AP psych
Hypochondriasis (Illness anxiety disorder) (somatoform disorders)
Excessive anxiety and concern with having or getting a serious medical condition.
Dissociative Amnesia (dissociative disorders)
Inability to recall important personal information, usually of a traumatic or stressful nature.
Dissociative Fugue (dissociative disorders)
Length of fugue ranges anywhere from a few hours to several months or longer.
Major (Clinical) Depression (mood disorders)
Occurs when at least five signs of depression (including lethargy, feelings of worthlessness, or loss of interest in family, friends, and activities) last two or more weeks and are not caused by drugs or a medical condition.
Catatonia (schizophrenia)
Remain motionless for periods of hours at a time.
Diagnostic Label: Schizophrenia Recommended Treatment(s): Antipsychotic Drugs
"They are following me. Quick, hide behind the stacks." Beth, a nineteen year-old college freshman, dragged her startled classmate by the sleeve as she peered between some books on the library shelves. "What are you talking about?" asked her friend. Beth cupped a hand over her friend's ear and whispered, "They watch me all the time. They don't think I recognize them just because they disguise themselves as teachers or students. But I can tell. I see right through their tricks." The other girl backed off and tried to gauge Beth's seriousness. Beth stepped close to her and said in an insistent whisper, "It's the Soviet KGB and the radical terrorists who are out to get me. They shoot electronic waves into my house to try to brainwash me. They douse us all with impulses to soften our brains and our resistance, and then they pipe preprogrammed thoughts into our heads. It's all part of their conspiracy to gain worldwide mind control." The other girl was backed into the far corner of the stacks by now, and, a little frightened by Beth's vehement accusations, she avoided her penetrating gaze. "You," muttered Beth, pointing a finger. "They already own you. I see it in your eyes." "Beth, I have to get to class," said the girl as she tried to squeeze past. "I knew it all along," said Beth, fleeing from the girl. "They've got you in their power just like they have seventy-five percent of the kids in this school." Diagnostic Label: Recommended Treatment(s):
Dissociative Amnesia with fugue
A 35-year-old businessman was brought to the police station after he was found wandering around downtown Baltimore in a confused state. The man was unable to recall important personal information or any facts about his past. Eventually, the police were able to identify him through a missing person's report that his brother filed ten months earlier. According to the report, the man, Harold, disappeared from his home in New York nearly one year earlier following the unexpected death of both his wife and children in a car accident when they were hit by a drunk driver.
Hypochondriasis
A 45-year-old white male, presents to a primary care clinic armed with multiple internet searches on the topic of cancer. He states that he "just knows" he has a GI cancer, "probably the colon or maybe the pancreas." When asked how long this concern has bothered him he says "for years I have been concerned that I have cancer." When asked about relevant symptoms, the patient is a bit vague, saying "I get some pain or pressure right here (he points to the left upper quadrant) but it is not there all the time." The patient reveals that he has had ultrasounds and colonoscopies in the past, but they could find anything. He then admits that he was initially relieved but a couple of weeks later he started to think that they must have just missed something and believes that he needs another colonoscopy and abdominal CT scan. When the doctor suggests a less invasive approach, the patient ends the encounter by stating that he will "find another doctor who sees my point and will get me what I need."
Schizophrenia
A man, aged 32, was admitted to a psychiatric hospital. Two months before commitment the patient began to talk about how he had failed, had "spoiled" his whole life, that it was now "too late." He spoke of hearing someone say, "You must submit." One night his wife was awakened by his talking. He told her of having several visions but refused to describe them. He stated that someone was after him and trying to blame him for the death of a certain man. He had been poisoned, he said. In the admission office of the hospital he showed many mannerisms, lay down on the floor, pulled at his foot, made undirected violent striking movements, again struck attendants, grimaced, assumed rigid postures, refused to speak, and appeared to be having auditory hallucinations. He was at once placed in a continuous bath where, when seen later in the day, he was found to be in an unresponsive state. His face was without expression, he was mute and rigid, and paid no attention to those around him or to their questions. His eyes were closed and the lids could be separated only with effort by a doctor. There was no response to pinpricks or other painful stimuli. For five days he remained mute, negativistic, and inaccessible, at times staring vacantly into space, at times with his eyes closed.
Diagnostic Label: Generalized Anxiety Disorder Recommended Treatment(s): Cognitive-Behavioral Therapy, Antianxiety Drugs
A married woman, whose life was complicated by her mother's living in their home, complained that she felt tense and irritable most of the time. She was apprehensive for fear that something would happen to her mother, her husband, her children, or herself. She has no definite idea what it was that she fears might happen. She suffers from occasional attacks in which her heart pounds with irregular beats; she cannot seem to catch her breath when this happens. Often she breaks out in a profuse perspiration. Her mouth seems to be always dry, even though she drinks a great deal of water, and because of this and her diffuse anxiety she cannot sleep. Diagnostic Label: Recommended Treatment(s):
Seasonal Affective Disorder (SAD) (mood disorders)
A mood disorder characterized by depression that occurs at the same time every year. This occurs around the same time every year can be triggered by that particular time.
Behavioral- Systematic Desensitization (type of exposure therapy). Patient creates a hierarchy
After confessing to your therapist that you are horribly afraid of bees, he works with you to construct a hierarchy of stimuli that are increasingly fearful to you. Lowest in the hierarchy is reading the word buzz and the highest on the list is seeing a bee flying close to your face. Once the hierarchy is completed, he teaches how to feel relaxed to these stimuli, starting first with the stimuli to which you are least afraid.
Cognitive- Rational-Emotive Behavior Therapy
After seeking help for feelings of anxiety and depression, your therapist counsels you that it is impossible for you to be loved and cared for by all people who are significant at your job and in your community. She further urges you to abandon the irrational approach you take to interpreting the events that occur in your life.
Humanistic- client-centered therapy (active listening, unconditional positive regard)
After spending some time with your therapist, it becomes obvious to you that she believes you are making unrealistic comparisons between the person you are and the person that you would like to be. You find that she mirrors many of your statements, as if asking you to reflect upon what you have just said. At the same time, you are convinced that she holds you in high esteem, no strings attached.
Dissociative Identity Disorder (DID) (dissociative disorders)
Disruption of identity characterized by two or more distinct personality states. Involves marked discontinuity in sense of self with related alterations in behavior, memory, perception, cognition, etc. (multiple personality disorder)
Post-Traumatic Stress Disorder (PTSD) (anxiety disorders)
An anxiety disorder characterized by haunting memories. Nightmares, social withdrawal, jumpy anxiety, and/or insomnia that lingers for four weeks or more after a traumatic experience.
Obsessive-Compulsive Disorder (OCD) (anxiety disorders)
An anxiety disorder characterized by unwanted repetitive thoughts (obsessions) and/or actions (compulsions).
Generalized Anxiety Disorder (anxiety disorders)
An anxiety disorder in which a person is continually tense, apprehensive, and in a state of autonomic nervous system arousal.
Panic Disorder (anxiety disorders)
An anxiety disorder marked by unpredictable minutes-long episodes of intense dread in which a person experiences terror and accompanying chest pain, choking ar other frightening situations.
Phobias (Specific) (anxiety disorders)
Are anxiety disorders in which an irrational fear causes the person to avoid some object, activity, or situation.
Major (clinical) depression
Becky's psychiatrist has prescribed as selective serotonin reuptake inhibitor (SSRI) to help Becky feel better. Becky has most likely been diagnosed with what disorder?
Dissociative Identity Disorder- amnesia
During an academic trip to China, a 29-year-old female was found in a hotel bathroom unconscious, with no signs of structural or neurologic abnormalities or alcohol or chemical consumption. The woman was sent home but could not remember her name, address, family, or any facts about her home life. She was taken to the local hospital where she remained for nearly 10 months, until the feeling of blood on the woman's fingers triggered the recollection of events from her time in China in which she finally remembered having witnessed a murder on the last night of her trip. She recalled being unable to help the victim out of fear for her own safety. Eventually, she came to remember other aspects of her life; however, some memories remain irretrievable.
Schizophrenia- delusions of reference
During an interview, the 50-year old female patient expressed beliefs covering almost the entire range of delusions. She felt that her niece was in on a plot with other relatives to take away the property she owned in 106 countries, which she was planning to use, after training religious missionaries, to establish missions to convert heathens. In spite of the fact that her husband was alive and visited her weekly, she maintained that her husband was dead and that he had been killed by the FBI. The FBI had 6 agents assigned to her alone and had killed her husband. She had learned of their spying and talking about her from the television where they were portraying her life in several of the continuing series programs. She had learned other things about the plot from the voices that came between the television programs and the commercials. She was convinced that the hospital attendants were in on the conspiracy and that poison was being placed in her food. She was also concerned about the electrical waves that were "messing up" her mind.
Agoraphobia (anxiety disorders)
Fear or avoidance of situations in which escape might be difficult or help unavailable when panic strikes.
Major Clinical Depression Persistent depression; key is that it lasted longer than two weeks
Following the breakup of her engagement, Martha has become very despondent. She shows little interest in her job (which previously she found exciting) and often calls in sick. She spends a great deal of time alone in her room, sitting idly by the window or listening to the radio. When friends call to invite her out Martha usually refuses, pleading illness or fatigue. She complains that she feels continually tired, has to force herself to undertake such simple tasks as getting dressed or fixing a meal, and cannot concentrate enough to read a newspaper or magazine. Tears flow at the slightest provocation, and she admits that she feels worthless and inadequate. Her condition does not improve after several months have passed.
Disorganized Thinking (Schizophrenia)
Fragmented and bizarre thinking that is distorted with false beliefs.
Diagnostic Label: Dissociative Fugue Recommended Treatment(s): Free-association
George T., a 35-year-old auto mechanic, on several occasions found himself in a motion picture theater after having left home to report for work. He would "come to" in a bewildered fashion and would go to a bar for a few drinks. Eventually he would go home. As a child, George had a pattern of wandering away from home. He came from a very unhappy family; his parents were divorced, and he was left at home with housekeepers. His father was very harsh with him and on several occasions gave him such severe whippings that the neighbors called the police. His mother was a highly emotional person and tried to discipline George by screaming at him and threatening to place him in a boarding home. In adolescence, he twice found himself going off to school and eventually, "coming to" in a park about two miles from home. In school, George got along well with the teachers and other students. He was a poor student and failed both the second and seventh grade. He quit school at 16. Diagnostic Label: Recommended Treatment(s):
Antisocial personality disorder
Luke is superficially charming and skilled at exploiting people for his own gain. He is also impulsive, irresponsible, and he generally disregards social norms. Luke would most likely be diagnosed with which psychological disorder?
Diagnostic Label: Social Phobia Recommended Treatment(s): Exposure Therapy, Systematic Desensitization, Antianxiety Medication
Heather, a 19 year old college junior, has an intense fear of speaking to people she does not know very well. During her first and second years, she chose large lecture courses, which allowed her to hide in the back of the lecture hall and not speak to other students or to participate in the class discussions. Heather received high marks in all of her courses, earning a place on the dean's list and the honor roll. In her third year, Heather is now required to take some smaller upper level courses in which class participation and small-group discussions are mandatory. She is sure that she will do something embarrassing, such as vomit, and others will judge negatively. Because of these fears, Heather has trouble sleeping at night and is considering dropping out of school. Diagnostic Label: Recommended Treatment(s):
Phobia
Hilda, a 32-year old mother of two small children, is admitted to the hospital following a panic attack that occurred while she was watching a local weather report in which the meteorologist predicted 3-4 inches of snow the following day. While being treated, Hilda admits that she has been terrified of snow for as long as she can remember and this fear severely restricts her day-to-day behavior. Following months of therapy, Hilda eventually remembers a ski trip she and her family took when she was 9-years old. During the trip, Hilda was buried briefly by a small avalanche of snow while playing at the ski lodge. Hilda is amazed by the revelation as she had no recollection of this experience until it was recovered in therapy.
Diagnostic Label: Conversion Disorder Recommended Treatment(s): Cognitive-Behavioral Therapy, Psychoanalysis
Manny, a twenty-year-old male, was driving home from a long road-trip when he fell asleep at the wheel and crashed his car into the nearby embankment. One of his best friends, Nick, was fatally injured and killed as a result of the accident. In the following weeks, Manny began to develop a marked contracture of his right hand and a partial paralysis of his arm which consequently left him unable to drive. Although he was examined by numerous physicians, and many different medical treatments were tried, Manny did not respond and the symptoms remained unaltered. Diagnostic Label: Recommended Treatment(s):
Phobia- agoraphobia- fear of being in public
Margaret, a 52-year old female, has become increasingly fearful of leaving the house by herself. She insists that a family member accompany her when she goes to the store or even walks as far as the mailbox. The thought of being in a crowd so terrifies her that she no longer attends concerts or church (activities she once enjoyed) regardless of whether someone accompanies her. Her life is confined within the walls of her home.
Diagnostic Label: Major Depressive Disorder (need to have two or more chronic depressive symptoms for at least a few years) Recommended Treatment(s): Selective Serotonin Reuptake Inhibitor, Rational-Emotive Behavioral Therapy, Cognitive-Behavioral Therapy
It takes the greatest effort to get out of bed in the morning. I am tired all day, yet when night comes, sleep evades me. I stare at the ceiling, wondering what has happened to my life, and what will become of me. Nothing is getting done at work. I have projects to complete, but I can't think. I try to focus on my work, and I get lost. I keep wondering when the boss will discover how little I have accomplished. My wife does not understand. She keeps telling me to "snap out of it." I'm irritable all the time. I often yell at the kids, and then I feel terrible later. Nothing is fun anymore. I can't read, and the music I used to enjoy so much does nothing for me. I am bored, but I feel like doing nothing. There are times that I think that life is hopeless and meaningless, and I can't go on much longer. Diagnostic Label: Recommended Treatment(s):
Generalized anxiety
Jane, a 43-year old female, has been referred to a psychiatrist by her local physician, who can find nothing physically wrong with her. She complains, however, of feeling tense and apprehensive most of the time; she has difficulty sleeping and experiences frequent headaches. Minor stresses that she once handled with ease, such as driving in traffic or presenting a paper in class, now make her extremely nervous. In addition, she has moments of terror during which she feels that something dreadful is about to happen to her. Jane has no idea of the source of her fears.
Obsessive Compulsive Disorder Key symptoms are persistent obsessions that are unwanted and repetitive thoughts; compulsions are the repetitive behaviors .
Janet, age 29 and the mother of a 6-year-old girl and an 8-year-old boy, has come to the community mental health center alone. She tells the psychiatric nurse practitioner that she is here because her husband said he would leave her if she didn't get some help. She describes her problem as, "my nerves are shot." When asked to explain, she states that she likes everything to be "in order." She says she cleans her house "from top to bottom" every day. Then when her husband and children come home, she "has to go along behind them and clean as they mess up!" She explains that she can't leave the house without checking and rechecking locks on all doors and windows, and checking and rechecking all electrical outlets and appliances. Sometimes, this routine takes most of an hour before she feels satisfied and ready to leave the house. She said she had to get started getting ready to come to the clinic this morning about 3 hours before she left. "We seldom go out anymore, because my husband says it's just not worth the effort. I'm driving everyone crazy, and I don't know how to stop. I can't stop!"
Diagnostic Label: Post-Traumatic Stress Disorder Recommended Treatment(s): Exposure Therapy, Cognitive-Behavioral Therapy, Antidepressant/antianxiety drugs
Joe saw a good deal of active combat during his service in the military. Some incidents in particular had never left his mind - like the horrifying sight of Gary, a close comrade and friend, being blown-up by a land-mine. Even when he returned to civilian life, these images haunted him. Scenes from battle would run repeatedly through his mind and disrupt his focus on work. Filing up at the gas station, for example, the smell of diesel immediately rekindled certain horrific memories. At other times, he had difficulty remembering the past — as if some events were too painful to allow back in his mind. He found himself avoiding socializing with old military buddies, as this would inevitably trigger a new round of memories. His girlfriend complained that he was always pent-up and irritable - as if he were on guard, and Joe noticed that at night he had difficulty relaxing and falling asleep. When he heard loud noises, such as a truck back-firing he literally jumped, as if he were readying himself for combat. He began to drink heavily. Diagnostic Label: Recommended Treatment(s):
Diagnostic Label: Seasonal Affective Disorder Recommended Treatment(s): Light Exposure Therapy
Melanie Johnson is a 35-year-old accountant who moved to Green Bay, Wisconsin, two years ago from her hometown of Sarasota, Florida. Beginning this past November, for the first time in her life, Melanie began experiencing periods of depression, lethargy, and excessive sleeping. In addition, she noticed that she was eating more than she had previously, and as a result, had gained 10 pounds. Melanie's condition remained unchanged for several months until she began to notice an improvement in her mood the following March. Diagnostic Label: Recommended Treatment(s):
Diagnostic Label: Obsessive Compulsive Disorder Recommended Treatment(s): Antianxiety drugs, exposure therapy, cognitive-behavioral therapy
Mike, a 32 year-old man, performed many acts that were preceded by a fear of harming other people. When driving, he had to stop the car often and return to check whether he had run over people, particularly babies. Before flushing the toilet, he had to check to be sure that a live insect had not fallen into the toilet, because he did not want to be responsible for killing a living thing. At home he repeatedly checked to see that the doors, stoves, lights, and windows were shut or turned off. . . . Mike performed these and many other checking behaviors for an average of 4 hours a day. Diagnostic Label: Recommended Treatment(s):
Bipolar Disorder Key symptom is a manic episode that lasts seven days Mrs.
Miller was first admitted to a state hospital at the age of 38, although since childhood she had been characterized by swings of mood, some of which had been so extreme that they had been psychotic in degree. At one point she became depressed and asked to return to the hospital where she had been a patient. She then became overactive and exuberant in spirits and visited her friends, to whom she outlined her plans for reestablishing different forms of lucrative business. She purchased many clothes, brought furniture, pawned her rings, and wrote checks without funds. For a period thereafter she was mildly depressed. In a little less than a year Mrs. Miller again became overactive, played her radio until late in the night, smoked excessively, took out insurance on a car she had not yet bought. On the day prior to her second admission to the hospital she purchased 57 hats.
Diagnostic Label: Panic Disorder Recommended Treatment(s): Antianxiety Medication, Rational-Emotive Behavioral Therapy
My breathing starts getting very shallow. I feel I'm going to stop breathing. The air feels like it gets thinner. I feel the air is not coming up through my nose. I take short rapid breaths. Then I see an image of myself gasping for air and remember what happened in the hospital. I think that I will start grasping. I get very dizzy and disoriented. I cannot sit or stand still. I start pacing. Then I start shaking and sweating. If feel I'm losing my mind and I will flip out and hurt myself or someone else. My heart starts beating fast and I start getting pains in my chest. My chest tightens up. I become very frightened. I get afraid that these feelings will not go away. Then I get really upset. If feel no one will be able to help me. I get very frightened I will die. I want to run to some place safe but I don't know where. Diagnostic Label: Recommended Treatment(s):
Conversion Disorder
On admission to a psychiatric hospital, a 42-year-old, married male was bent forward at the waist (at a 45-degree angle) unable to straighten his body or move his legs. For 15 years, he had complained of lower back pain. Despite two orthopedic surgeries, his complaints continued. Every four to six weeks, he had 10- to 14-day episodes of being totally unable to walk. The patient had been hospitalized many times and treated with heat and muscle relaxants. He had been retired for five years and had taken on household duties while his wife went to work to support the family. Orthopedic and neurological evaluations revealed no abnormalities. Behavioral assessment, however, indicated that the patient received considerable reinforcement for his physical complaints, such as being served breakfast in bed and not having to do household chores. Moreover, a number of stressors in his life coincided with periods of being unable to walk. These included problems with his children and difficulty adjusting to the role reversal with his wife.
Diagnostic Label: Bipolar Disorder Recommended Treatment(s): Mood-stabilizing medication
Prior to being admitted to the hospital, Archie, a forty-year-old male, provided the following description of how he had been feeling over the last several months. "There is a particular a kind of pain, elation, loneliness, and terror involved in this kind of madness. When you're high, it's tremendous. The ideas and feelings are fast and frequent like shooting stars, and you follow them until you find better and brighter ones. Shyness goes, the right words and gestures are suddenly there, the ability to captivate others a felt certainty. There are interests found in uninteresting people. Feeling of ease, intensity, power, well-being, financial omnipotence, and euphoria pervade one's marrow. But, somewhere, this changes. The fast ideas are far too fast, and there are far too many; overwhelming confusion replaces clarity. Memory goes. Humor and absorption upon friends' faces are replaced by fear and concerns. Everything previously moving with the grain is not against -you are irritably, angry, frightened, uncontrollable, and enmeshed totally in the blackest caves of the mind. You never knew those caves were there. It will never end for madness carves its own reality." Diagnostic Label: Recommended Treatment(s):
Antisocial Personality Disorder Doesn't feel guilt or anxiety
Ralph is a highly impulsive person who has difficulty making plans or sticking to a job for any length of time. He has been fired from several jobs because he was caught stealing or because of frequent absences due to periodic drinking and gambling sprees. He always blames his employer for his dismissal and will not admit that his own behavior is responsible for his poor job history. Women tend to find him charming and personable, but they soon tire of his irresponsible behavior, frequent financial sponging, and general lack of consideration. His quick temper and disregard for social regulations have brought him intro frequent brushes with the law, but he usually manages to charm his way out and has never been convicted of a crime. He appears to feel little guilt or anxiety regarding his behavior.
Dissociative Identity Disorder
Sharon, a 27 year-old female who had been physically and sexually abused by her father throughout her childhood and adolescence, has been receiving intensive therapy sessions for the past three years. Throughout her adulthood, Sharon has exhibited at least four personalities. Each personality was of a different age, representing the phases of the woman's experience - a fearful child, a rebellious teenager, a protective adult, and the woman's primary personality. Only one of the personalities, the protective adult, was consciously aware of the others, and during therapy sessions was realized to have been developed to protect the woman during the abusive experiences. When one of the secondary personalities took over, Sharon would often act out according to the nature of the dominating personality.
Mania
Terrance O'Reilly, a single 39-year old transit authority clerk, was brought to the hospital by the police after his increasingly hyperactive and bizarre behavior and nonstop talking alarmed his family. He loudly proclaimed that he was not in need of treatment, and threatened legal action against the hospital and police. The family reported that a month prior to admission Mr. O'Reilly took a leave of absence from his civil service job, purchased a large number of cuckoo clocks and then an expensive car which he planned to use as a mobile showroom for his wares, anticipating that he would make a great deal of money. He proceeded to "tear around town" buying and selling the clocks and other merchandise, and when he was not out, he was continuously on the phone making "deals." He rarely slept, and, uncharacteristically, spent every evening in neighborhood bars drinking heavily and according to him, "wheeling and dealing." Two weeks before admission, his mother died suddenly of a heart attack. He cried for two days, but then his mood then began to soar again. At the time of admission, he was $3000 in debt and had driven his family to exhaustion with his excessive activity and over talkativeness. He said, however, that he felt "on top of the world".
Bipolar Disorder (mood disorders)
This disorder is one one will be experience severe depression for multiple weeks but their mood will change into a manic state where they would feel elated. This would last for a week or so as well.
Doesn't appear to cause him distress or dysfunction in his day-to-day functioning.
Thomas is 30 years old and is very shy. He tends to avoid social situations and rarely leaves his home. However, he writes a very successful internet blog and is usually content while working at home. Why would psychologists not label his behavior as a disorder.
Conversion Disorder (somatoform disorders)
Typically results from extreme stress or anxiety. Individual will "convert" psychological stress into a physical ailment.
Psychoanalytic- free association (goal is for transference to occur)
Upon entering his office, your therapist asks you to sit down and be comfortable. He then tells you that you should speak freely, and not to worry about censoring any thoughts you may have during the therapy session. He sits behind you to minimize any eye contact--he does not wish to serve as an authority figure during your session. At one point, he cautions you about becoming defensive and suggests that you might be unconsciously attempting to block his access into gaining insight into the inner workings of your thought processes.
Mania (manic episode) (mood disorders)
When an individual goes hyper crazy and happy. This can lead to poor decision making and has a lot to do with one's impulse
