Vig Final

panic

A feeling of sudden, intense fear.

What was Gretchen experiencing? Iwas 25 when I had my first attack. It was a few weeks after I'd come home from the hospital. I had had my appendix out. The surgery had gone well, and I wasn't in any danger, which is why I don't understand what happened. But one night I went to sleep and I woke up a few hours later—I'm not sure how long—but I woke up with this vague feeling of apprehension. Mostly I remember how my heart started pounding. And my chest hurt; it felt like I was dying—that I was having a heart attack. And I felt kind of queer, as if I were detached from the experience. It seemed like my bedroom was covered with a haze. I ran to my sister's room, but I felt like I was a puppet or a robot who was under the control of somebody else while I was running. I think I scared her almost as much as I was frightened myself. She called an ambulance.

A panic attack

What is the difference between a panic disorder and a social anxiety disorder?

A panic disorder has unexpected panic attacks while social anxiety disorder has panic attacks when a person is put in a social situation.

What is the criteria for a manic episode?

A. A distinct period of abnormally and persistently elevated, expansive, or irritable mood and abnormally and persistently increased goal-directed activity or energy, lasting at least 1 week and present most of the day, nearly every day (or any duration if hospitalization is necessary). B. During the period of mood disturbance and increased energy or activity, three (or more) of the following symptoms (four if the mood is only irritable) are present to a significant degree and represent a noticeable change from usual behavior: 1. Inflated self-esteem or grandiosity 2. Decreased need for sleep (e.g., feels rested after only 3 hours of sleep) 3. More talkative than usual or pressure to keep talking 4. Flight of ideas or subjective experience that thoughts are racing 5. Distractibility (i.e., attention too easily drawn to unimportant or irrelevant external stimuli), as reported or observed 6. Increase in goal-directed activity (either socially, at work or school, or sexually) or psychomotor agitation (e.g., purposeless non-goal-directed activity) 7. Excessive involvement in activities that have a high potential for painful consequences (e.g., engaging in unrestrained buying sprees, sexual indiscretions, or foolish business investments) C. The mood disturbance is sufficiently severe to cause marked impairment in social or occupational functioning or to necessitate hospitalization to prevent harm to self or others, or there are psychotic features. D. The episode is not attributable to the physiological effects of a substance (e.g., a drug of abuse, a medication, other treatment) or to another general medical condition. Note: A full manic episode that emerges during antidepressant treatment (e.g., medication, electroconvulsive therapy) but persists at a fully syndromal level beyond the physiological effect of that treatment is sufficient evidence of a manic episode and, therefore, a bipolar I diagnosis.

What is the diagnostic criteria for Major Depressive Disorder?

A. At least one major depressive episode (DSM-5 Table 7.1 Criteria A-C). B. The occurrence of the major depressive episode is not better explained by schizoaffective disorder, schizophrenia, schizophreniform disorder, delusional disorder, or other specified and unspecified schizophrenia spectrum and other psychotic disorders. C. There has never been a manic episode or hypomanic episode. Note: This exclusion does not apply if all of the manic-like or hypomanic-like episodes are substance-induced or are attributable to the direct physiological effects of another medical condition. Specify the clinical status and/or features of the current or most recent major depressive episode: Single episode or recurrent episode Mild, moderate, severe With anxious distress With mixed features With melancholic features With atypical features With mood-congruent psychotic features With mood-incongruent psychotic features With catatonia With peripartum onset With seasonal pattern (recurrent episode only) In partial remission, in full remission

What is the diagnostic criteria for GAD?

A. Excessive anxiety and worry (apprehensive expectation), occurring more days than not for at least 6 months about a number of events or activities (such as work or school performance). B. The individual finds it difficult to control the worry. C. The anxiety and worry are associated with at least three (or more) of the following six symptoms (with at least some symptoms present for more days than not for the past 6 months) [Note: Only one item is required in children]: 1. Restlessness or feeling keyed up or on edge 2. Being easily fatigued 3. Difficulty concentrating or mind going blank 4. Irritability 5. Muscle tension 6. Sleep disturbance (difficulty falling or staying asleep or restless, unsatisfying sleep) D. The anxiety, worry or physical symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning. E. The disturbance is not due to the direct physiological effects of a substance (e.g., a drug of abuse, a medication) or a general medical condition (e.g., hyperthyroidism). F. The disturbance is not better explained by another mental disorder (e.g., anxiety or worry about having panic attacks in panic disorder, negative evaluation in social anxiety disorder).

What is the diagnostic criteria for Posttraumatic Stress Disorder?

A. Exposure to actual or threatened death, serious injury, or sexual violence in one (or more) of the following ways: 1. Directly experiencing the traumatic event(s). 2. Witnessing, in person, the event(s) as they occurred to others. 3. Learning that the event(s) occurred to a close relative or close friend. In cases of actual or threatened death of a family member or friend, the event(s) must have been violent or accidental. 4. Experiencing repeated or extreme exposure to aversive details of the traumatic event(s) (e.g., first responders collecting human remains; police officers repeatedly exposed to details of child abuse). Note: Criterion A4 does not apply to exposure through electronic media, television, movies, or pictures, unless this exposure is work related. B. Presence of one (or more) of the following intrusion symptoms associated with the traumatic event(s), beginning after the traumatic event(s) occurred: 1. Recurrent, involuntary and intrusive distressing memories of the traumatic event(s). Note: In young children, repetitive play may occur in which themes or aspects of the traumatic event(s) are expressed. 2. Recurrent distressing dreams in which the content and/or affect of the dream are related to the traumatic event(s). Note: In children, there may be frightening dreams without recognizable content. 3. Dissociative reactions (e.g., flashbacks) in which the individual feels or acts as if the traumatic event(s) were recurring. (Such reactions occur on a continuum, with the most extreme expression being a complete loss of awareness of present surroundings.) Note: In young children, traumaspecific reenactment may occur in play. 4. Intense or prolonged psychological distress at exposure to internal or external cues that symbolize or resemble an aspect of the traumatic event(s). 5. Marked physiological reactions to internal or external cues that symbolize or resemble an aspect of the traumatic event(s). C. Persistent avoidance of stimuli associated with the traumatic event(s), beginning after the traumatic event(s) occurred, as evidenced by one or both of the following: 1. Avoidance of or efforts to avoid distressing memories, thoughts, feelings, or conversations about or closely associated with the traumatic event(s). 2. Avoidance of or efforts to avoid external reminders (people, places, conversations, activities, objects, situations) that arouse distressing memories, thoughts, or feelings about or closely associated with the traumatic event(s). D. Negative alterations in cognitions and mood associated with the traumatic event(s), beginning or worsening after the traumatic event(s) occurred, as evidenced by two (or more) of the following: 1. Inability to remember an important aspect of the traumatic event(s) (typically due to dissociative amnesia and not to other factors such as head injury, alcohol, or drugs). 2. Persistent and exaggerated negative beliefs or expectations about oneself, others, or the world (e.g., "I am bad," "no one can be trusted," "the world is completely dangerous," "My whole nervous system is permanently ruined"). 3. Persistent distorted cognitions about the cause or consequences of the traumatic event(s) that lead the individual to blame himself/herself or others. 4. Persistent negative emotional state (e.g., fear, horror, anger, guilt, or shame). 5. Markedly diminished interest or participation in significant activities. 6. Feelings of detachment or estrangement from others. 7. Persistent inability to experience positive emotions (e.g., inability to experience happiness, satisfaction, or loving feelings). E. Marked alterations in arousal and reactivity associated with the traumatic event(s), beginning or worsening after the traumatic event(s) occurred, as evidenced by two (or more) of the following: 1. Irritable behavior and angry outbursts (with little or no provocation) typically expressed as verbal or physical aggression toward people or objects. 2. Reckless or self-destructive behavior. 3. Hypervigilance. 4. Exaggerated startle response. 5. Problems with concentration F. Sleep disturbance (e.g., difficulty falling or staying asleep or restless sleep).Duration of the disturbance (Criteria B, C, D and E) is more than one month. G. The disturbance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning. H. The disturbance is not attributable to the physiological effects of a substance (e.g., medication, alcohol) or another medical condition. Specify if: With delayed expression: If the full diagnostic criteria are not met until at least 6 months after the event (although it is understood that onset and expression of some symptoms may be immediate). Specify whether: With Dissociative Symptoms: The individual's symptoms meet the criteria for posttraumatic stress disorder, and in addition, in response to the stressor, the individual experiences persistent or recurrent symptoms of either depersonalization or derealization.

What is the 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; at least one of the symptoms is either (1) depressed mood or (2) loss of interest or pleasure. Note: Do not include symptoms that are clearly due to a general medical condition or mood-incongruent delusions or hallucinations. 1. Depressed mood most of the day, nearly every day, as indicated by either subjective report (e.g., feels sad or empty) or observation made by others (e.g., appears tearful). Note: in children and adolescents can be irritable mood. 2. Markedly diminished interest or pleasure in all, or almost all, activities most of the day, nearly every day (as indicated by either subjective account or observation made by others). 3. Significant weight loss when not dieting or weight gain (e.g., a change of more than 5% of body weight in a month), or decrease or increase in appetite nearly every day. Note: in children, consider failure to make expected weight gains. 4. Insomnia or hypersomnia nearly every day. 5. Psychomotor agitation or retardation nearly every day (observable by others, not merely subjective feelings of restlessness or being slowed down). 6. Fatigue or loss of energy nearly every day. 7. Feelings of worthlessness or excessive or inappropriate guilt (which may be delusional) nearly every day (not merely selfreproach or guilt about being sick). 8. Diminished ability to think or concentrate, or indecisiveness, nearly every day (either by subjective account or as observed by others). 9. Recurrent thoughts of death (not just fear of dying), recurrent suicidal ideation without a specific plan, or a suicide attempt or a specific plan for committing suicide. B. The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning. C. The symptoms are not due to the direct physiological effects of a substance (e.g., a drug of abuse, a medication) or a general medical condition (e.g., hypothyroidism).

What is the diagnostic criteria for specific phobia?

A. Marked fear or anxiety about a specific object or situation (e.g., flying, heights, animals, receiving an injection, seeing blood). B. The phobic object or situation almost always provokes immediate fear or anxiety. Note: In children, the anxiety may be expressed by crying, tantrums, freezing, or clinging. 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, 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 social, occupational or other important areas of functioning. G. The disturbance is not better explained by the symptoms of another mental disorder, including fear, anxiety and avoidance of: situations associated with panic-like symptoms or other incapacitating symptoms (as in agoraphobia); objects or situations related to obsessions (as in obsessive-compulsive disorder); reminders of traumatic events (as in posttraumatic stress disorder); separation from home or attachment figures (as in separation anxiety disorder); or social situations (as in social anxiety disorder). Specify type: 1. Animal 2. Natural environment (e.g., heights, storms, and water) 3. Blood-injection-injury 4. Situational (e.g., planes, elevators, or enclosed places) 5. Other (e.g., phobic avoidance of situations that may lead to choking, vomiting, or contracting an illness; or in children, avoidance of loud sounds or costumed characters)

What is the diagnostic criteria for SAD?

A. Marked fear or anxiety about one or more social situations in which the person is exposed to possible scrutiny by others. Examples include social interactions (e.g., having a conversation; meeting unfamiliar people), being observed (e.g., eating or drinking), or performing in front of others (e.g., giving a speech). Note: In children, the anxiety must occur in peer settings and not just in interactions with adults. B. The individual fears that he or she will act in a way, or show anxiety symptoms, that will be negatively evaluated (i.e., will be humiliating, embarrassing, lead to rejection, or offend others). C. The social situations almost always provoke fear or anxiety. Note: in children, the fear or anxiety may be expressed by crying, tantrums, freezing, clinging, shrinking, or failing to speak in social situations. D. The social situations are avoided or endured with intense fear or anxiety. E. The fear or anxiety is out of proportion to the actual threat posed by the social situation, and 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 or impairment in social, occupational or other important areas of functioning. H. The fear, anxiety or avoidance is not attributable to the effects of a substance (e.g., a drug of abuse, a medication) or another medical condition. I. The fear, anxiety or avoidance is not better explained by the symptoms of another mental disorder, such as panic disorder (e.g., anxiety about having a panic attack) or separation anxiety disorder (e.g., fear of being away from home or a close relative). J. If another medical condition (e.g., stuttering, Parkinson's disease, obesity, disfigurement from burns or injury) is present, the fear, anxiety or avoidance is clearly unrelated or is excessive. Specify if: Performance only: If the fear is restricted to speaking or performing

What is the diagnostic criteria for Agoraphobia?

A. Marked fear or anxiety about two or more of the following five situations: Public transportation, open spaces, enclosed places, standing in line or being in a crowd, 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 or other incapacitating or embarrassing symptoms (e.g., fear of falling in the elderly, fear of incontinence). C. The agoraphobic 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 out of proportion to the actual danger posed by the agoraphobic situations, and 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 or impairment in social, occupational or other important areas of functioning. H. If another medical condition (e.g., inflammatory bowel disease, Parkinson's disease) is present, the fear, anxiety or avoidance is clearly 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, situational type; do not involve only social situations (as in social anxiety disorder) and are not related exclusively to obsessions (as in obsessive-compulsive disorder), perceived deficits or flaws in physical appearance (as in body dysmorphic disorder), reminders of traumatic events (as in posttraumatic stress disorder), or fear of separation (as in separation anxiety disorder)

What is the diagnostic criteria for Body Dysmorphic Disorder?

A. Preoccupation with one or more defects or flaws in physical appearance that are not observable or appear slight to others. B. At some point during the course of the disorder, the individual has performed repetitive behaviors (e.g., mirror checking, excessive grooming, skin picking, reassurance seeking) or mental acts (e.g., comparing his or her appearance with that of others) in response to the appearance concerns. C. The preoccupation causes clinically significant distress or impairment in social, occupational, or other 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 diagnostic criteria for an eating disorder. Specify if: With good or fair insight: The individual recognizes that the body dysmorphic disorder beliefs are definitely or probably not true or that they may or may not be true. With poor insight: The individual thinks that the body dysmorphic disorder beliefs are probably true. With absent insight/delusional beliefs: the individual is completely convinced that the body dysmorphic disorder beliefs are true. With muscle dysmorphia: The individual is preoccupied with the idea that his or her body build is too small or insufficiently muscular. This specifier is used even if the individual is preoccupied with other body areas, which is often the case.

What is the diagnostic criteria for Panic Disorder?

A. Recurrent unexpected panic attacks are present. B. At least one of the attacks has been followed by 1 month or more of one or both of the following: (a) Persistent concern or worry about additional panic attacks or their consequences (e.g., losing control, having a heart attack, "going crazy"), or (b) A significant maladaptive change in behavior related to the attacks (e.g., behaviors designed to avoid having panic attacks, such as avoidance of exercise or unfamiliar situations). C. The disturbance is not attributable to the physiological effects of a substance (e.g., a drug of abuse, a medication) or another medical condition (e.g., hyperthyroidism, cardiopulmonary disorders). 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).

Recurrence is important in in predicting the future course of what disorder? As well as in choosing appropriate treatments?

Major Depressive Disorder

bullimia nervosa

Alejandro was a wrestler all throughout high school and he got in the habit of cutting weight. He's now 24 and has just moved in with his boyfriend as things are getting serious. His boyfriend however is concerned that Alejandro still has that "old behavior." According to the BF, Alejandro will eat three boxes of cookies and four big bags of chips in one sitting. After doing this though Alejandro generally feels really guilty and will take a bunch of laxatives to try to "balance out" what he has done. Alejandro's boyfriend thinks he is just stuck in the past but nonetheless says he shouldn't be eating like that because his "episodes" are expensive and Alejandro is starting to gain a "lil weight."

What is the diagnostic criteria for Panic Attack?

An abrupt surge of intense fear or intense discomfort that reaches a peak within minutes, and during which time four (or more) of the following symptoms occur: 1. Palpitations, pounding heart, or accelerated heart rate 2. Sweating 3. Trembling or shaking 4. Sensations of shortness of breath or smothering 5. Feeling of choking 6. Chest Pain or discomfort 7. Nausea or abdominal distress 8. Feeling dizzy, unsteady, lightheaded, or faint 9. chills or hear sensations 10. Paresthesias (numbness or tingling sensations) 11. Derealization (feelings of unreality) or depersonalization (being detached from oneself) 12. Fear of losing control or going crazy 13. Fear of dying

MDD or PDD or both with catatonic features

Anastasia has been referred to therapy by her husband. He told her if she didn't go he would divorce her. Her husband says he's tired of being married to "a sloth." When you ask him to elaborate he states "yea a sloth, a slow moving sloth." Her husband states that for the last several years Anastasia rarely leaves the house. He says "she's always in a bad mood and never wants to do anything. Anytime I suggest something fun she says "no" sometimes she says nothing at all and just looks past me." Her husband states that she has always been withdrawn but over the last few months he finds her behavior to be worse. He states that he has caught her standing up with her head pressed to the kitchen window for hours, looking at nothing. "I tried to get her attention but its like she was in a daze. Hours later she finally snapped out of it and walked back to the room very slowly and laid in bed the rest of the day." Her husband says he has tried to cheer her up repeatedly and that even when he makes a grand gesture like bringing her home a puppy she doesn't really seem to care all that much, for example she said "oh ".

PTSD

Anika was in a terrible earthquake last year while visiting Hong Kong. Her best friend was actually killed in the quake and Anika had to dig her body out from under the rubble. Anika's life has changed a lot since then. She has stopped going out with friends and is no longer pursing her degree. Her parents say she's disengaged and unmotivated for life and that she's a "Shell of the old Anika." When you talk to Anika she has a very flat affect. She tells you that she wakes up dripping in sweat 3 nights of week because of the terrible nightmares she has. She tells you that she has no desire to go out anymore because "everything is in a building. My friends want to go to bars and malls and restaurants, those are all building. If I have learned one thing its that buildings can fall."

MDD w/ atypical features

Babs is 22 and lives alone. She reports that for the last few weeks she hasn't felt like seeing her friends or going out. She states that she sits alone in her room and watches tv all day. She states that she doesn't have the energy to even shower. She also states that she has been sleeping about 15 hours a night and cannot stop eating junk food. She says she isn't interested in anything except for old reruns of friends and pizza and those are the only two things that make her feel happy anymore but that the feeling is fleeting.

What are the four sub-types of specific phobias?

Blood-injury-injection Situational Natural environment Animal Other (may include vomiting or loud sounds)

Bipolar- probably BPD 1 but you can make a rationale for BPD2

Carol's mom calls you in a panic. Carol's mom has been coming to you for years to work on her self esteem issues but now she is calling because she says her daughter is "out of control." Her mom says Carol has been really difficult to deal with this last week. Carol has been demanding money from family members so that she can pursue an idea of hers for creating self-slicing vegetables. When her family has attempted to question this idea or denied her the money she becomes aggressive and starts screaming at them. She calls them "sheep" and "morons" and says they are too stupid to understand a real genius at work. Carol has been messaging every family member she knows for the last few days at all hours of the day with paragraphs of texts that just ramble on and on. Her mom says she isn't sleeping that she seems to be awake all night working on "inventions" and that the whole family can her in her room and the attic banging around pots and pans and screaming and yelling with excitement as she does. Her mom is worried about her

anorexia nervosa

Danielle was voted prom queen in her high school in rural Mississippi. Once she moved to Miami to start college she started to feel a little self conscious about her body though, she's 5'7'' but feels like she is much bigger than the girls in Miami. Danielle began dieting recently and noticed how well it was working. She lost 20 pounds in only 2 weeks. Danielle decided that if she kept exercising and became even stricter with her dieting then she would lose even more weight. Recently Danielle has been eating very little all day but allows herself a meal at lunch which she immediately follows with a purging session where she will either take a laxative or force herself to vomit. She has now lost 50 pounds and currently weighs 93 pounds. Danielle told her parents that she was going to stop dieting because they are very worried about her and told her she looks like a "skeleton" but she told her best friend that she just says that to get them off her back and that she needs to keep losing weight.

OCD comorbidity

Depression !!!, Anxiety Disorders, Eating Disorders, Substance Abuse, Tourette's Syndrome, Trichotillomania

What does DD stand for?

Double Depression

ASD

Eddie is always picked on in school mostly because he doesn't like to interact with other kids or share his toys. He is starting the 3 rd grade this year and his teachers want to hold him back. They say that his language isn't where it should be. His mom reports that he is a temperamental kid. He is very picky with his food and toys (they have to be a certain way) and has little interest in anyone other than her. When observing him in school you notice that he does not make eye contact when speaking to people and that he has difficulty communicating his needs. He went up to the teacher and said "wash you" while holding out his hands because they had some glue on them. The teacher told him to wash his own hands and he instantly began crying and just repeated what she said over and over again "wash own hands, wash own hands, wash own hands."

TRUE OR FALSE: anxiety is a past oriented mood state

FALSE: It is a FUTURE oriented mood state

TRUE OR FALSE: people with ptsd do not try to avoid emotions like people with panic disorder

FALSE: People with ptsd may try to avoid emotions because emotions may bring back memories

TRUE OR FALSE: hypo means above

FALSE: hypo means below

TRUE OR FALSE: OCD is the least severe of the anxiety disorders because it doesnt have the most hospitalizations or psychosurgery

FALSE: it is the most severe because it has the most hospitalizations and psychosurgery

TRUE OR FALSE: many people with ocd do not have fundamental religious beliefs

FALSE: they do have

GAD

Freddy is always tense and has been that way for many years. He is always worried about what he has to do, possible things that could happen, ways he is going to mess up and what could go wrong. He complains that he is always tired but cannot sleep at night. He seems edgy and irritable when you talk to him and states that he might lose his job because he has been so unfocused at work lately.

What does MDD and PDD look like?

MDD goes back to baseline but drops to a steep degree PDD never reaches baseline and is always changing between bad and worse

no diagnosis hes on DRUGS

Jax is a really difficult student. He is never paying attention in class, he blurts out answers without waiting to be called on. He often forgets to turn in his assignments and sometimes doesn't even show up for school. Jax seems to be distracted by everything, the slightest noise in the room and he's up from his seat to investigate. Jax is a junior in high school but his grades are so bad because of this behavior they are threating to hold him back. Teachers have tried to talk to him but its no use. Today his mom calls up the school office and says she found a bunch of rolled up dollar bills in his backpack last week and a bag of white powder. She had his urine tested and it came back positive for cocaine and the facility that tested it said "yes ma'am your son uses cocaine. He uses lots of cocaine and has obviously been doing so for a while based on those levels."

What is the most common diagnosis with anxiety?

MDD- Major Depressive Disorder 55% of those diagnosed with anxiety or depressive disorder had at least one other at the time of the diagnosis

What kind of disorder does Kevin have? "First time it happened to me, I was driving down the highway, and I had a kind of a knot in my chest. I felt like I had swallowed something and it got stuck, and it lasted pretty much overnight.... I felt like I was having a heart attack.... I assumed that's what was happening. I felt very panicky. A flushed feeling came over my whole body. I felt as though I was going to pass out."

Kevin has panic disorder

MDD w/ psychotic features

Latonya's grandmother passed away a few months ago and she recently broke up with her girlfriend. Latonya reports feeling empty and worthless. She also reports a lot of guilt related to her grandmother's death. She also reports that she can't concentrate on anything. Latonya appears to have lost a lot of weight in the last few weeks. She tells you that sometimes she hears a woman's voice telling her to "kill herself because she is a piece of trash."

OCD

Lena is a 35-year-old mother. Recently she had trouble taking care of her kids and has had to hire help. Lena spends hours every day organizing the house. Lena often organizes the same area three or four times while continually counting to 23 in her head. Lena's husband and parents have tried to get her to cut back on organizing but this creates more distress. Lena says that if she does not organize the house every day that something terrible will happen to her daughters.

schizophernia

Lester is a "weird guy" according to his family. They state that for the last 2 years he's been getting more and more strange, they think it has something to do with him graduating college. When Lester finally comes in for his appointment he is wearing a helmet covered in tinfoil. You ask him repeatedly about the helmet but he doesn't answer you. He just sits in silence staring at the wall, then the ground and then the wall again. He doesn't make eye contact and it looks like he hasn't showered in a while. When you take out your cell phone to send a quick message Lester jumps up from the chair and begins screaming. It's hard to understand exactly what he saying because the sentences are so jumbled but it sounds like he's afraid that aliens are going to come through your phone and infest his body.

Which one is more severe: manic episode or hypomanic episode?

Manic episode is more severe

specific phobia-

Maria Elena is 32 and unemployed. She lives in NYC and cannot seem to find or keep a job because "every building has a damn elevator" and for her that is a non-negotiable aspect, she refuses to ride in elevators. Maria Elena reports that she is terrified of being caught in an elevator to the point that she once walked up 21 flights of stairs to get to a doctors appointment and by the time she got there she was 30 minutes late. Maria Elena says the thought of being in an elevator makes her feels sweaty and out of breath. When you bring up the idea of going into the hallway to look at the elevator together her eyes widen with terror and she starts crying "no I can't. I just can't".

What is SAD?

Marked anxiety in social or performance situations common types of performance anxiety- public speaking, eating in a restaurant, signing a check

STPD, or prodromal schizophrenia

McClain is 22 years old and has recently begun acting "weird" according to his family. McClain talks about having a "6 th sense" and being able to sense things that are not present. He also states that sometimes he feels as if people on his favorite tv shows are actually trying to communicate with him directly. He was always a socially anxious child and never really had the best social skills but it seems like as he gets older he is becoming more odd, especially in the last year or so.

grief no diagnosis

Nicole was referred by her boss for counseling. Rose has periods of time when she is accomplishing so much at work and really appears to be the star employee. She's energetic and positive and gives pep talks to all the other employees. However this last week has been different. She seems to have trouble focusing and looks tired. She's been coming in late and when asked about her projects she reports feeling pretty unsure of herself and her abilities. Once you meet Nicole she breaks down in tears telling you that her mom just passed away a week and half ago.

What disorder does Richard suffer from? Richard, a 19-year-old college freshman majoring in philosophy, withdrew from school because of incapacitating ritualistic behavior. He abandoned personal hygiene because the compulsive rituals that he had to carry out during washing or cleaning were so time consuming that he could do nothing else. Almost continual showering gave way to no showering. He stopped cutting and washing his hair and beard, brushing his teeth, and changing his clothes. He left his room infrequently and, to avoid rituals associated with the toilet, defecated on paper towels, urinated in paper cups, and stored the waste in the closet. He ate only late at night when his family was asleep. To be able to eat, he had to exhale completely, making a lot of hissing noises, coughs, and hacks, and then fill his mouth with as much food as he could while no air was in his lungs. He would eat only a mixture of peanut butter, sugar, cocoa, milk, and mayonnaise. All other foods he considered contaminants. When he walked, he took small steps on his toes while continually looking back, checking and rechecking. Occasionally, he ran quickly in place. He withdrew his left arm completely from his shirt sleeve as if he were crippled and his shirt was a sling. Like everyone with OCD, Richard experienced intrusive and persistent thoughts and impulses; in his case, they were about sex, aggression, and religion. His various behaviors were efforts to suppress sexual and aggressive thoughts or to ward off the disastrous consequences he thought would ensue if he did not perform his rituals. Richard performed most of the repetitive behaviors and mental acts mentioned in the DSM-5 criteria. Compulsions can be either behavioral (hand-washing or checking) or mental (thinking about certain words in a specific order, counting, praying, and so on) (Foa et al., 1996; Purdon, 2009; Steketee & Barlow, 2002). The important thing is that they are believed to reduce stress or prevent a dreaded event. Compulsions are often "magical" in that they may bear no logical relation to the obsession.

OCD

What disorder was formally called dysthymia?

PDD

Which one is more severe: MDD or PDD?

PDD because it has a higher comorbidity with other disorders, less responsive to Tx, slower rate of improvement

What is PD?

Panic Disorder

he's fine. gender nonconformity is what he is presenting with but that is NOT a diagnosis its an adjective

Pedro is a homosexual male. He reports being bullied in high school for this but states that now that he is an adult he feels supported and confident in his sexuality. When you meet with him you notice that he tends to talk in a very high-pitched voice and wears somewhat feminine clothes, like leggings and sometimes high heeled shoes. When confronted on this behavior he states that he is an up and coming fashion designer and that he is "living his best life" and does not care if others do not approve of his appearance because he is more than confident in his identity and sexuality. Pedro states "I am gone with the wind fabulous honey."

What is the diagnostic criteria for OCD?

Presence of obsessions, compulsions or both: Obsessions are defined by 1 and 2: 1. Recurrent and persistent thoughts, urges, or images that are experienced, at some time during the disturbance, as intrusive and inappropriate and that in most individuals cause marked anxiety or distress 2. The individual attempts to ignore or suppress such thoughts, impulses, or images, or to neutralize them with some other thought or action Compulsions are defined by 1 and 2: 1. Repetitive behaviors (e.g., handwashing, ordering, checking) or mental acts (e.g., praying, counting, repeating words silently) that the individual feels driven to perform in response to an obsession, or according to rules that must be applied rigidly 2. The behaviors or mental acts are aimed at preventing or reducing distress or preventing some dreaded event or situation; however, these behaviors or mental acts either are not connected in a realistic way with what they are designed to neutralize or prevent or are clearly excessive B. The obsessions or compulsions are time-consuming (e.g., take more than 1 hour per day), or cause clinically significant distress or impairment in social, occupational or other important areas of functioning. C. The disturbance is not due to the direct physiological effects of a substance (e.g., a drug of abuse, a medication) or another medical condition. D. The disturbance is not better explained by the symptoms of another mental disorder (e.g., excessive worries, as in generalized anxiety disorder, or preoccupation with appearance, as in body dysmorphic disorder). Specify if: With good or fair insight: the individual recognizes that obsessive-compulsive disorder beliefs are definitely or probably not true or that they may or may not be true. With poor insight: The individual thinks obsessive-compulsive disorder beliefs are probably true. With absent insight/delusional: the person is completely convinced that obsessive-compulsive disorder beliefs are true. Specify if: Tic-related: The individual has a current or past history of a tic disorder.

BDD

Racheli hates her skin complexion. She's constantly looking in the mirror and picking at her skin because she states that she has "hideous blemishes." Racheli has some freckles and mild redness on her skin by her cheeks but she is convinced she looks "hideous and disgusting." She's had microderm abrasion and acid peels but feels nothing has made her skin better. Her dermatologist referred her to the psychiatrist recently because despite all the treatments that she has done and the fact that her skin looks great to the doctor, Racheli decided to buy some Clorox Bleach and to soak her face in it for 30 minutes. As a result her skin was severely damaged and now Racheli is even more distressed than before.

Social Anxiety Disorder abbreviation

SAD

PTSD

Shelby was raped in an abandoned building last year while walking home from work. Shelby comes into your office asking for prescription drugs. She says she cannot sleep at night because she tosses and turns with terrible nightmares about being raped again. When asking Shelby details about the event she has a hard time remembering. She tells you that she knows it happened but doesn't remember it. She tries to change the subject several times so you get the feeling she is trying to avoid thinking about it. When you ask her about her family and friends she says she prefers to be alone. For the last year she has found it "easier" to be alone so she doesn't have to answer any questions or "pretend to be ok" in front of her family.

TRUE OR FALSE: 50% of those with acute stress disorder go on to develop ptsd

TRUE

TRUE OR FALSE: Anxiety can co-occur with physical disorders such as: thyroid, respiratory, gastrointestinal, arthritis, migraines, allergies

TRUE

TRUE OR FALSE: In order to diagnose PTSD there has to be a clear antecedent

TRUE

TRUE OR FALSE: OCD and BDD often co-occur

TRUE

TRUE OR FALSE: The symptoms of agoraphobia are not confined to specific phobia, situational type

TRUE

TRUE OR FALSE: tendency to panic runs in families

TRUE

TRUE OR FALSE: OCD AND BDD often co-occur

TRUE OCD is found in families of BDD ex: the intrusive horrible thoughts are about appearance and the compulsive behaviors might be constantly checking in the mirror (often to see if this ugly feature has changed)

Exhibitionist disorder

Terrance is 42 years old and was referred by therapy by the court system. Terrance was caught sneaking into the dorm rooms of an all-girls prep school and waiting for the girls to wake up where he would then open his trench coat and expose his penis. On a few occasions he would then masturbate while the girls yelled and screamed. When you meet with Terrance you are surprised to learn that he has been doing this for years but only recently has been caught. Terrance states that he has had only a few lovers in his life and that most of the time things end poorly because the partners don't like his "kinks" In the bedroom.

Separation Anxiety Disorder

begins in childhood with the fear that something will happen to them if they separate from parents/caregivers all kids have to some extent in some cases onset is adulthood, the feat that something will happen to a loved one when you leave

Fetish

Tim has always been somewhat socially isolated. He doesn't have a lot of close relationships and his coworkers might say he is a bit socially awkward. Tim is very interested in finding a girlfriend but hasn't had any success. Most women are turned off by his need to hold or touch a high heeled shoe while they are having sex. His ex-girlfriend said "it seems like he wants to do the shoe and not me."

borderline personality disorder

Wanda is 24 and has never been alone. Her boyfriend recently dumped her and now she is in a relationship with a woman. Wanda has a history of cutting and lately says that she feels very depressed. Wanda says that she just wants to feel happy but cannot feel happy without her ex. He won't have anything to do with her though. He states that's she emotionally unstable and that she has attacked him several times in the past and often makes threats to hurt herself if he doesn't immediately agree not to break up with her. Wanda comes from a very abusive home and seems to have poor social support.

What is ptsd?

When a person is exposed to a traumatic event and then re-experiences the event through memories "flashbacks" and nightmares

MDD w/ peripartum onset

Yelensky gave birth three months ago and still feels like she hasn't bonded with the baby. Her husband asks her all the time if she feels depressed, she doesn't really know what to say. She doesn't really feel anything. She has no desire to play with the baby and no real desire to get out of bed. Yelensky hasn't been sleeping very well and has no real appetite. Her husband is very worried about her.

Double Depression

You have been seeing Natasha for a while now. She originally came in stating she couldn't focus and had no energy and for the last two years that you have been seeing her she continues to report those symptoms more days than not. However, in the last week she appears to be struggling even more. She came into your office tearful yesterday. She said "I just don't know what the point is. Why am I here? The world would be better off without me." Natasha then revealed to you she had been contemplating suicide the last few days.

How long after the trauma can you diagnose someone with PTSD?

You have to wait at least one month after the event because many people who experience trauma have a difficult time some develop a delayed onset of 6+ months after the event

ASPD

You meet Heath at an AA meeting. He has been court ordered to attend and seems to have a reputation among the other members as being pretty aggressive. When you meet him, he seems pretty charming and somewhat intriguing. He engages you in a conversation and before you know it, you have agreed to let him borrow $100. After you give Heath the money, he leaves the AA meeting and on his way out you notice that he takes one of the other member's purse with him. He notices you watching but continues to take the purse and doesn't seem to care that he's been spotted.

gender dysphoria

Yousef is a 16 year old boy that was referred to you by his parents. His parents are extremely upset with him and feel like he is engaging in morally corrupt behavior. His father says that being gay is a sin and wants you to address his son. When you speak to Yousef he denies being gay. He states that he like girls but he doesn't like himself. He says "my dad thinks I'm gay because I grow out my hair and wear women's clothing. What he doesn't understand is that I am not a boy. I think I was given the wrong body at birth. Its just never felt right. The people who really love me and care about me don't even call me Yousef. I have asked my parents to stop calling me that for years but they refuse. My name is Jessica."

What is a hypomanic episode?

a less severe version of a manic episode that does not cause marked impairment in social or occupational functioning and need last only 4 days rather than a full week

What is anxiety?

a negative mood state characterized by bodily symptoms of physical tension and apprehension about the future

Bipolar disorder

moving from one pole to the other

What is a panic attack?

abrupt experience of intense fear or acute discomfort, accompanied by the physical symptoms of heart palpitations, chest pain, and shortness of breath

Major Depressive Episode

an extremely depressed mood state that lasts at least 2 weeks and includes cognitive symptoms (such as feelings of worthlessness and indecisiveness) and disturbed physical functions (such as altered sleeping patterns, significant changes in appetite and weight, or a notable loss of energy) to the point that even the slightest activity or movement requires an overwhelming effort. Barlow, David H.; Durand, V. Mark; Hofmann, Stefan G.. Abnormal Psychology: An Integrative Approach (p. 218). Cengage Learning. Kindle Edition.

fear

an immediate alarm reaction to danger

What does BDD stand for?

body dysmorphic disorder

Mixed features

can experience symptoms of one pole (either depression or mania) in the other

What is persistent depressive disorder?

depressed mood that continues at least 2 years, during which the patient cannot be symptom free for more than 2 months at a time even though they may not experience all of the symptoms of a major depressive episode.

two types of panic attacks

expected and unexpected

Mood Disorders

experiences of depression and mania

Unipolar disorder

experiencing either depression or mania (mania can occur alone but this is rare and most do develop depression eventually)

What is a setting event?

exposure to a traumatic event

What is panic disorder?

fear when you have no real reason = panic

What is agoraphobia?

fear/avoidance of situations/places where person feels unsafe or unable to escape

What does GAD stand for?

generalized anxiety disorder

Trichotillomania

hair pulling disorder

Isolated sleep paralysis

individual unable to move and experience terror (panic attack)

What is mania?

individuals find extreme pleasure in every activity; some patients compare their daily experience of mania with a continuous sexual orgasm.

what are obsessions?

intrusive and mostly nonsensical thoughts, images or urges the the person tries to resist

Specific Phobia

irrational fear of specific object/situation that interferes with functioning

Persistent depressive disorder shares many symptoms of ________________________ but differs in its course

major depressive disorder

What is GAD characterized by?

muscle tension, mental agitation, susceptibility to fatigue, irritability, difficulty sleeping, focusing attention is difficult

Nocturnal panic

panic attacks occurring 1:30-3:30 am most often 60% of people with PD have experienced this

What does PDD stand for?

persistent depressive disorder

What does PTSD stand for?

post traumatic stress disorder

excoriation

skin picking disorder

What is Major Depressive Disorder?

the presence of depression and the absence of manic, or hypomanic episodes, before or during the disorder. An occurrence of just one isolated depressive episode in a lifetime is now known to be relatively rare Barlow, David H.; Durand, V. Mark; Hofmann, Stefan G.. Abnormal Psychology: An Integrative Approach (p. 220). Cengage Learning. Kindle Edition.

what are compulsions?

thoughts or actions that are used to suppress the obsessions and provide relief

What is BDD?

when relatively normal looking people refuse to interact with others or function normally because they believe they are hideous or have some drastic ugly feature

What is GAD?

worrying indiscriminately about everything