Ab Psyc Exam 2

PDD w/ MDE entire time

Basically, MDD that lasts 2 or more years is PDD

Bulimia

Binge-eating, which includes: Eating a larger amount than most would, in a discrete period of time Feeling lack of control over eating Inappropriate compensatory behaviors to prevent weight gain Self-induced vomiting, laxative/diuretic misuse, fasting, excessive exercise Binge/compensatory behaviors occur, on average, at least once/week for 3 months Self-evaluation unduly influenced by weight/shape Doesn't have AN Severity: avg. # weekly episodes binge/ compensatory behavior

CASE: Bob presents to you in a very active state. He says he feels energized and "ready to go." He is speaking very quickly, describes his thoughts as bouncing around from idea to idea, and seems easily distracted. He says he has "never felt better," even though he has only had 2 hours of sleep per night. He has been doing a lot of gambling, and just drained his 401K savings at the MGM casino last weekend. He says this has gone on for 8 days. He also describes a history of depressive episodes in the past (including depressed mood, difficulty sleeping, lack of appetite, low energy, and difficulty concentrating). -Which disorder does he most likely have?

Bipolar I Disorder

Why does he not have Bipolar II?

Bob has manic episodes, which automatically puts him in the realm of Bipolar I. Although MDEs are not required for a diagnosis of Bipolar I, people with Bipolar I often also have a history of MDEs (so don't let that fool you)!

Why?

Bob meets criteria for a manic episode, including an elevated mood and increased energy, with decreased need for sleep, talkativeness, flight of ideas, distractibility, and impulsivity that have lasted for longer than a week (8 days). It has caused him impairment (gambling). There is no mention of a Schizophrenia Spectrum Disorder.

CASE: Cara reports that she has periods of time when she doesn't eat at all. She does this to make up for a period of time, usually lasting around 30 minutes, in which she eats up to 2,500 calories of fast food because she does not feel like she can stop. She does not engage in self-induced vomiting. This pattern of eating episodes and restricted eating occur about 3 times per week, and have lasted for 9 months. Cara said that she feels like a bad person because she is "fat." She has a BMI of 23. -Which disorder does she most likely have?

Bulimia Nervosa

Why does she not have Binge Eating Disorder?

Cara does experience binge eating episodes, but she engages in inappropriate compensatory behavior (fasting). Individuals with BED do not engage in inappropriate compensatory behaviors that average more than once/week like Cara does.

Why?

Cara's BMI is in the average range; she does not have AN (would require BMI less than 18.5 or significantly low weight based on age, sex, medical history, etc.). She binge eats (large amount of food in a discrete period of 30 minutes AND lack of control over eating). She engages in inappropriate compensatory behavior (i.e., fasting; note that fasting can be a form of inappropriate compensatory behavior and self-induced vomiting is not REQUIRED). This pattern of binge-eating and compensatory behavior occurs an average of 3/week for 9 months (more than the once/week for 3 months required). Her self-evaluation is unduly influenced by weight (i.e., thinks she's a bad person because she's fat).

Why does she not have Anorexia Nervosa?

Cara's BMI is not less than 18.5 to suggest significantly low weight (and no suggestion here that this BMI of 23 somehow significantly low based on her characteristics/background, etc.). If it were significantly low, she would have AN!

Delusional Disorder

Delusions for 1+ months Just delusions-- no other positive, negative, or disorganized symptoms Functioning not strongly impaired, usually delusions are not bizarre (they are POSSIBLE, but untrue) Not only during manic or depressive episode Not better accounted for by another disorder (e.g., OCD)

ECT and when it is used

Effective in treating depression for about 50% of those for whom meds did not work Brief electrical current to brain, causes seizure, for 6-10 treatments Can cause short-term memory loss that usually go away Unclear why it works Used for Schiz patients

Types of delusions:

Erotomanic- someone is in love with you Grandiose- great talent/discovery/famous Jealous- lover is unfaithful Persecutory- out to get me Somatic- body

Hallucinations

Experience of sensory events without environmental input Can involve all senses Hearing (auditory), seeing (visual), feeling (tactile), smelling (olfactory) Auditory most common

MDD

Experiencing an MDE (earlier slide--- 5+ symptoms, have distress or impairment, etc. ) Not better explained by a schizophrenia spectrum disorder Never been a manic or a hypomanic episode Can diagnose while grieving, but consider whether a normal reaction to loss (Grief: self-esteem maintained, some positive emotions, desire to join deceased)

1. Compare and contrast the symptoms and timelines of Major Depressive Disorder, and the types of Persistent Depressive Disorder (including Double Depression)

For major depressive disorder you must have at least one major depressive episode for the time period of 2 weeks to 2 years. One can return to normal mood but cannot stay there for 2 months. If its under 2 months of normal mood then it is still considered one episode and if the normal mood exceeds 2 months and another MDE occurs it is MDD recurrent. PDD consists of 2 or more years of depressed mood with going no more than 2 months of normal mood . One must have atleast 2 of the following: Low self esteem, change in appetite, change in sleep, hopelessness and concentration issues. There are 3 subtypes of PDD. The first is chronic MDE for the entire time, the second version never hits MDE but still isn't at normal mood functioning, it is a mild depression in the middle. And lastly, double depression is when the mood changes from mild middle depression and dips to MDE and back and fourth between them. In both cases one can never have had an episode of mania or hypomania to be considered for MDD or PDD. Also it cant be better explained by a schizophrenia spectrum disorder and cannot be due to drugs or a condition.

Why?

For over two years (27 months is 2 years and 3 months), she has reported low mood and hopelessness. There is not a period of longer than two months in which she feels normal (6 weeks is less than two months). She also reports impairment in her work and financial functioning. In addition, she also reports some periods within her PDD that meet criteria for MDE. For one month (i.e., longer than the two weeks needed), she reports 5 symptoms of an MDE (i.e., depressed mood, increased appetite, concentration difficulties, suicidal thoughts, hypersomnia). Thus, she has "Double Depression," a form of PDD.

PDD with intermittent MDEs ("Double Depression"; "Double-Dip Depression")

For two or more years, having intermittent MDEs, never fully returning to normal mood in-between **In MDD, returns to normal mood for 2+ mos. at a time

Why?

Jeffery reports a somatic delusion (that his blood has been replaced by lava). (Of note, this is a "bizarre" delusion, meaning that it is impossible). He also reports auditory hallucinations, hearing voices of people who are not there. There is also evidence of disorganized speech, in the form of word salad in this example. Thus, he meets three of the required types of symptoms. He also has impairment in his work and social functioning as a result of his symptoms. These symptoms have been going on for 8 weeks (2 months), which is between 1 and 6 months. He also does not have a history of manic episodes (so he can't have Bipolar I Disorder), or MDEs (so he can't have Bipolar II Disorder). This lack of major mood episodes also means he can't have Schizoaffective Disorder. There is no evidence this is the result of a substance or medical condition. Therefore, he has Schizophreniform Disorder.

Psychosis

Loss of contact with reality. Most frequently thought of as 2 types of symptoms (present among 50-70% of those with Schizophrenia): Hallucinations & Delusions

Why does she NOT have MDD, recurrent?

MDD, recurrent, is diagnosed when MDEs are separated by periods of time of 2 months or longer in which the client returns to normal functioning. The period of time in which Diane was symptom-free was only 6 weeks.

MDD Single Ep

MDD: At least 2 weeks (can be up to 2 years) than return to normal mood

MDD recurrent

Most have more than one episode in their lives (recurrence of MDEs) You are recovered for 2+ months and then have another episode Average: 4-7 MDEs across lifetime (25% will have 6+)

BPD II

Must have had at least 1 hypomanic episode AND -Must have had at least 1 MDE AND -No history of manic episodes AND Sig. distress or impairment in functioning Must not be better explained by a schizophrenia spectrum disorder Bipolar II (At least 1 Hypomanic episode, at least one MDE)

BPD I

Must have had at least 1 manic episode (distress or impairment already present in manic episode) Must not be better explained by a schizophrenia spectrum disorder May also have MDEs, but not required

Obesity

NOT a diagnosis in DSM BMI = 30+ (38% of U.S. adults) Some binge-eat, but only 7-20% have BED Though there are some genetic, biological, and psychological causes, the primary cause is an inactive, sedentary lifestyle and availability of high-fat, inexpensive foods!

PDD w/o MDEs

Never total MDEs, but 2+ of those low mood symptoms for 2 years Never return to normal mood for longer than 2 months

Binge Eating Disorder

New disorder in DSM-5. Must have binge-eating episodes (same criteria as in BN Criterion A) but without compensatory behaviors. Binge on average at least once/week for 3 months Must be distressed over binge-eating Also, binges must include one of these: Eating faster than normal, Eating until uncomfortably full Eating large amounts when not hungry Eating alone due to embarrassment Feeling disgusted, depressed, or guilty after binge

Catatonia

Not a disorder, but a specifier that can go with Schizophrenia or other disorders Unusual motor responses and mannerisms. Some are: No motor activity (stupor), Mutism Agitation Repetitive, meaningless movements (stereotypy) Mimicking others' speech (echolalia) or movements (echopraxia) Odd posture Severe, rare

Hypomanic Episode

Overall, same criteria, but--- Shorter than manic episode (4+ days) Same # of symptoms required But... though it represents a "change" in functioning/mood that others can observe it is "Not severe enough to cause marked impairment" in functioning

Manic Episode

Period of 1 week or longer, elevated or expansive mood and increased activity or energy, nearly every day*** 3+ of the following, which are not normal behavior for person Distractible Impulsive, high-risk behaviors Grandiose/Inflated self-esteem Flight of ideas (i.e., racing thoughts) Activity increased (or psychomotor agitation) Sleep (decreased need) Talkative/pressure to keep talking Causes Impairment, not due to substance/medical condition (Note: Do not have to be hospitalized or have psychotic features to meet criteria, but if you have these, it is mania and not hypomania) *** Can be just irritable, but then need 4+ symptoms

CASE: Diane has been experiencing depressed mood, a very high appetite, difficulty with concentration, suicidal thoughts, and has been sleeping over 12 hours each night. Though this period of most difficulty symptoms usually lasts about one month each time, she reports consistently depressed mood and hopelessness for 27 months. She has only felt "normal" for a period of 6 weeks at one point during this time. She says that these symptoms have led her to miss a lot of work and that she isn't keeping up with her bills. She has never had a manic or hypomanic episode. -Which disorder does she most likely have?

Persistent Depressive Disorder (Double Depression)

Anorexia

Restricts eating, leading to significantly low body weight Based on age, sex, health, etc., often BMI <18.5 Intense fear of or behavior interfering with weight gain At least one of these: Self-evaluation unduly influenced by weight/shape, OR disturbance in way one views one's body, OR failure to recognize seriousness of low weight Severity: Determined by BMI

Schizofeniform

Same as Schizophrenia, but lasts between 1-6 months >6 months = schizophrenia

CASE: Jeffery says that his blood has been replaced with lava and he fears that he will burn up on the inside. He said that there are "lava people" who speak to him as well. He then says, "Lava people cat bring apples box!" His mother says that these symptoms have been going on for 8 weeks. Because of these symptoms, Jeffery has stopped attending work and no longer leaves his home or spends time with friends. He has never had a manic episode, and does not report a history of MDEs. -What disorder does Jeffery have?

Schizophreniform Disorder

Premenstrual Dysphoric Disorder (PMDD)

Significant depressive symptoms, occurring prior to menses during the majority of cycles Not just typical PMS--- very severe, interfering, distressing 2-5% of women Controversial diagnosis Advantage: Legitimizes the difficulties some women face when symptoms are very severe Disadvantage: Pathologizes an experience many consider to be normal

Disorganized Emotion/Behavior

Silliness, laughing/crying at inappropriate times, agitation, can even be catatonia...

Cyclothymic Disorder

Similar to PDD, a chronic version of bipolar disorder 2+ years Mild depressive and hypomanic symptoms alternate and do not reach full MDE, mania, or hypomania Each mood state may persist for long periods Causes distress/ impairment Facts and statistics Average age of onset is 12-14 yrs Women> Men Often chronic and lifelong, 1/3 to 1/2 develop full-blown bipolar Varying elevated and low mood over 2+ years, never full mania, hypomania, MDE (Never "normal mood" for longer than 2 months)

Why does he not have Cyclothymic Disorder?

Since he meets for manic episodes, he cannot meet for Cyclothymic Disorder, which requires that you never have had a full manic episode, hypomanic episode, or MDE. Also, his symptoms have not been continuous for over 2 years.

2. Discuss the causes of Mood Disorders. Include in your response genetic/biological causes, psychological causes, and social causes. (NOTE: Just one of each will not be a sufficient response.)

Some biological causes are just being related to someone with a mood disorder, the chances increase by 2-3 times more. Genetics have more of an effect with bipolar disorders over depressive disorders. And there is a stronger correlation in women than men. Although the exact genes involved aren't known there are multiple. Also lack of sleep that can trigger an episode of mania or depression. Psychological causes can be negative stressful events can lead to depression, like a job loss can lead to depression. Positive stressful events such as maybe a new job or getting married can casue manic episodes. Seligmen and beck both had theories about negativity. The hopelessness theory where everything is bad so why even try. And becks theory was about constant negativity . Social cues that can cause mood disorders are relationships, loneliness and gender.

3. Discuss some of the causes of Schizophrenia, including genetic influences, neurotransmitter imbalances, prenatal viral exposure, and psychological stressors. Describe 2 problems with the dopamine hypothesis.

Some causes of schizophrenia are genetic inheritance, for instance if one has an identical twin with schizophrenia the chances of getting it is around 45%. There are multiple gnes incolved with schizophrenia. Dopamine plays a possible role, It is thought by some that high levels of dopamine cause schizophrenic symptoms but using dopamine blockers doesn't relieve symptoms for everyone, the symptoms change is slow and ti doesn't help negative symptoms. It can be seen that in some peoples scans those with schizophrenia have brain abnormalities like larger ventirles and less frontal cortex function. Prenatal viral exposure is when for instance if the pregnant mother is sick like having the flu during the second trimester, which can damage the babys brain. Along with pregnancy complications can affect the baby causing schizophrenia. Regarding psychological stressors, the siathesis stress model can play a role where one who is stressed activates underlying vulnerability to schizophrenia. High expressed emotion can potentially cause relapse risk where parents are overinvolved that it has a negative affect

Delusions

Strong, inaccurate beliefs that persist in the face of evidence to the contrary Most common: Delusions of grandeur ("I'm a God") Delusions of persecution ("They're out to get me")

Suicide risk

Suicide in the family Preexisting psychological disorder Alcohol Use/Abuse Stressful life event, especially humiliation Past suicidal behavior Feeling you are a burden to others Sense of not belonging Hopelessness Plan and access to lethal methods Low serotonin

Schizoaffective Disorder

Symptoms of schizophrenia and a major mood episode (MDE or manic) Symptoms of mania or MDE are present for most of the time But, psychotic symptoms have to also occur for at least 2 (or more) weeks when not in mood episode i.e., not just psychotic symptoms when manic/depressed Like Schizophrenia, typically chronic

High expressed emotion (EE)

- criticism, hostility, overinvolvement-- associated with relapse View patient as "not trying" "Why don't you just try to keep your mind off it?"

Avolition(Apathy)

- inability to initiate and continue activities (e.g., not performing hygiene, day-to-day tasks)

Anhedonia

- lack of pleasure (as in depression, in food, sex, socializing)

Affective Flattening (Flat Affect)

- little outward emotional response (e.g., vacant stare, flat speech)

Alogia

- slow/delayed speech, brief responses ("pulling teeth" to get response)

Choose another Schizophrenia Spectrum Disorder, and describe why he does NOT have that disorder.

-Schizophrenia: Jeffery meets all of the criteria for Schizophrenia except that the total duration is not 6 months. If it goes on for more than 6 months, we would diagnose him with Schizophrenia! -Brief Psychotic Disorder: Jeffery meets more than enough criteria (only 1 psychotic type of symptom is required for Brief Psychotic Disorder), but his symptoms have lasted longer than 1 month, and this disorder requires that symptoms last between 1 day and 1 month. Because it has been 2 months, and he has 2+ symptoms, he would meet for Schizophreniform disorder. -Delusional Disorder: Jeffery meets for more than just delusions--- he has hallucinations and disorganized speech. His symptoms also cause functional impairment. Thus, he does not meet for Delusional Disorder. -Schizoaffective Disorder: As noted above, Jeffery does not report manic episodes or MDEs. Thus, he cannot meet for Schizoaffective Disorder, which requires some type of major mood episodes (manic or MDE) that occur for a majority of the duration of the illness. (Note that Schizoaffective Disorder also requires some signs of psychotic symptoms for 2 weeks when the person is NOT experiencing a major mood episode such as mania or an MDE.)

Brief Psychotic Disorder

1+ psychotic symptoms lasting <1 month

5. In what ways do patients with Anorexia Nervosa and Bulimia Nervosa tend to be similar (at least 2 ways) and in what ways do they differ (at least 2 ways)? In addition, how are their treatments similar and different (including medication and psychological treatments)?

2 ways that anorexia is similar to bulimia is that in both cases an individual is scared of gaining weight and they both value themselves based on their looks and body types (self evaluation). A way that they are different is that people with anorexia nervosa are prideful in what they are doing, where people who are bulimic are shameful. Another difference is bulimia always has compensatory actions where anorexia can or cannot. Regarding treatments people with anorexia wont take antidepressants due to their pride but antidepressants can be useful for those with bulimia. With therapy the first goal is to regain healthy weight for anorexia and discuss self worth for both.

PDD

2+ years of depressed mood on most days No more than 2 months symptom-free Must have at least 2 of related symptoms: Low self-esteem, hopelessness, concentration troubles, appetite issues (too low, too high), sleep disturbance (insomnia, hypersomnia) Distress/Impairment Never manic/hypomanic, not due to schizophrenia spectrum disorder, substance or medical condition

Schizofrenia

2+, for a significant portion of a 1 month period. At least one must be #1, 2, or 3: 1) Delusions 2) Hallucinations 3) Disorganized Speech 4) Disorganized or Catatonic Behavior 5) Negative symptoms Continuous signs of some symptoms for 6+ months Causes Impairment Not due to substance, medical condition Not better explained by bipolar or schizoaffective disorders

6. Describe a manic episode, including at least 4 symptoms and other characteristics of a manic episode in your response. How do hypomanic episodes differ from manic episodes? Next, briefly explain how Bipolar I Disorder, Bipolar II Disorder, and Cyclothymia can be differentiated from one another.

A manic episode has the symptoms of distractible, impulsive, grandiose, flight of ideas, agitation, sleep, and being talkative. One muse have 3 or more of these symptoms for a week or longer and then in general the mood is elevated or expansive. If one is just irritable then 4 or more symptoms are required. Hypomanic episodes are basically the same but have a minimum time frame of 4 days instead of a week, and the symptoms are not severe enough to cause impairment. In bipolar 1 you must have atleast 1 manic episode and you can have MDE but not required. Bipolar 2 must have atleast 1 hypomanic episode and 1 MDE but no manic episodes. Distress or imparment is caused. Cyclothymia is similar to PDD, it is a chronic version of bipolar 2. It must last for 2 or more years . Mild depressive symptoms that never reach MDE alternate with hypomanic symptoms but never reach hypomania.

Negative Symptoms

Absence of normal behavior (25% of those with Schizophrenia)- 4As Avolition (or apathy) Alogia Anhedonia Affective flattening (flat affect)

Major Depressive Episodes

At least 5+ symptoms, most of the day, nearly every day, 2+ weeks Must have either #1 or 2: depressed mood loss of interest or pleasure (anhedonia) Concentration difficulties, problems thinking, or making decisions Guilt or feelings of worthlessness Fatigue/loss of energy Psychomotor changes (feeling restless or feeling slowed down) Appetite or weight change (+ or -) Sleep Changes (Insomnia or Hypersomnia) Suicidal ideation or thoughts of death Must cause distress or Impairment Not due to substance or medical condition

4. Describe the three main types of symptoms in Schizophrenia (i.e., positive, negative and disorganized), giving examples of each. Compare Schizophrenia to other Schizophrenia Spectrum Disorders, including Schizoaffective Disorder and Delusional Disorder, in terms of their symptoms, duration, and outcomes.

The three man types of symptoms in schizophrenia are positive, negative and disorganized. Positive symptoms are when things are added or enhanced. Like hallucinations (sensory stimulation without any environmental input) and delusions which are strong inaccurate beliefs. Negative symptoms are when there is a lack of normal behavior. Like anhedonia which is the lack of pleasure in activities and alogia which is slow short responses while talking. Then disorganized speech and behavior are self explanatory. Some types of disorganized speech is word salad when nothing makes sense, loose association which is the abrupt change in topic and tangiental where one gets off topic but eventally gets back to the point. Schizophrenia must have 2 or more but 1,2or,3 of delusions, hallucinations, speech, behavior and negative symptoms. They must hold for 1 month with everything but atleast 6 months with some. . Schizoaffective disorder is the combination of having schizophrenia and a mood disorder. A person must have psychotic symptoms for 2 or more weeks without a mood episode. Delusional disorder has the best outcome for a patient. Delusional disorder is not very impairing, only must have 1 of these delusions for 1 or more month not during a manic episode. Persecutory, grandeur, jealousy, erotomanic, and somatic.

Why does she NOT had Premenstrual Dysphoric Disorder (PMDD)?

There is no evidence from this description that the symptoms occur each month prior to menses or that they cease once menses begins. The fact that they go on for so long suggests that they are not tied to a particular hormonal phase

Disorganized Speech

not logical or appropriate to context (Example: Etta) Tangential- goes off but returns to point Loose associations - abrupt change in topic Word Salad- sentence does not make sense together