the examiner should say and how the responses should be recorded.
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What are the characteristics of Personality Inventories?
1. Self-report questionnaires that assess personality traits by asking respondents to identify descriptions that apply to them.
2. What is necessary from these types of tests is not whether the questions necessarily make sense on the surface, but rather what the answers to these questions predict.
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What are the characteristics of The Thematic Apperception Test (TAT)?
1. Developed by Christiana Morgan & Henry Murray, the TAT consists of a series of 31 cards: 30 with pictures on them and 1 blank. However, only 20 cards are typically used during each administration.
2. The instructions for the TAT ask the person to tell a dramatic story about the picture. The tester presents the pictures and tells the patient, ‘This is a test of imagination, one form of intelligence’.
3. Several variations of the TAT have been developed for different groups, including a Children Apperception Test and a Senior Apperception Technique.
4. Unfortunately, the TAT and its variants continue to be used inconsistently. How the stories people tell about these pictures are interpreted depends on the examiners frame of reference.
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The most widely used type of Personality Inventory test.
The Minnesota Multiphasic Personality Inventory (MMPI) is based on an empirical approach, that is, the collection and evaluation of data.
1. The individual being assessed reads statements and answers either ‘true’ or ‘false’. Some statements from the MMPI are: cry readily, often happy for no reason, am being followed, fearful of things.
2. A problem with the MMPI is that it is time-consuming.
3. The Lie scale measures whether the person is falsifying answers.
4. The Infrequency scale measures false claims about psychological problems.
5. The Subtle Defensiveness scale assesses whether the person sees themselves in unrealistically positive ways.
6. The MMPI is extensively reliable and valid.
101
What are the characteristics of Intelligence Tests?
1. The Stanford-Binet test was used to administer academic success. The test provided a score known as an Intelligence Quotient (IQ).
2. Intelligence Quotient (IQ) is the score on an intelligence test estimating a person’s deviation from average test performance.
3. Current tests use a deviation IQ. A person’s score is compared only to scores of others of the same age.
4. Another widely used set of intelligence tests is the Wechsler test. They include the Wechsler Adult Intelligence Scale (WAIS), Wechsler Intelligence Scale for Children (WISC), and Wechsler Preschool and Primary Scale of Intelligence (WPPSI).
5. In South Africa, we have local adaptations of the Wechsler protocols, including the SAWAIS and JSAIS.
6. IQ tests tend to be reliable, and to the extent that they predict academic success, they are valid assessment tools, however, they disregard the influence of external factors such as culture, language, fatigue.
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What are the characteristics of Neuropsychological tests?
1. Neuropsychological tests measure abilities in areas such as receptive and expressive language, attention and concentration, motor skills, learning and abstraction.
2. A simple neuropsychological test is the Bender Visual-Motor Gestalt Test: the patient is given a series of cards on which are drawn various lines and shapes. The errors on the test are compared with test results of controls of the same age. If the number of errors exceeds a certain figure, then brain dysfunction is suspected.
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What is a Neuropsychological test?
The assessment of brain and nervous system functioning by testing an individual’s performance on behavioural tasks.
104
What is False Positive?
When a test shows a problem when none exists.
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What is a False Negative?
When no problem is found even though impairment is indeed present.
106
What is Neuroimaging?
Sophisticated computer-aided procedures that allow non-intrusive examination of nervous system structure and function. It can be divided into two categories: structural neuroimaging and functional neuroimaging.
107
What are the types of Structural Neuroimaging?
1. CAT-scan or CT scan (Computerised Axial Tomography) are particularly useful in locating space-occupying lesions, such as bleeds, tumours and injuries.
2. Magnetic Resonance Imaging (MRI) takes much longer than CT-scans but does not make use of radiation or X-rays.
108
What is Psychophysiological Assessment?
The measurement of changes in the nervous system reflecting psychological or emotional events such as anxiety. The most widely used physiological investigation is the Electroencephalogram (EEG).
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What are the types of Functional Neuroimaging?
1. Position Emission Tomography (PET-scanning): Patients are injected with a tracer substance that interacts with blood, oxygen or glucose in the brain. Thus, we can learn what parts of the brain are working and what parts are not.
2. Single Photon Emission Computed Tomography (SPECT): much like PET, although a different tracer substance is used. It is less expensive and somewhat less accurate.
109
What is Electroencephalogram (EEG)?
The measure of electrical activity patterns in the brain, taken through electrodes placed on the scalp.
110
What is Idiographic Strategy?
The close and detailed investigation of an individual emphasising what makes that person unique.
111
What is Nomothetic Strategy?
The identification and examination of large groups of people with the same disorder to note similarities and develop general laws.
112
What is Classification?
The assignment of objects or people to categories on the basis of shared characteristics. If the classification is in a scientific context, it is often called taxonomy.
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What is Nosology?
The classification and naming system of disease, medical and psychological phenomena.
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What is Nomenclature?
The actual labels or names that are applied in nosology, for example, anxiety or mood disorders.
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International Classification of Diseases (ICD) .
Was published by the World Health Organisation (WHO) in 1948. The most recent edition is the ICD-11 (2022).
116
What is the Classical (pure) Categorical Approach of classification?
A classification method founded on the assumption of clear-cut differences between disorders, each with a different known cause.
116
Diagnostic and Statistical Manual of Mental Disorders (DSM) .
Was published by the American Psychiatric Association (APA) in 1952. The most recent is the DSM-5-TR (2022).
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What is the Dimensional Approach of classification?
The method of categorising characteristics on a continuum rather than on a binary either-or, or all-or-none, basis. For example, on a scale of 1 to 10, a patient might be rated as severely anxious (10), moderately depressed (5) and mildly manic (2) to create a profile of emotional functioning (10,5,2).
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DSM-5 and DSM-5-TR (text revision).
1. The most advanced, scientifically based system of nosology.
2. The use of dimensional axes of rating severity, intensity, frequency of disorders is also a feature of the DSM-5.
3. The DSM-5-TR adds new disorders: prolonged grief disorder, unspecified mood disorder, olfactory reference disorder and major or mild neurocognitive disorder.
118
What is the Prototypical Approach?
A system for categorising disorders using both essential, defining characteristics and a range of variations on other characteristics.
119
What is Familial Aggregation?
The extent to which a disorder is found among a patient’s relatives.
120
What does Culture refer to?
The values, knowledge and practices that individuals derive from membership in different ethnic, religious groups, as well as how membership in these groups may affect the individual’s perspective on their experience with psychological disorders.
121
What is Comorbidity?
The presence of two or more disorders in an individual at the same time.
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What is Labelling?
Applying a name to a pattern of behaviours. The label may acquire negative connotations.
123
What is Stigma?
A combination of stereotypic negative beliefs, prejudices and attitudes resulting in reduced life opportunities.
124
What is Somatic Symptom Disorder?
A disorder involving extreme and long-lasting focus on multiple physical symptoms, for which no medical cause is evident, associated with distress and maladaptive use of health care resources.
125
What is Dissociative Disorder?
A disorder in which individuals feel detached from themselves or their surroundings, and reality, experience and identity may disintegrate.
126
The DSM-5 diagnostic criteria for Somatic Symptom Disorder (SSD).
A. One or more somatic symptoms that are distressing and/or result in significant disruption of daily life.
B. Excessive thoughts, feelings and behaviours related to the somatic symptoms as manifested by at least one of the following:
1. Disproportionate and persistent thoughts about the seriousness of one’s symptoms.
2. High level of health-related anxiety.
3. Excessive time and energy devoted to these symptoms.
C. Although one symptom may not be continuously present, the state of being symptomatic is persistent (typically more than 6 months).
126
What is Illness Anxiety Disorder?
A somatic symptom disorder characterised by severe anxiety or belief in having a disease process without any evident physical cause. The occurrence of actual somatic symptom is not prominent.
127
The DSM-5 diagnostic criteria for Illness Anxiety Disorder (IAD).
A. Preoccupation with having or acquiring a serious illness.
B. Somatic symptoms are not present or, if present, are only mild in intensity.
C. If another medical condition is present or there is a risk for developing a medical condition, the preoccupation is clearly disproportionate.
D. There is a high level of anxiety about health, and the individual is easily alarmed about personal health status.
E. The individual performs excessive health-related behaviours or exhibits maladaptive avoidance (avoids doctor’s appointments).
F. Illness preoccupation has been present for at least 6 months, but the specific illness that is feared may change over that period of time.
G. The illness-related preoccupation is not better explained by another mental disorder, PD, GAD, BDD, OCD.
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Management of Somatic Symptom Disorder & Illness Anxiety Disorder.
1. Psychoeducation: Understanding the nature of your condition and how these misperceptions can influence you. Recognising distressing situations and avoiding them.
2. Biological treatments: Most common medication such as fluoxetine. SSRIs offer improvement for SSD, while antidepressants offer pain relief.
3. Psychotherapy: CBT helps patients to reinterpret their symptoms as less threatening. Explanatory therapy helps patients to understand the origins and source of their symptoms. Family therapy involves the family and educates them about the patient’s condition, encouraging the family to reinforce ‘well’ behaviours.
128
Causes of Somatic Symptom Disorder & Illness Anxiety Disorder.
1. Maladaptive cognitions & emotional contributions: Psychopathological processes play a role in SSD. These disorders are basically disorders of cognition with strong emotional contributions.
2. Social & behavioural factors: Illness runs in the family, and there is a modest genetic contribution. Learnt from family members to focus their anxiety on specific physical conditions and illnesses. Illness develops in the context of stressful life events. The benefits of being sick: increased attention for being ill and being able to avoid work or other responsibilities.
129
What is Conversion Disorder (functional neurological symptom disorder)?
Physical malfunctioning, such as blindness or paralysis, suggesting neurological impairment but with no organic pathology to account for it.
130
What is Aphonia?
When a person is able to talk only in a whisper.
131
Conversion symptoms and their positive indicators.
1. Sensory (blindness, deafness): Careful neurological examinations. Someone reporting conversion blindness.
2. Motor (weakness, paralysis): Bobbing of the head on the trunk. Abnormal movements typically worsen.
3. Pseudo-seizure (paroxysmal events that resemble convulsive epileptic seizures): Excessive thrashing. Injuries are uncommon.
4. Mixed (aphonia, globus hystericus): Spasm of the throat muscles.
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What is Globus Hystericus?
When an individual experiences a sensation of having a lump in their throat.
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The DSM-5 diagnostic criteria for Conversation Disorder (functional neurological symptom disorder).
A. One or more symptoms of altered voluntary motor or sensory function.
B. Clinical findings provide evidence of incompatibility between the symptom and recognised neurological or medical conditions.
C. The symptom is not better explained by another medical or mental disorder.
D. The symptom causes clinically significant impairment in important areas of functioning.
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Differentiating between conversion disorder and malingering.
Conversion Disorder: More likely to be friendly and co-operative. Usually, welcome treatments to find a cure. Eagerly accept opportunities of employment.
Malingering: Very suspicious and uncooperative. May try to avoid diagnostic evaluations or treatments. More likely to refuse employment.
133
What is Malingering?
Intentionally deceitful presentation of physical or psychological symptoms for gain, in the presence of an external, identifiable motivation, such as avoiding prosecution or military duty.
134
What is Factitious Disorder?
Intentionally deceitful production of physical or psychological symptoms in the absence of an external motivation. The patient engages in this deceit to assume the sick role. Formerly known as Munchausen’s syndrome.
134
What is La belle indifference?
The lack of distress in the presence of apparently serious symptoms.
135
What is Factitious Disorder Imposed on Another?
When an individual deliberately makes someone else sick.
136
The DSM-5 diagnostic criteria for Factitious Disorders.
A. Falsification of physical or psychological symptoms, associated with identifiable deception.
B. The deceptive behaviour is evident even in the absence of obvious external reward.
C. The individual presents to others as ill, impaired or injured.
D. The behaviour is not better explained by another mental disorder such as delusional belief system.
137
What is Depersonalisation-Derealisation Disorder?
A dissociative disorder in which feelings of depersonalisation are so severe they dominate the client’s life and prevent normal functioning.
137
What are the Causes of Conversion Disorder?
1. Freudian psychodynamic view: The individual experiences a traumatic event (an unacceptable unconscious conflict). Because the conflict is unacceptable, the person represses the conflict, making it unconscious. The anxiety continues to increase and threatens to emerge into consciousness, and the person ‘converts’ it into physical symptoms.
2. Primary gain is the notion that anxiety reduction is the principal reinforcement for the display of psychological symptoms.
3. Secondary gain is additional reinforcer beyond primary gain that a person may obtain through the display of symptoms. These may include attention, sympathy and avoidance of unwanted responsibilities.
138
What are the two types of Dissociative Disorders?
1. Depersonalisation: altering of perception that causes people to temporarily lose a sense of their own reality. There is often a feeling of being outside observers of their own behaviour. “I am not really me in a real world.”
2. Derealisation: situation in which the individual loses a sense of reality of the external world. “I am real, the world around me is not real”.
139
What are the Causes of Depersonalisation-Derealisation Disorder (DDD)?
1. Deficits in attention, information processing and short-term memory.
2. Deficits in emotional regulation.
3. Common among people exposed to multiple childhood traumas.
139
The DSM-5 diagnostic criteria for Depersonalisation-Derealisation Disorder (DDD).
A. The presence of persistent experiences of depersonalisation, derealisation, or both.
B. During the depersonalisation or derealisation experience, reality testing remains intact.
C. The symptoms cause clinically significant distress or impairment in important areas of functioning.
D. The disturbances are not attributable to the physiological effects of a substance or another medical condition.
E. The disturbance is not better explained by another mental disorder, such as schizophrenia, PD, MDD, PTSD.
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What is Dissociative Amnesia (DA)?
A dissociative disorder featuring the inability to recall personal information, usually of a stressful or traumatic nature.
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What is Generalised Amnesia?
The loss of all personal information, including identity.
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What is Localised/Selective Amnesia?
Memory loss limited to specific times and events, particularly traumatic events.
143
The DSM-5 diagnostic criteria for Dissociative Amnesia (DA).
A. An inability to recall important information, usually after a traumatic or stressful event.
B. The symptoms cause clinically significant impairment in important areas of functioning.
C. The disturbance is not attributable to the physiological effects of a substance or a neurological or other medical condition.
D. The disturbance is not better explained by DID, PTSD, SSD.
144
What is a subtype of Dissociative Disorder?
Dissociative Fugue is a type of dissociative amnesia featuring sudden, unexpected travel away from home, along with an inability to recall the past, sometimes with the assumption of a new identity.
145
What is Dissociative Identity Disorder (DID)?
A disorder in which as many as 100 personalities or fragments of personalities coexist within one body and mind. Formerly known as multiple personality disorder.
146
The DSM-5 criteria for Dissociative Identity Disorder (DID).
A. Disruption of identity characterised by two or more distinct personality states, which may be described in some cultures as an experience of possession. The disruption of marked discontinuity in sense of self, alteration in affect, behaviour, consciousness.
B. Recurrent gaps in the recall of everyday events, important personal information.
C. The symptoms cause clinically significant impairment in important areas of functioning.
D. The disturbance is not a normal part of a broadly accepted cultural or religious practice.
E. The symptoms are not attributable to the physiological effects of a substance or another medical condition.
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What are the Causes of Dissociative Identity Disorder?
1. Social Factors: History of severe, chronic trauma, usually sexual or physical abuse, and childhood abuse. Chaotic, non-supportive family environment.
2. Psychological Factors: Natural tendency to escape or ‘dissociate’ from negative effects associated with trauma. Diathesis-stress model: hypothesis that both an inherited tendency and specific stressful conditions are required to produce a disorder.
3. Biological Factors: Heritable traits, such as tension and responsiveness to stress, may increase vulnerability. Individuals with certain neurological disorders may experience dissociative symptoms. Sleep deprivation produces dissociative symptoms such as marked hallucinations.
148
The Management of Dissociative Identity Disorder.
1. Psychological Interventions: Long-term therapy that focuses of the reintegration of identities. Identify and neutralise triggers that provoke memories of trauma and gain control.
2. Medication: Medication is combined with therapy, but there is little indication of efficacy. Antidepressants may be appropriate in some cases.
149
What is Mood?
The enduring period of emotionality.
150
What are Mood Disorders?
A group of disorders involving severe and enduring disturbances in emotionality ranging from elation to severe depression.
151
What is Major Depressive Episode?
The pathological expression of depression, including depressed mood, anhedonia, feelings of guilt and worthlessness, disturbances of sleep, poor concentration, and thoughts around death and suicide, occurring most of the day, for at least two weeks.
152
What is Anhedonia?
The inability to experience pleasure, associated with some mood and schizophrenic disorder
153
The DSM-5 diagnostic criteria for Major Depressive Episode.
A. Five or more of the following symptoms have been present during the same 2-week period and represent a change from previous functioning:
1. Depressed mood most of the day, nearly every day, as indicated by either subjective report or observation by other.
2. Markedly diminished interest or pleasure in all or almost all activities.
3. Significant weight loss when not dieting or weight gain or decrease or increase in appetite nearly every day.
4. Insomnia or hypersomnia nearly every day.
5. Psychomotor agitation or retardation nearly every day.
6. Fatigue or loss of energy nearly every day.
7. Feelings of worthlessness or inappropriate guilt nearly every day.
8. Diminished ability to think or concentrate nearly every day.
9. Recurrent thought of death, recurrent suicidal ideation without specific plan, or suicide attempt.
B. The symptoms cause clinically significant impairment in important areas of functioning.
C. The symptoms are not due to the direct physiological effects of a substance, or general medical condition.
154
What is Manic Episode?
A period of abnormally elevated or irritable mood that may include inflated self-esteem, decreased need for sleep, pressured speech, flight of ideas, self-destructive behaviour, and may be accompanied by psychotic symptoms.
155
What is Bipolar I Disorder?
The occurrence of one manic or mixed episode, often recurrent, or alternating with major depressive episodes.
156
What is Hypomanic Episode?
Attenuated form of mania, with similar, but less severe symptoms and less disruption, occurring for at least 4 days without the occurrence of psychotic symptoms, or the need for hospitalisation.
157
What is Bipolar II Disorder?
The occurrence of hypomanic episodes, frequently alternating with major depressive episodes. It has a greater tendency of recurrent cycles of mood disturbances.
158
The DSM-5 diagnostic criteria for Manic Episode.
A. A distinct period of persistently elevated, expansive, or irritable mood and abnormally and persistently increased goal-directed activity or energy, lasting at least 1 week and present for most of the day, nearly every day.
B. During this period, 3 or more of the following symptoms are present to a significant degree and represent a change from usual behaviour:
1. Inflated self-esteem.
2. Decreased need for sleep.
3. More talkative/pressure to keep on talking.
4. Flight of ideas.
5. Distractibility
6. Increased goal-directed activity or psychomotor agitation.
7. Excessive involvement in high-risk activities.
C. The mood disturbance is severe to cause impairment in important areas of functioning or to necessitate hospitalisation to prevent harm to self or others.
D. The episode is not attributable to the physiological effects of a substance or medical condition.
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What is Cyclothymic Disorder?
A chronic (at least 2 years) mood disorder characterised by alternating mood elevation and depression levels that are not as severe as manic or major depressive episodes.
160
What is Mixed Features?
A condition in which the individual experiences both elation and depression or anxiety at the same time. Also known as dysphoric manic episode or mixed manic episode.
161
What is Unipolar Mood Disorder?
A mood disorder characterised by depression or mania but not both. Most cases involve unipolar depression.
161
What is Major Depressive Disorder?
A mood disorder involving one or more major depressive episode.
162
The DSM-5 diagnostic criteria for Major Depressive Disorder (MDD).
A. At least one major depressive episode.
B. At least one major depressive episode is not better explained by or superimposed on a schizophrenia spectrum or other psychotic disorder.
C. There has never been a manic or hypomanic episode.
Specifiers
Severity. With psychotic features. With anxious distress. With mixed features. With atypical features. In partial remission or full remission.
163
The DSM-5 diagnostic criteria for Persistent Depressive Disorder (PDD).
A. Depressed mood for most of the day, for more days than not, for at least two years.
B. Presence, while depressed, of 2 or more of the following:
1. Poor appetite/overeating.
2. Insomnia/hypersomnia.
3. Low energy or fatigue.
4. Low self-esteem.
5. Poor concentration/difficulty making decisions.
6. Feelings of hopelessness.
C. During the 2-year period, a person has never been without symptoms for more than 2 months at a time.
D. Criteria for depression may be continuously present for two years.
E. There has never been a manic/hypomanic episode and criteria have never been met for a cyclothymic disorder.
F. Disturbance not better explained by a schizophrenia spectrum or other psychotic disorder.
G. Symptoms are not attributable to the effects of a substance or general medical condition.
H. Symptoms cause clinically significant impairment in important areas of functioning.
Specifiers
With anxious distress. In remission. Onset. With pure dysthymic syndrome. With major depressive episode. With intermittent major depressive episode, with/without current episode.
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What is Persistent Depressive Disorder?
A mood disorder involving persistently depressed mood, with low self-esteem, withdrawal, despair, present for at least 2 years, with no absence of symptoms for more than 2 months.
164
What is Premenstrual Dysphoric Disorder?
A condition characterised by mood disturbances and uncomfortable physical symptoms associated with female periods.
165
What is Disruptive Mood Dysregulation Disorder?
A condition in which a child has chronic negative moods such as anger and irritability without any mania.
166
The DSM-5 diagnostic criteria for Premenstrual Dysphoric Disorder.
A. In the majority of menstrual cycles, at least 5 symptoms must be present in the final week before menses.
B. One or more of the following symptoms must be present:
1. Marked affective lability.
2. Marked irritability or anger.
3. Marked depressed mood.
4. Marked anxiety.
C. One or more of the following symptoms must be present, to reach a total of 5 symptoms:
1. Decreased interest in usual activities.
2. Subjective difficulty in concentration. Lack of energy.
3. Marked change in appetite.
4. Hypersomnia or insomnia.
5. Physical symptoms such as breast tenderness.
D. The symptoms cause significant impairment in important areas of functioning.
167
What is Bipolar I Disorder?
168
The DSM-5 diagnostic criteria for Bipolar I Disorder.
A. Criteria have been met for at least one manic episode.
B. At least one manic episode is not better explained by or superimposed on a schizophrenia spectrum or other psychotic disorder.
169
What is Bipolar II Disorder?
170
The DSM-5 diagnostic criteria for Bipolar II Disorder.
A. Criteria have been met for at least one hypomanic and at least one major depressive episode.
B. There has never been a manic episode.
C. At least one hypomanic and at least one major depressive episode are not better explained by a schizophrenia spectrum or other psychotic disorder.
D. The symptoms of depression or the frequent alternations between moods cause significant impairment in important areas of functioning.
Specifiers
With hypomanic. With anxious distress. With mixed features. With seasonal pattern. Severity. In full/partial remission.
171
What are the Causes of Mood Disorders?
1. Psychological Dimensions: Stress & trauma are strongly related to the onset of mood disorders. People who are vulnerable to depression might be more likely to enter situations that will lead to stress. People become anxious and depressed when they make an attribution that they have no control over the stress in their lives. Depression may result from a tendency to interpret life events negatively.
2. Social and Cultural Dimensions: Marital dissatisfaction is related to mood disorders. Women are expected to be more passive, sensitive and dependent on others. These increases feelings of uncontrollability & helplessness and a risk for developing depression. Lack of social support is related to depression.
171
The DSM-5 diagnostic criteria for Cyclothymic Disorder.
A. For at least 2 years, there have been numerous periods with hypomanic symptoms and depressive symptoms.
B. Symptoms are present for at least half of the time and individual has never been without symptoms for more than 2 months at a time.
C. Criteria for a major depressive, manic or hypomanic episode have never been met.
D. Symptoms are not better explained by a schizophrenia spectrum or other psychotic disorder.
E. Symptoms are not attributable to the effect of a substance or another medical condition.
F. Symptoms cause significant impairment in important areas of functioning.
172
What is Arbitrary inference?
Emphasizing the negative, rather than the positive aspects of a situation.
172
What is Overgeneralisation?
Negatives apply to all situations.
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The Integrative Theory of mood disorders.
1. Biological vulnerability: Depression and anxiety may often share a common biological vulnerability that can be described as an excessive neurobiological response to stressful life events.
2. Psychological vulnerability: People who develop mood disorders possess a psychological vulnerability experienced as feelings of inadequacy for coping with stressful life events.
3. Stressful events: Stressful events trigger the onset of depression (personal loss) and mania (achievements).
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What is the Depressive Cognitive Triad?
Thinking errors in depressed people negatively focused in 3 areas: themselves, their immediate world and their future.
175
The Management of Mood Disorders.
1. Cognitive therapy is a treatment approach that involved identifying and altering negative thinking styles and replacing them with more positive beliefs and attitudes.
2. The focus is on preventing avoidance of social and environmental cues that produce depression. The individual is helped to face the cues and work through them.
3. Interpersonal psychotherapy (IPT) is a brief treatment approach that emphasises resolution of interpersonal problems and stressors.
4. These include dealing with interpersonal disputes (marital conflict); adjusting to the loss of a relationship; acquiring new relationships; and identifying and correcting deficits in social skills.
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What is Psychological Autopsy?
The post-mortem psychological profile of suicide victims constructed from interviews with people who knew the person before death.
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What are the Risk Factors of Suicide?
1. Family History: If a family member committed suicide, there is an increased risk that someone else in the family will too. This suggests some biological (genetic) contribution to suicide.
2. Neurobiology: Low central nervous system serotonin activity may be associated with suicide.
3. Existing Psychological Disorders and other Psychological Risk Factors: Suicide is often associated with mood disorders. The combination of borderline personality disorder and depression is particularly dangerous.
4. Stressful Events: Stressful event experienced as shameful or humiliating, such as failure at school is a risk factor.
SLK 310
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