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Which symptom is not typically associated with Major Depressive Disorder?
What emotional state is primarily characterized by feeling worthless and empty?
What type of sleep disturbance is more likely to be experienced by females with Major Depressive Disorder?
In terms of physical symptoms, what condition is likely to exacerbate signs of depression?
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What is one common cognitive symptom associated with Major Depressive Disorder?
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What term describes the loss of pleasure in most activities, commonly experienced in Major Depressive Disorder?
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What is a characteristic motivational symptom of Major Depressive Disorder?
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Which of these features describes psychomotor retardation in the context of Major Depressive Disorder?
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Which of the following factors is NOT mentioned as a condition that can be misinterpreted as dementia?
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What percentage of the U.S. population is diagnosed with Major Depressive Disorder (MDD) at any given time?
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Which symptom is NOT commonly associated with females experiencing Major Depressive Disorder?
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In less-Westernized societies, how is depression primarily expressed compared to more Westernized societies?
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What is a common misconception about symptoms of Major Depressive Disorder?
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What may account for the differences in the presentation of depression across various cultures?
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Which group has a higher lifetime prevalence of Major Depressive Disorder?
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Which of the following is identified as a risk factor for Major Depressive Disorder?
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What is a common first-line treatment for Major Depressive Disorder (MDD)?
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Which of the following best describes the symptoms of Premenstrual Dysphoric Disorder (PMDD)?
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What is the main focus of Cognitive Behavior Therapy (CBT) in treating depression?
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Physical symptoms such as joint pain and weight gain can be associated with which condition?
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Which treatment is specifically mentioned as a recommendation for Treatment-Refractory Depression (TRD)?
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What might a person with depression typically misinterpret when yelling at a friend who does not respond?
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Which type of therapy focuses on developing new ways to interpret setbacks and replace negative thoughts?
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What physical treatment approach is mentioned for individuals suffering from MDD with seasonal patterns?
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What is a characteristic symptom of Generalized Anxiety Disorder (GAD)?
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Which treatment option is primarily used for acute relief in Panic Disorder?
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What is a common misconception regarding the relationship between Panic Disorder and internal sensations?
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In the treatment of Agoraphobia, which method is most typically employed?
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Which of these medications is commonly prescribed as a first-line treatment for Panic Disorder?
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What percentage of individuals with Panic Disorder have reported suicidal ideation?
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Which factor is identified as a potential trigger for panic attacks?
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What best describes how panic attacks relate to the development of Agoraphobia?
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Which symptom is considered a cognitive sign of anxiety?
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What is a key feature of Panic Disorder?
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Which treatment option is often recommended for Generalized Anxiety Disorder (GAD)?
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Which of the following is primarily associated with Social Anxiety Disorder?
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What is a common physiological symptom of anxiety?
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Which option accurately describes a chronic form of anxiety?
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Which symptom may indicate a recent panic attack?
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Which of the following is NOT a sympathetic treatment for anxiety disorders?
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Which of the following is NOT a common symptom of a panic attack?
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What role does the locus coeruleus play in anxiety responses?
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Which neurotransmitter is associated with deficits in anxiety-prone individuals?
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Which treatment option is known to mimic the effects of GABA in anxiety management?
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What physiological response is triggered by the sympathetic nervous system during an anxiety episode?
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Which of the following symptoms may indicate a person is experiencing depersonalization?
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What aspect of anxiety disorders has been showing recent increases, particularly during and after Covid?
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Which symptom could lead individuals to think they are having a heart attack during a panic attack?
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What is a mental disorder?
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Mental disorders are only illnesses of the brain.
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Which of the following is considered a type of mental disorder? (Select all that apply)
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Mental disorder diagnoses can be used as tools for ______.
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What is the current diagnostic bible for mental disorders?
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What is the primary purpose of a clinical assessment?
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Diagnosis in mental health is typically phenotypic.
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What is a common consequence of mental disorder diagnoses?
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The act of assigning a nosological category to a patient is called ______.
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What consequence can mental disorders impose on families?
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Which statement about mental disorders is true?
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How can mental disorders be characterized in terms of their impact on individuals?
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Which of the following is a reason for why studying mental disorders is vital?
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What is a common misconception about mental disorders?
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What is the one-year prevalence percentage of Social Anxiety Disorder among adults?
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Which mental disorder has the highest lifetime prevalence among U.S. adults?
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What percentage of adults aged 18-25 had a diagnosable mental disorder in 2021?
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Which anxiety disorder has a lower lifetime prevalence compared to the others listed?
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What is the difference between one-year prevalence and lifetime prevalence?
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What percentage of the adult population is affected by Posttraumatic Stress Disorder (PTSD) in their lifetime?
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Which factor contributed to an increase in mental health issues during Covid?
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What was the one-year prevalence of Generalized Anxiety Disorder in adults?
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What treatment method involved the use of exorcism during the Middle Ages?
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Which condition was associated with the belief that mentally ill individuals were regressing to an animalistic state?
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What novel treatment introduced by Julius Wagner-Jauregg earned a Nobel Prize?
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What is considered the first major tranquilizer that helped reduce psychotic symptoms in the 1950s?
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What was Philippe Pinel known for during the early 19th century?
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Which therapy method was associated with the use of severe restraint on mentally ill individuals?
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Electroconvulsive Therapy (ECT) primarily became known as a treatment in which era?
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What was the primary focus of pyrotherapy in the 1930s and 1940s?
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What percentage of adolescents reported having a Major Depressive Episode in 2021?
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Which group reported the highest rate of seriously considering suicide?
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Which factor is NOT listed as a contributor to the decline in mental health among young people?
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What trend has been observed in college students regarding their mental health over the past decade?
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What percentage of college students reported moderate or severe psychological distress during the 2020-21 school year?
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How has the demand for college counseling services changed from 2009 to 2015?
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What notable shift occurred regarding the number of patients seen by the average college counselor?
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What significant change occurred in the rate of suicide consideration among teenage females over the past decade?
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What was a significant factor that contributed to the deinstitutionalization movement?
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Which of the following was not a result of deinstitutionalization?
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What is one consequence of insufficient funding for community mental health facilities?
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How did the psychiatric profession's expectations contribute to deinstitutionalization?
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What did the phrase 'chemical strait-jacket' refer to in the context of psychiatric medications?
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What is a significant issue that arose from the deinstitutionalization process?
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Which among the following best describes the primary effect of deinstitutionalization?
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What legal factor significantly impacted state hospitals during the deinstitutionalization era?
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Study Notes
Major Depressive Disorder (MDD)
-
Cognitive Features:
- Pervasive sadness, tearfulness, guilt, helplessness, emptiness, worthlessness.
- Recurrent thoughts of death, suicidal ideation, or suicide attempts.
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Motivational Features:
- Pervasive anhedonia (lack of pleasure).
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Neurovegetative Features:
- Significant weight change due to decreased or increased appetite (females more likely to experience increased appetite).
- Sleep disturbance: insomnia or hypersomnia (females more likely to experience hypersomnia).
- Psychomotor agitation or retardation (females more likely to experience retardation).
- Pervasive fatigue or loss of energy.
- Difficulty thinking, concentrating, or making decisions.
Prevalence of Major Depressive Disorder (MDD)
- Point Prevalence: Approximately 5% of the U.S. population are diagnosable with depression.
- One-Year Prevalence: Approximately 7% in the U.S., but prevalence varies widely across geographic regions.
- Lifetime Prevalence: 20.1% (26% of females, 12% of males), mostly moderate or severe.
- Subsyndromal Depression: 15-20% of the U.S. population may experience depressive symptoms that don't meet the criteria for diagnosis.
Risk Factors for Major Depressive Disorder
- Genetic predisposition: Evidence suggests a genetic link to depression.
- Premenstrual Dysphoric Disorder (PMDD): This affects females and includes mood swings and other MDD symptoms that begin the week before menstruation and improve within a few days afterward.
Depression Treatment
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First-Line Treatments:
- Psychotherapy, particularly Cognitive Behavior Therapy (CBT) and Interpersonal Therapy (IPT).
- Antidepressant medication.
- Phototherapy for Seasonal Affective Disorder.
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Treatment-Refractory Depression (TRD):
- Augmented (multiple) medications.
- Electroconvulsive Therapy (ECT).
Cognitive Behavior Therapy (CBT)
- Focuses on uncovering automatic self-defeating thinking patterns.
- Developing new interpretations of setbacks through normalization, logical analysis, and decatastrophizing.
- Replacing old automatic thoughts with new ones.
- Examining the patient's views of self, important life events, and the future.
Panic Disorder
- Panic attacks can be triggered by stimulants such as caffeine, nicotine and marijuana.
- People with Panic Disorder seem to be more aware of internal sensations than others, leading to a feedback loop of anxiety.
- 25% of people with Panic Disorder have suicidal ideation.
1st Line Panic Disorder Treatments
- Dietary and medication control can help reduce panic attacks.
- Anxiolytic medication, mainly benzodiazepines, can be used for acute treatment but often leads to rebound anxiety.
- Antidepressant medication, particularly SSRIs, can be used chronically to prevent panic attacks.
- Psychotherapy, such as cognitive therapy and supportive therapy, can be helpful.
Agoraphobia
- Marked fear or anxiety triggered by situations where escape may be difficult or help unavailable.
- Prevalence is around 1.5% with a 2:1 female to male ratio.
- Often develops after panic attacks, as individuals avoid situations that could trigger them.
- Treatment involves antidepressants and in vivo desensitization.
Generalized Anxiety Disorder (GAD)
- Debilitating worry and fretfulness for at least 6 months.
- The worry is excessive and difficult to control.
Common Signs/Symptoms of Anxiety
- Cognitive: Objectless fear, heightened sense of vulnerability, worrying, rumination, going blank, irritability, impatience, distractibility, hypervigilance.
- Physiological: Trembling, twitching, fatigue, restlessness, muscle tension, dizziness, lightheadedness, increased heart rate, sweating, cold or clammy hands, dry mouth, nausea, diarrhea, altered appetite and sleep.
Signs/Symptoms of Panic Attack (Acute Anxiety Episode)
- Palpitations, pounding heart, accelerated heart rate, sweating, trembling, shortness of breath, choking, chest pain, nausea, dizziness, lightheadedness, fainting, derealization, depersonalization, fear of dying, losing control, numbness, tingling, chills, hot flushes.
Fear, Anxiety, and the Brain
- The amygdala registers emotional aspects of situations, including threat.
- The locus coeruleus controls arousal of the neocortex and activates the hypothalamic-pituitary axis and the Autonomic Nervous System.
Autonomic Nervous System (ANS)
- The ANS consists of the sympathetic and parasympathetic nervous systems.
Anxiety-Related Actions of the Sympathetic Nervous System
- The pituitary gland releases ACTH, which triggers the release of steroid hormones from the adrenal gland causing increased appetite and anti-inflammatory actions.
- The adrenal gland secretes epinephrine and norepinephrine.
- Effects: Pupillary dilation, drying of mucosal linings, sweating, increased heart rate, constriction of blood vessels in the skin and gut, diversion of blood flow to muscles, speeded respiration, airway relaxation, emergency release of glucose into the circulation.
GABA and Anxiety
- GABA plays a role in anxiety regulation.
- Anxiety-prone individuals may have deficits in GABA.
- Blocking GABA chemically increases anxiety.
- Ethanol (alcohol) and some anti-anxiety medications bind to GABA receptor areas, mimicking GABA.
- Other neurotransmitters besides GABA are involved in anxiety.
Anxiety Disorders
- Most common psychiatric problems, increasing in adolescents and young adults.
Monism vs Dualism in Psychopathology
- Monism: mind and body are one
- Reductive Materialism: everything is based on physiological mechanisms.
- Mental disorders = brain disorders
- Dualism: Mind and body different;
- Mind = brain's software, behavior = hardware
- Mental disorders = disorders of mental processes
The Scope of Mental Disorders
- Originally, "mental illness" = "insanity" - now strictly a legal term
- Mental disorder = preferred to "mental illness"
- Range of severity:
- Brain diseases: Schizophrenia, Alzheimer's
- Behavior patterns: Homosexuality, Alcoholism, Psychopathy
- Troublesome conditions: OCD, Premenstrual Dysphoria
- Defining mental disorders is difficult; no consistent and universally accepted definition
Why Is Defining Mental Disorders Challenging?
- Diagnoses can be stigmatizing.
- Diagnoses can be used for political persecution.
- Can be misused to excuse individuals from responsibility for their actions
Dichotomies in Definitions
- "Normal" vs "Abnormal":
- Deviance (statistical, moral, cultural)
- Distress (one's own and/or others')
- Dysfunction (inability, efficiency, maladaptation)
- Danger (to self and/or others)
Prototypes and DSM-5-TR
- Most people have "prototype" conceptions of mental disorders.
- These are based on:
- Direct experience: personal situations, mental health services
- Indirect experience: books, films, TV, friends
- Training: Classic case studies.
- DSM-5-TR - Current Diagnostic Bible
- Mental disorder = clinically significant behavioral/psychological syndrome
- Associated with: Distress, Disability, Increased risk of suffering
- Must not be a normal response to an event (e.g., grief)
Diagnostic Terminology and Process
- Nosology: Science of disease categorization and classification
- Diagnosis: Assigning a nosological category to a patient
- Etiology: Cause
- Course: Trajectory of the disorder
- Prognosis: Outcome
- Signs: Observable markers
- Symptoms: Patient reports
- Syndrome: Signs + Symptoms
- Disorder: Syndrome + Course
- Disease: Disorder + Tissue Damage (few mental disorders meet disease criteria)
Purpose of Diagnosis
- Prognosis: understand anticipated outcome
- Treatment: Inform treatment decisions
- Communication: between professionals
- Contagion: Assess risk of spread
- Legal reasons: competence, insanity determinations
- Financial reasons: insurance claims, compensation
- Research:
Problems with Diagnosis
- Uniqueness: sacrifices individual patient characteristics
- Etiology: Can falsely imply cause.
- Treatment rigidity: Limits possible options.
- Iatrogenic illness: Treatment itself may be harmful
- Stigmatization: Negative social labeling
- Secondary gain: Using symptoms for benefits
Phenotypic vs Genotypic Diagnosis
- Phenotypic: Signs, symptoms, course, outcome, response to treatment
- Genotypic: Causes - genes, germs, tissue abnormalities.
- Endophenotypic: subclinical, behavioral, or lab-based markers (e.g., brain imaging, cognitive tests); may be present in family members of those with the disorder
Ingredients of a Diagnosis
- Symptoms (patient reports)
- Signs (observable markers)
- Course of illness
- Age of onset
- Family history
- Recent events (triggers, stressors)
- Recent behavior
- Psychological tests (IQ, personality)
- Laboratory tests (neuroimaging, hormone levels, genetics)
- Response to treatment (past or current)
Diagnosis is Multifactorial
- Pattern-based:*
- No single sign/symptom is pathognomonic (indicative) of a disorder.
- E.g., Trauma is required for PTSD, but many other factors are needed to develop PTSD.
- Diagnosis based on a syndrome (pattern of signs and symptoms)
- Nosology: the patterns of syndromes and courses of illness that define mental disorders
About Diagnoses
- Informed guesses: Best fitting diagnoses
- Not set in stone: May change with new information
- Comorbidity: Multiple diagnoses are frequently present
Current DSM-5-TR Diagnostic Features
- Phenotypic diagnosis: Observations only
- Abandonment of intra-psychic concepts: "neurosis" and "internal conflicts"
- Field-tested for reliability
- Importance of medical/psychosocial factors:
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Decision-tree approach:
- Inclusion criteria: signs/symptoms supporting the diagnosis
- Exclusion criteria: signs/symptoms ruling out the diagnosis
Examples of DSM-5-TR Diagnostic Criteria
-
Specific Phobia:
- Inclusion criteria: Marked fear/anxiety about specific object/situation; provokes immediate fear; actively avoided or endured; disproportionate to actual danger; persistent; causes significant distress/impairment.
- Exclusion criteria: Not better explained by other mental disorders, obsessions, traumatic events, separation anxiety, etc.
Clinical Assessment
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Clinical interview: most valuable assessment tool
- Length: ~ 1 hour
-
Information and Goals:
- Current/past symptoms onset, intensity
- Signs from presentation
- Personal/family history (parenting, childhood, abuse, substance use, medical, social, financial)
- Mental health history (hospitalizations, therapy)
- Goals:
- Assess suitability for therapy
- Determine referral needs: psychiatrist, PCP, neurologist, social worker
Signs Noted in Clinical Interviews
- Attire and grooming
- Posture: (defiant, compliant, guarded, etc.)
- Physical characteristics: skin tone, weight, symmetry
- Mannerisms, spasms, or tics
- Speech: Articulation, Prosody (tone of voice)
- Consciousness: (alertness, fogginess, hypervigilance)
- Emotional state: (upbeat, hopeless, frustrated)
- Thought content: (delusions, hallucinations)
- Thought processes: (boundary violations, broadcasting)
- General knowledge:
- Abstract thinking
- Social judgment
- Insight
- Cognitive functioning: (usually assessed with brief screening)
Montreal Cognitive Assessment (MOCA)
- Screening tool for dementia
-
Areas Assessed:
- Visuospatial/executive
- Naming
- Memory
- Attention
- Abstraction
- Language
- Delayed recall
- Orientation
Ancillary Diagnostic Information
- Information from:
- Family members
- Physicians
- Employers
- Medical chart
- Previous psychological testing
- Previous therapists' summaries
- Hospital discharge summaries
The Importance of Family History
- Helps identify risk factors for specific mental disorders: AN (Anxiety disorders), BPD (Bipolar disorder), SZ (Schizophrenia), PANIC (Panic disorders), UP (Unipolar depression), ALC (Alcoholism)
Mental Disorders: Prevalence & Impact
- Mental disorders are common and can affect anyone.
- They can significantly impact individuals, families, and society as a whole.
- In 2021, 1 in 4 adults experienced a diagnosable mental disorder, with a 25-30% increase since pre-COVID levels.
- The COVID-19 pandemic exacerbated mental health issues due to social isolation, loss of recreational outlets, and disrupted treatment access.
- Mental health decline in youth is particularly concerning, with increased rates of depression, suicidal ideation, and sexual violence.
- College mental health has also declined, with significant increases in students seeking help and a surge in psychological distress.
Early Views of Psychopathology
- During the Middle Ages, mental disorders were often attributed to demonic possession and treated through exorcism and even burning at the stake.
- From the 1700s to the 1800s, mental illness was seen as a form of evolutionary regression, comparing individuals with mental disorders to animals.
- Mentally ill individuals were often housed in deplorable conditions, restrained, and treated through inhumane methods like bloodletting.
The Rise of "Moral Treatment"
- Philippe Pinel, a French physician, advocated for "moral treatment" which emphasized humane care and individual attention for individuals with mental disorders.
- This approach marked a significant shift away from the brutal practices of the past.
The State Hospital Era (1900-1960)
- State-run mental hospitals became the primary institutions for managing people with mental disorders.
- However, the state hospital era saw the rise of questionable and often harmful treatments, including:
- Pyrotherapy (1930-40s): This involved inducing fever through malaria inoculation to treat general paresis.
- Insulin Coma Therapy (1930-40s): A treatment based on inducing comas with insulin.
- Metrazol Shock Therapy (1930s-40s): This treatment involved inducing convulsions with metrazol.
- Electroconvulsive Therapy (ECT) (1940s-present): Convulsions are produced using electrical stimulation.
- Prefrontal Lobotomy (1940s): Surgical procedures designed to sever connections in the prefrontal area of the brain.
- Despite its limitations, the development of medication like Thorazine (Chlorpromazine) in the 1950s led to a significant reduction in the need for long-term hospitalization.
Deinstitutionalization (1960-present)
- The movement to deinstitutionalize individuals with mental disorders began in the 1960s, motivated by factors like the availability of medication, concerns about civil rights, and cost considerations.
- Unfortunately, the transition was often poorly planned, leading to inadequate community mental health facilities, a rise in homelessness among individuals with mental illness, and increased reliance on the criminal justice system to manage these individuals.
Contemporary Views of Psychopathology
- Psychodynamic Views: Based on the work of Freud and others, this approach emphasizes unconscious conflicts and early childhood experiences.
- Behavioral Views: Focus on the role of learning and environmental factors in shaping behavior and influencing mental disorders.
- Biological Views: Focus on the role of biological factors, including genetics, neurotransmitters, and brain structure, in contributing to mental disorders.
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Description
Explore the cognitive, motivational, and neurovegetative features of Major Depressive Disorder (MDD). Learn about its prevalence in the U.S. along with key symptoms and statistics related to this mental health condition. This quiz helps to deepen your understanding of MDD's various aspects.
