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average.The greater Psychological Disorder the deviation, the is a psychological abnormal it is. dysfunction within an individual associated Three Major Categories th...
average.The greater Psychological Disorder the deviation, the is a psychological abnormal it is. dysfunction within an individual associated Three Major Categories that with distress or make up the study and impairment in discussion of psychological functioning and a disorders response that is not typical or culturally 1. Clinical Description expected. 2. Causation (etiology) 1. Psychological 3. Treatment & Outcome Dysfunction - Breakdown in Psychopathology cognitive, is the scientific study of emotional, or psychological disorders. behavioral functioning Scientist-Practitioner 2. Personal Distress MH Professionals who practice - Behavior must be scientific approach to associated with clinical work distress prior it can be classified Role of A as abnormal adds an Scientist-Practitioner important component 1. Consumer of Science And seems clear: Enhancing the practice the criterion is 2. Evaluator of satisfied if the Science Determining individual is the extremely upset. effectiveness of the 3. Atypical or Not practice. Culturally Expected 3. Creator of Science - Important but also Conducting research that insufficient to leads to new procedures determine useful in practice abnormality by itself.At times, Dimensions something is 1. Biological considered abnormal 2. Psychological because it occurs 3. Social infrequently; it 4. Sociocultural deviates from the 2 1 behavioral techniques to Center: Resilience/Mental free patient from phobia 200 B.C - Galen suggest that Mary Cover Jones Disorder normal and abnormal behavior are related to four bodily fluids or Supernatural Tradition humor Demons and Witches Stress and Melancholy 400 B.C Treatments for - Hippocrates suggest that possession disorders have a Mass Hysteria psychological and The moon and stars biological cause. Biological Tradition Hippocrates and Galend 1300s Syphilis - Superstitions and mental John P. Grey disorders are blamed on demons and witches. Electric Shock and Brain Surgery Exorcism performed to free victims. Psychotic Drugs Emil Kraepelin (modern 1400s psychiatry) - Insanity is caused by Moral Therapy mental and emotional Psychological Tradition stress. Philippe Pinel- modern 1500s psych, mental - Paracelsus suggest that institutions, more the moon and the stars humane affect people’s Dorothea Dix- Asylum psychological Reform, MEntal Hygiene functioning not by the Movement devil Anton Mesmer- Father of - hypnosis. Subjects 1400-1800 appear in trance. - Bloodletting and leeches Sigmund freud are used to rid the body of Abraham Maslow unhealthy fluids and Person-centered therapy restore chemical balance Carl Rogers 3 Ivan Pavlov Classical Conditioning Behavioral Model 1793 interpretation of dreams for physiology of 1904 digestion, condition - Ivan Pavlov Nobel Prize reflexes of dogs - Philippe Pinel moral 1920 therapy and make french - John Watson Conditioned mental institutions more fear in little albert humane using a white rat 1930 1825-1875 - Insulin/electric shock - Syphilis caused by therapy treatments and specific bacterium or brain surgery penicillin as a cure. 1938 1848 - B.F Skinner publishes - Dorothea Dix campaign the behavior of for more humane organisms. Principles of treatment in American operant conditioning Mental institutions 1943 1854 - The Minnesota - John Fret head of New Multiphasic Personality York Utika Hospital, Inventory is Published insanity is the result of physical causes, 1946 psych treatments/ - Anna Freud Ego and the Mechanisms of Defense 1870 - Louis Pasteur germ 1950 theory of disease help - The first effective identify bacteria that drugs for severe causes syphilis psychosis are developed. Based on Carl Jung, 1895 roger, and alfred adler - Josef Breuer treats gains more acceptance. hysterical anna o, leading to 1952 psychoanalytic theory - First edition of Diagnostic and 1900 Statistical Manual - Sigmund Freud the 4 1958 - Joseph Wope Effectively treats patients with phobia using systematic desensitization based on behavioral science. 1968 - DSM II is published 1980 - DSM III 1987 - DSM III R 1990s - Sophisticated research method.Biological and environmental found to cause PD in isolation from the other 1994 - DSM IV 2000 - DSM IV TR 5 sinoaortic baroreflex arc Chapter Two 2. Social - Disruption in school and home early middle age (early - Friends rush to help Influences of Judy’s - Principal suspends Blood-Injection-Injury Phobia her - Doctors nothing 1. Biological wrong physically - Vasovagal syncope 3. Behavioral causing increase in - Conditioned heart rate and response to sight blood pressure of blood or even - Light-headness and words queasiness - Tendency to escape - Fainting and avoid - Inherited situations overreactive involving blood 4. Emotional and Cognitive 6 - Increased fear and anxiety Human Genome individual’ Huntington’s Disease - Degenerative brain disease that appears in Diathesis: each tendency is 40s) complete set of genes. - Causes: genetic defect Consist of more than 2000 in the basal ganglia genes - Effect: broad changes in personality, cognitive Quantitative Genetics functioning, motor - Sums up all the tiny behavior including effects across many involuntary shaking or genes w/o telling which jerkiness. genes is responsible for PhenylKetonuria (PKU) which effects - Disorder present at birth. Inability to Molecular Genetic breakdown phenylalanine. - Focuses on examining the Both parents pass the actual structure of genes to their child. genes w/ advance - Cause: A defect in a technologies like DNA single gene w/ little microarrays. contribution from other genes and environment Development in the Study of - Effect: Intellectual genes and Behavior Disability/Mental Retardation Environment: Life events such as chaotic childhood can The nature of Genes overwhelm the influence of genes. Genes long molecules of DNA at various locations on Psychological:Genetic factors chromosomes within the cell make some contribution to all nucleus. disorders but all account for less than half of the Dominant Genes one pair of explanation. genes that strongly influences a particular Diathesis-Stress Model trait. One is needed to Inherit tendencies to determine eye or hair color express certain traits or behaviors which may be Recessive Genes paired with activated under another recessive gene to stress. determine a trait susceptible to developing disorder. FOREBRAIN Central Nervous System - Cerebral Cortex (largest Process all information part of the forebrain) received from our Left Hemisphere – senses. Organs react as responsible for verbal necessary. and other cognitive Spinal Cord- Sending messages processes to the brain. Most complex Right Hemisphere – organ in the body. MAjor better at perceiving the component of CNS world around us and Neurons- is a nerve cells creating images. that control every thought and action Peripheral Nervous System Neurotransmitters- (the 1. Autonomic N/S body’s chemical messengers) - SNS and PNS are transmitted from one Regulates: neuron to another. 1. cardiovascular system (for example the heart Major neurotransmitter and blood vessels, relevant to psychopathology, 2. endocrine system (for include example, the pituitary, norepinephrine (also known as adrenal, thyroid and noradrenaline), serotonin, gonadal glands), and dopamine, gamma-aminobutyric 3. perform various other acid (GABA), and glutamate. functions including aiding digestion and regulating the Structure of The Brain Limbic body temperature. System- regulate our emotional experiences and ENDOCRINE SYSTEM expressions, and our ability to control our impulse. Adrenal glands – produce (consist of: hippocampus (sea epinephrine (also called horse), cingulate gyrus adrenaline) (girdle), in response to stress and septum (partition), and salt-regulating hormones. amygdala (almond). 7 Thyroid glands – produces thyroxine, which facilitates energy Basal Ganglia- Control Motor Pituitary (the master gland) –produces a variety of regulatory metabolism and growth hormones Activity Gonadal glands – produce sex hormones such as released in the cortical estrogen and part of the adrenal testosterone glands. Hypothalamus connects to the adjacent pituitary NEUROTRANSMITTERS gland, which may stimulate the cortical Amino Acids Category part of the adrenal glands. 1. Glutamate – excitatory Surge of epinephrine transmitter that turns on (hormone from adrenal many different neurons, glands) tends to leading to action. energize, arouse and get 2. Gamma-aminobutyric Acid the body ready for (GABA) – an inhibit or threat or challenge. regulate the transmission of Cortisol (stress information and action hormone) may also be potentials. 8 - reduce overall arousal somewhat and to temper our emotional responses 3. Glutamate and GABA– chemical brothers, they work together to balance functioning in the brain and they act fast for the brain to keep up with the many influences in the environment that requires action. AMINO ACIDS CATEGORY process information. Gamma-aminobutyric Acid (GABA) genetically influenced reduce overall arousal somewhat dysregulation in the system and to temper our emotional that contributed to depression responses MONOAMIN CATEGORY 1.Norepinephrine/Noradrenaline MONOAMINE CATEGORY Stimulate at least two groups of 1. Serotonin receptors; alpha adrenergic and influence a great deal of our beta-adrenergic receptors. behavior, moods, and Drug called beta-blockers particularly the way we inhibits the surge of norepinephrine, which keeps the blood pressure and heart CHOICES OF TREATMENT COULD BE: rate down. a) Neurosurgery 2. Norepinephrine circuits when suffering is severe and Located in hindbrain, an area other treatments have failed. that controls basic bodily b) Drug functions such as respiration. affecting neurotransmitters. It Influence the emergency is not a cure or even an reactions or alarm responses effective treatment in all cases Acts in a more general way to c) Psychological Treatments based regulate or modulate certain on brain imaging it is effective behavioral tendencies and enough to address the issue. 3. Dopamine (Ex. Cognitive-Behavioral Therapy) Implicated in the d) Placebos pathophysiology of not usually effective, but they schizophrenia are also treating patient Also have a significant role in psychologically by inducing depression and ADHD positive expectation for change Deficiencies have been and it change the brain function associated with Parkinson’s disease Cognition & Cognitive Processes Cognitive Science concerned with how we acquire and process information and how we store and ultimately retrieve it. Complex cognitive processing of information and emotional processing are involved when conditioning occurs. Psychosocial Influences on Brain Structure and Function Learned Helplessness occur when encounter a conditioning over which they have no control. Learned Optimism BLIND SIGHT or UNCONSCIOUS VISION opposite of learned helplessness Medical: SOCIAL LEARNING An individual who has a Based on Albert Bandura’s successful operation, (removed Modeling/Observational small section of his Learning, individuals does not visual cortex) became blind in need to experience certain both eyes. events in their environment to This is associated with real learn effectively, rather, they brain damage. can learn just as much by Psychopathology: observing what happens to Normal individuals provided with someone else in a given hypnotic suggestions can situation. function visually but have no awareness or memory of their visual abilities. Implicit Memory information you consciously work to remember Explicit Memory information remembered unconsciously and effortlessly PREPARED LEARNING Methods to Study the Unconscious 1. We have become highly prepared Black Box for learning about certain types refers to unobservable feelings of object or and cognitions inferred from an situations over the course of individual’s self report. evolution because this knowledge 2. Stroop Color-Naming Paradigm an contributes to the survival of individual is shown a variety of the species. words, each printed in a different color Cognitive Science & The Unconscious Emotion The Physiology and Purpose of Fear First emotion theorist Charles Darwin, pointed out more than 100 years ago, the surge of arousal (flight or fight) programmed in all animals, including humans, which suggests that it serves a useful function. helps our ancestors lived in unstable circumstances and survive. EMOTIONS PHENOMENA Emotion Emotions and Psychopathology defined as a tendency to behave Suppressing almost any kind of in a certain way (ex. escape), emotional response, such as anger elicited by an external event(a or fear, increases sympathetic threat) and a feeling state nervous activity, which (terror) and accompanied by a contributes to psychopathology. (possibly) characteristic physiological response. Emotions and mood affect our short-lived, temporary states cognitive processes: if your mood is lasting from several minutes to positive, then your associations, several hours, occurring in interpretations, and impressions also response to an external event tend to be positive. Mood persist period of affect or emotionality Cultural, Social and Interpersonal Emotional Disorders Factors a term not formally used in Psychopathology Voodoo, the Evil Eye, and Other Fears 1. Anxiety Disorder Fright disorder 2. Mood Disorder exaggerated startle responses and other observable fear and Components of Emotion anxiety reactions. a) behavioral, b) physioloy Latin American Susto c) cognition describes various anxiety based symptoms including insomnia, irritability, phobias, and the marked somatic symptoms of sweating and increased heart rate. Cause: has little ability to cope the individual believes that s/he because there is no social has become the object of black support. magic, or witchcraft and suddenly badly frightened. Gender Sinister Influence is called the A phobia is likely to develop to Evil Eye. females for the environment accepts them to acknowledge Haitian phenomenon of Voodoo fearfulness. Death Reason for this gender imbalance suggested that the sentence of is that males are likely than death by a medicine man may females to self medicate their create an intolerable autonomic fear and panic arousal in the participant, who with alcohol which may lead to addition. Social Effects on Health and Behavior SOCIAL RELATIONSHIPS protect individuals against many physical and psychological disorders such as high blood pressure, depression, alcoholism, arthritis, the progression of AIDS, and bearing low birth weight babies. Social Stigma Psychological disorders continue to carry a substantial stigma in our society Lifespan Development Principle of Equifinality Used in developmental psychopathology to indicate that we must consider a number of paths to a given outcome. BS PSYCH 3-1 NEURODEVELOPMENTAL DISORDERS Group of conditions with onset in the developmental period; they typically manifest early in development, often before the child enters grade school. ATTENTION-DEFICIT/HYPERACTIVITY DISORDER (ADHD) PRIMARY CHARACTERISTICS/ 2 CATEGORIES OF SYMPTOMS (DSM-5) 1. Pattern of inattention Hyperactivity and 2. Impulsivity Hyperactivity includes fidgeting, having trouble sitting for any length of time, and always being on the go Impulsivity includes blurting out answers before questions have been completed and having trouble waiting turns. TAKE NOTE: EITHER THE FIRST OR THE SECOND AND THIRD SET OF SYMPTOMS MUST BE PRESENT FOR SOMEONE TO BE DIAGNOSED WITH ADHD. SUBTYPES/DIFFERENT PRESENTATIONS OF ADHD 1. Inattentive Subtype(ADD) 2. Hyperactive/Impulsive Subtype 3. Combined subtype PSYCH 3155 1 Abnormal Psychology BS PSYCH 3-1 TRUE: BOYS ARE 2-3 TIMES MORE LIKELY TO BE DIAGNOSED WITH ADHD THAN GIRLS It may be that adults are more tolerant of hyperactivity among girls, who tend to be less active than boys with ADHD. Boys tend to be more aggressive, which will more likely result in attention by MH Professionals. BOYS TEND TO BE MORE AGGRESSIVE WHILE GIRLS WITH ADHD TEND TO DISPLAY MORE BEHAVIORS REFERRED TO AS INTERNALIZING -- specifically, anxiety and depression group. TAKE NOTE: 2.5 fewer years of education and were Children with ADHD are first identified as much less likely to hold higher degrees. different from their peers around age 3 More likely to be divorced and to have or 4. The symptoms become increasingly substance use problems and antisocial obvious during the school years. personality disorder. Overtime, they seem to be less impulsive, although inattention persists. During CAUSES adolescence, the impulsivity manifests GENETICS VS. ENVIRONMENT itself in different areas. DOPAMINE SPECIFIC LEARNING DISORDER WHAT HAPPENS TO CHILDREN WITH ADHD AS THEY BECOME ADULTS? The majority were employed but in jobs with significantly lower positions than the comparison Performance is SUBSTANTIALLY BELOW (considering the person’s age, intelligence quotient (IQ) score, and education "UNEXPECTED UNDERACHIEVEMENT" History: Defined as a DISCREPANCY of more than two standard deviations between achievement and Iq PSYCH 3155 2 Abnormal Psychology common of the learning disorders. TREATMENTS Primarily requires EDUCATIONAL INTERVENTION DIRECT INSTRUCTION - one approach that has received considerable research support; includes several components. + 2 Components Systematic Instruction and Teaching for Mastery AUTISM SPECTRUM DISORDER (ASD) FALSE: A diagnosis of this disorder must NOT be caused TWO MAJOR CHARACTERISTICS: 1. by a sensory difficulty, such as trouble with sight Impairments in social communication and social or hearing, and should NOT be the result of poor interaction or absent instruction. 2. Restricted, repetitive patterns of behavior, interests, or activities CAUSES 1. Genetic Impairments in social communication and 2. Neurobiological social interaction 3. Environmental BS PSYCH 3-1 + DIFFICULTIES WITH Reading are the most - Impairments are present in EARLY CHILDHOOD and they limit daily functioning (DSM-5) - Includes problems with social reciprocity (a failure to engage in back-and-forth social interactions), nonverbal communication, and initiating and maintaining social relationships. Restricted, repetitive patterns of behavior, interests, or activities MAINTENANCE OF SAMENES - Stereotyped and ritualistic behaviors: spinning around in circles, waving their hands in front of their eyes with their heads cocked to one side or biting their hands. PSYCH 3155 3 Abnormal Psychology BS PSYCH 3-1 FALSE: Majority of people with ASD have low Iq scores. 3 LEVELS OF SEVERITY (DSM-5) Level 1: Requiring support Level 2: Requiring substantial support Level 3: Requiring very substantial support RETT DISORDER is a genetic condition that affects mostly Females and is characterized by HAND WRINGING AND POOR COORDINATION. CAUSES Wrongly seen as the result of failed parenting. ADULTS WITH AND WITHOUT THE DISORDER HAVE AN AMYGDALA OF ABOUT THE SAME SIZE BUT THAT THOSE WITH ASD HAVE FEWER NEURONS IN THIS STRUCTURE. 1. CONCEPTUAL INTELLECTUAL DISABILITY 2. SOCIAL (INTELLECTUAL DEVELOPMENTAL 3. PRACTICAL DISORDER) AGE OF ONSET FOR PEOPLE WITH ID DSM-IV-TR: MENTAL RETARDATION - - Before the person is 18. Deficits in general mental abilities, such as reasoning, problem solving, planning, abstract LEVEL OF SUPPORT/ASSISTANCE PEOPLE thinking, judgment, academic learning, and WITH ID NEED: learning from experience. Disorder evident in 1. INTERMITTENT LIMITED childhood as significantly BELOW-AVERAGE 2. LIMITED INTELLECTUAL AND ADAPTIVE FUNCTIONING 3. EXTENSIVE 4. PERVASIVE + To be diagnosed with ID, a person must have significantly SUBAVERAGE INTELLECTUAL CAUSES FUNCTIONING, a determination made with one - Multiple genetic influences appear to contribute of several IQ tests with a cutoff score set by to ID, including chromosomal disorders (eg. DSM-5 of approximately 70 having an extra 21st chromosome, as in Down Syndrome), single gene disorders, and TAKE NOTE: mitochondrial disorders The course of ID is CHRONIC -- meaning that people do not go through periods of remission, Lesch-Nyhan Syndrome such as with substance use or anxiety D.O. - An X-linked disorder characterized by ID, DIFFICULTIES IN 3 DOMAINS (DSM-5) signs of cerebral palsy (spasticity or PSYCH 3155 4 Abnormal Psychology Fragile X Syndrome - Second common chromosomally related cause tightening of the muscles), and self injurious of ID behavior, including finger and lip biting - Caused by an abnormality on the X chromosome, a mutation that makes the tip of + TRUE: In Lesch-Nyhan Syndrome, only males the chromosome look as though it was hanging are affected. Women could be carriers as well from a thread, giving it the appearance of but they do not show any of the symptoms. fragility. - Same with Lesch-Nyhan Syndrome that it also Down Syndrome affects males; the difference is that, in Fragile X - The most common chromosomal form of ID syndrome, women commonly display First identified by the British physician Lang-don mild-to-severe learning disabilities. Down. "Mongoloid" - Presence of an extra 21st chromosome andis TREATMENT OF ID therefore sometimes referred to as Trisomy 21. - - It parallels the treatment of individuals with The incidence of children born with Down more severe forms of ASD:Focused on teaching Syndrome has been tied to: them the skills they need to become more MATERNAL AGE: As the age of the mother productive and independent. increases, so does her chance of having a child - For individuals with MILD ID, intervention is with this disorder. similar to that for people with learning disorders. obvious pauses, or substituting words to LANGUAGE DISORDER replace ones that are difficult to articulate. There is limited speech in all situations. Expressive language (what is said) is significantly BELOW receptive language (what is understood) BS PSYCH 3-1 Deficits in the comprehension or production of vocabulary, sentence structure, and discourse. CHILDHOOD-ONSET FLUENCY DISORDER (STUTTERING) - A disturbance in speech fluency; problems with speech such as repeating syllables or words, prolonging certain sounds, making PSYCH 3155 5 Abnormal Psychology BS PSYCH 3-1 + Childhood-OnsetFluencyDisorder begins most often in children by the age of 6 TREATMENT Regulated-Breathing Method - promising behavioral treatment in which the person is instructed to stop speaking when a the stuttering episode occurs and then to take a deep breath (exhale, then inhale) before proceeding SOCIAL (PRAGMATIC) COMMUNICATION DISORDER Tourette’s disorder - Involuntary motor movements twitching, or vocalizations, (tics), such as such as grunts, head that often occur in rapid succession, come on suddenly, and happen in idiosyncratic or stereotyped ways. the involuntary Vocal tics often include repetition of obscenities. - Onset is before age 18 years. PSYCH 3155 6 Abnormal Psychology SCHIZOPHRENIA SPECTRUM & OTHER PSYCHOTIC DISORDERS 2. Philippe Pinel (1801/1809) - A French physician who described cases of SCHIZOPHRENIA schizophrenia - A disorder characterized by severely impaired cognitive processes, personality disintegration, 3. Benedict Morel (1852) disturbances, and social and mood withdrawal. - who used the term démence précoce (in Latin, dementia praecox ), meaning early premature or HISTORY & EA RLY MA J OR FIGURES (précoce) loss (démence) to describe schizophrenia EARLY FIGURES IN THE HISTORY OF SCHIZOPHRENIA 4. Emil Kraepelin (1898/1899) - unified the distinct categories of schizophrenia 1. John Haslam (1809) (hebephrenic, catatonic, and paranoid) under - In Observations on Madness and Melancholy, the name dementia praecox he outlined a description of the symptoms of schizophrenia 5. Eugen Bleuler (1857/1939) - who introduced the term schizophrenia, “splitting meaning of the mind.” Delusion - Misinterpretation of reality called OTHER THEORISTS "disorder of thought content" or false beliefs/ fixed beliefs 6. Ernst Krets Chmer - Types: - a superficial impression of the body types in 1. Grandiose many persons with schizophrenia 2. Persecutory 3. Referential 7. Kurt Schneider - contributed a description of first-rank symptoms 1 8. Karl Jaspers 4. Erotomanic - interested in the phenomenology of mental 5. Nihilistic illness and the subjective feelings of patients 6. Somatic with mental illness 7. Thought broadcasting 8. Thought withdrawal 9. Adolf Meyer - saw schizophrenia as a reaction to life stresses Negative Symptoms Alogia CLINICAL DESCRIPTIONS & SYMPTOMS - relative absence of speech Positive Symptoms Affective Flattening - Presence of inappropriate symptoms obvious - exhibits flat affect; lack of emotion signs of psychosis"add" (+) Anhedonia Negative Symptoms - presumed lack of pleasure - Absence of appropriate ones "subtract" (-) or decrease/diminished Asocial Behavior/Asociality - lack of interest in social interactions Disorganized Symptoms - problems in organizing ideas in speaking, Avolition thinking, and inappropriate behavior - an inability to initiate and persist in activities; "apathy" Movement/ Motor Symptoms - abnormal psychomotor behavior refers to Ambivalence disturbances in movement behavior - a non-dialectic and unsurpassable manner - Catatonia as the prime exampl for the subject—two affective attitudes or two opposite ideas coexist at the Positive Symptoms same time and with the same intensity Hallucinations - perception-like experiences without an Disorganized Symptoms external stimulus "false perception Tangentiality - Types: - speak in an unintelligible manner or reply 1. Auditory tangentially to questions 2. Visual - loosening of associations or cognitive 3. Olfactory slippage 4. Tactile - shifting from topic to topic without any 5. Gustatory apparent logical or meaningful connection between thoughts symptoms subside due to successful treatmen Movement/ Motor Symptoms Inappropriate Affect - Behavior in improper times, such as laughing, crying, and exhibit bizarre behavior such as hoarding, and "active" behaviors than unsual Catatonia - a condition involving a lack of responsiveness to the environment, peculiar body movements or postures, strange gestures and grimaces, or a combination of these DSM-5 DIAGNOSTIC CRITERIA Diagnosis - a diagnosis of schizophrenia requires the presence of two of the following: delusions, hallucinations, disorganized speech, gross motor disturbances, or negative symptoms Prevalence - The symptoms must be present most of the time for at least 1month, and the disturbance 2 must persist for at least 6 months, unless the be easily fit into one type or another. DSM-IV TR Residual: Absence of a complete set of active symptoms or insufficient symptoms. - With subtypes or classification said to have clinical significance and are still used Paranoid: With one or more by most clinicians in the persecutory delusions or United States and around the frequent auditory world to describe the hallucinations. phenomenology of schizophrenia. Disorganized: Marked regression to primitive, DSM-5 disinhibited, and unorganized behavior. Eliminated the subtypes of schizophrenia due to their Catatonic: Marked limited diagnostic stability, disturbance in motor low reliability, and poor function. validity. Undifferentiated: Cannot EPIDEMIOLOGY NEUROTRANSMITTER Dysregulation Dopamine - Excessive dopamine release in patients with schizophrenia has been linked to the severity of positive psychotic symptom Serotonin - Posit serotonin excess as a cause of both positive and negative symptoms in schizophrenia. GABA - patients with schizophrenia have a loss of GABAergic neurons in the hippocampus. - GABA has a regulatory effect on dopamine activit 3 OTHER PSYCHOTIC DISORDER Schizophreniform Disorder - People experience symptoms between 1 to 6 months only. - The DSM-5 diagnostic criteria: presence of two or more of the following symptoms: delusions, hallucinations, disorganized speech, gross motor disturbances, or negative symptom include onset of psychotic symptoms within 4 weeks of the first noticeable change in usual behavior confusion at the height of the psychotic episode good premorbid (before the psychotic episode) social and occupational functioning absence of blunted or flat affect Brief Psychotic Disorder - For at least 1 day but last less than 1 month. - The DSM-5 diagnostic criteria: requires the presence of one or more psychotic symptoms, including at least one symptom involving delusions, hallucinations, or disorganized speech symptoms sometimes occur during pregnancy or within 4 weeks of childbirth often precipitated by extremely stressful situations there is often a full return to normal functioning after the episode 4 Schizoaffective Disorder - Presence of a mood disorder, delusions, or hallucinations for at least 2 weeks in the absence of prominent mood symptoms. - The DSM-5 diagnostic criteria: The psychotic features must continue for at least 2 weeks after symptoms of the manic or depressed episode have subsided include onset of psychotic symptoms within 4 weeks of the first noticeable change in usual behaviorhas features of both schizophrenia and a depressive or bipolar disorder relatively rare but more prevalent to women Individuals tend not to get better on their own and are likely to continue experiencing major life difficulties for many years Delusional Disorder - The presence of one (or more) delusions with a duration of 1 month or longer. - The DSM-5 diagnostic criteria: major feature is the persistent belief that is contrary to reality, in the absence of other characteristics of schizophrenia DSM-5 recognizes the following delusional subtypes: eroto manic, grandiose, jealous, persecutory, and somatic shared psychotic disorder (folie à deux), the condition in which an individual develops delusions simply as a result of a close relationship with a delusional individual Schizotypal Personality Disoder - Characterized by peculiar thoughts and behaviors and by poor interpersonal relationships. - People given a diagnosis of schizotypal personality disorder have psychoticlike (but not psychotic) symptoms such as social deficits, and sometimes cognitive impairments or paranoia - have odd, eccentric, paranoid, or peculiar thoughts and behaviors and a high degree of discomfort with and reduced capacity for interpersonal relationships considered by some to be on a continuum with schizophrenia—but without some of the more debilitating symptoms, such as hallucinations and delusions - Beginning in early adulthood and present in variety of context: 5 or more of the criteria (DSM-5) 5 INTERVENTIONS AND TREATMENTS Antipsychotic Medications - reduce the severity of the positive symptoms Cognitive Behavioral Therapy - Therapists teach coping skills that allow clients to manage their positive and negative symptoms, as well as the cognitive challenges associated with schizophrenia. Important for those who do not respond to medication Involvement of Family - Family approaches and social skills training are much more effective in preventing relapse than drug treatment alone 6 made for the first time before 6 years or after Disruptive Mood Dysregulation 18 years old. Disorder H. By history or observation, the age at Only up 6 to 18 years old onset of criteria A-E is Those with symptoms of before 10 years. Bipolar but without manic I. There has never been a episodes distinct period lasting more than 1 day during Similar to ADHD but more negative affect or which the full symptom inability to regulate criteria, except mood. duration, for a manic or hypomanic episode have Criteria been met. A. Severe recurrent temper J. The behaviors do not outburst manifested verbally or behaviorally occur exclusively during that are out of an episode of major proportion in intensity depressive disorder and or duration to the are not better explained situation or provocation. by another mental disorder. B. The temper outbursts are K. Not attributable to the inconsistent with developmental level. physiological effects of a substance or to another C. Temper outbursts occur medical or neurological on average 3 or more condition times per week. D. The mood between temper Bipolar Disorders outbursts is persistently irritable or angry most of the day. Manic Depressive E. Criteria A-D have been Tendency of manic present for 12 or more episodes to alternate months. Not having 3 or with major depressive more consecutive months episodes. without all of the Manic episodes might symptoms. occur only once or F. Present in at least two repeatedly. or three settings and 27 26 are severe in one of Bipolar II Disorder these. G. Diagnosis should not be their dress, makeup, or personal appearance to a that they are ill or in need of more sexually suggestive treatment 3. Sharper Senses- Smell, Major depressive hearing or vision episodes (necessary for 4. Impulsivity- Gambling diagnosis) alternate ANtisocial behavior with with hypomanic episodes manic episodes. rather than full manic 5. Hostility- physical episodes. threatening to others Average onset is mid-20s and when delusional 5% to 15% of individuals assaultive or suicidal. have multiple (four or *During manic or hypomanic more) mood episodes phases, patients often deny (hypomanic or major they have a problem, which depressive) within the was characteristic of Billy. previous 12 months Even spending inordinate Associated Features amounts of money or making 1. Impulsivity- suicide foolish business decisions. attempts and substance abuse PSYCHOTHERAPY 2. Heightened Interpersonal and social creativity-their dress, rhythm therapy (IPSRT). makeup, or personal Cognitive behavioral appearance to a more therapy (CBT). sexually suggestive Psychoeducation. 3. Sharper Senses Family-focused therapy. Bipolar I Disorder Major depressive Cyclothymic Disorder episodes (not necessary Milder but more chronic for diagnosis) alternate version of bipolar with full manic disorder. chronic episodes. alternation of mood Hypomanic episodes can elevation and depression occur between episodes that does not reach the of severe mania and severity of manic or major depression. 28 Mean age onset is 18 y/o major depressive Associated Features 1. Resistance to Treatment often do not perceive C. Criteria for a major 2. Flamboyant- may change episodes. One mood state or the depressive, manic, or other for years with hypomanic episode have relatively few periods never been met. of neutral or EUTHYMIC D. The symptoms in mood. criterion A are not Patterns last for at better explained by least 2 years, 1 for schizoaffective children and disorder, schizophrenia, adolescents. schizophreniform disorder, delusional Mild depressive symptoms alternate with hypomanic disorder, or other episodes. specified or unspecified schizophrenia spectrum Must be treated because and other psychotic of increased risk to disorder. develop more severe E. The symptoms are not bipolar I or II attributable to the disorder. physiological effects of a substance Criteria F. The symptoms cause A. For at least 2 years ( 1 child and adolescents) clinically significant there have been numerous distress or impairment periods with hypomanic in social, occupational, symptoms but not meet or other important areas of functioning the criteria of Specify if: With anxious hypomanic episode and distress numerous periods with depressive symptoms but does not meet the In typical cases, cyclothymia is chronic and lifelong. In criteria for a major about one third to one half depressive episode. of patients, cyclothymic mood B. Above the 2 year period swings develop into the hypomanic and full-blown bipolar disorder depressive periods have (12-14 y/0) been present for at least half the time. And Specifier of BIPOLAR DISORDER not have been without same to depressive disorder. symptoms for more than 2 months. 29 *Rapid-Cycling Specifier- Move quickly in and out of depressive or manic episodes. Experiences at least four manic or depressive episodes withina year is considered to havea rapid-cycling pattern, which appears to be a severe variety of bipolar disorder that does not respond well to standard treatments. severe variety of bipolar disorder that does not respond well to standard treatments The average age of onset for bipolarI disorder is from 15 to 18 and for bipolar II disorder from 19 and 22, although cases of both can begin in childhood *It is relatively rare for someone to develop bipolar disorder after the age of 40. A. 5 or more symptoms have been present during the same 2-week period and Depressive Disorders = represent a change from Affective Disorders or previous functioning. Depressive neurosis. Under Either 1.) DEPRESSED MOOD MOOD DISORDERS. or 2.) LOSS OF INTEREST OR PLEASURE. Anhedonia- Loss of energy or inability to engage in *Symptoms not from pleasurable activities or have general medical any fun. conditions or delusions and hallucinations. Major Depressive Episode Most commonly diagnosed and - Depressed mood most of most severe depression. the day, nearly everyday. Most central indicators of (subjected report or a full MDE are Somatic or observation by others) vegetative symptoms and *Children and behavioral shutdown. 30 Criteria hospitalization. adolescents= Irritable *irritability, mood. self-destructive buying - Diminished interest or spree, anxious or pleasure in all or almost depressed (part). all activities. Untreated : 3 to 4 months - Significant weight loss Hypomanic Episode or gain, more than 5% in Less severe version of a month or decrease in manic episode. appetite nearly every Not marked in impairment day. in social or occupational - Insomnia or Hypersomia - functioning. Psychomotor agitation or Last only in 4 days. retardation. (observed by Hypo = Below thus, below others) level of manic episode. - Fatigue or loss of energy Not problematic but - Feelings of worthlessness contribute to the or excessive or definition of several inappropriate guilt. mood disorders. - Diminished ability to think or concentrate *Individuals who experience Indecisiveness either depression or mania = - Recurrent thoughts of unipolar mood disorder death. (remains at one “pole”) seems B. Symptoms cause to be rare because it results clinically significant in depression. distress or impairment in social, occupational and * Manic episodes= frequent in others. ADOLESCENT. C. Symptoms are not due to the direct physiological *Alternates depression and effects of a substance. mania is said to have BIPOLAR DISORDER. IF UNTREATED : 4 to 9 months. 31 *abnormally exaggerated Mixed Features- Experience elation, joy or euphoria. manic symptoms but feel (MANIA) somewhat depressed or anxious. Depressed with symptoms of mania. Manic Episode Characteristics of Manic Requires 1 week less, if Episode severe requires 1. Dysphoric- Anxious or Depressive. Can be 2. Decreased need for severe. Most commonly. sleep 3. More talkative than Criteria for Manic Episode A. usual or pressure Distinct period of to keep talking abnormally and persistently 4. Flight of ideas or elevated, expansive or thoughts are racing irritable mood and 5. Distractibility abnormally persistently 6. Increase in goal-directed activity or goal-directed energy. Activity. *Lasting at least 1 WEEK 7. Activities with for nearly everyday. painful result 1. Inflated C. mood disturbance is self-esteem or severely marked by impairment grandiosity 32 in social or occupational functioning. D. Not attributable to the physiological effect ofa substance. *Full manic episode emergence during antidepressant treatment. individual was not depressed. Major Depressive Disorder *35% to 85% of people with Most easily recognized mood single-episode occurrences of disorders. major depressive disorder later experience a second Presence of depression and episode absence of manic or *Unipolar Depression is often hypomanic episodes. CHRONIC. Occurrence of just ONE isolated depressive Criteria for MDD episode in a lifetime is A. At least one major relatively RARE. depressive episode. RECURRENT B. Occurrence of the major Two or more major depressive episode not depressive episodes explained by occurred and were schizoaffective separated by at least 2 disorder, schizophrenia months during which the and other psychotic disorders. All criteria is not for MDD C. No or never has been a but does not meet the two manic or hypomanic years requirement. episode. 33 Persistent depressive disorder Persistent depressive disorder (DYSTHYMIA) with persistent major Many symptoms of major depressive episode- All depressive disorders but criteria for Major depressive differs in course, fewer symptoms for at least 2 years. in symptoms. Depressed mood that PDD “with intermittent major continues at least 2 depressive episodes,” - double years, not symptoms free depression. for more than 2 months With intermittent major even though may not depressive episodes, with experience all symptoms. current episode: if full More severe than MDD since criteria for a major higher rates of depressive episode are comorbidity with other currently met, but there have mental disorders, less been responsive to treatment, periods of at least 8 weeks in slower rate of at least the preceding 2 years improvement. with symptoms below the *chronicity - important threshold for a full major distinction in diagnosing depressive episode depression. 20% of patients with a major depressive With intermittent major episode report chronicity of depressive episodes, without this episode for at least two current episode: if full years, thereby meeting criteria for a major criteria for persistent depressive episode are not depressive disorder currently met, but there has been one or more major Double Depression- MDE and PD depressive episodes in at least the preceding 2 years The relapse rate of depression among people meeting criteria Criteria for PDD (Dysthymia) for DSM IV dysthymia was A. Depressed mood for most 71.4%. of the day for at least 2 years. Persistent depressive disorder *Children and adolescents with pure dysthymic syndrome- can be mood 34 irritable and must be at least 1 year. H. Causes clinically B. Presence, while significant distresss or depressed, of two (or more) impairment in socia, of the following: 1. Poor occupational or other Appetite or functioning. overeating 2. Insomia or *Investigators have found a Hypersomia lower (0.07%) prevalence of 3. Low energy or persistent mild depressive fatigue symptoms in children compared 4. Low self-esteem with adults 5. Pooor concentration *Persistent depressive or difficulty disorder may last 20 to 30 making decisions. years or more, although 6. Feeling of studies have reported a median hopelesness. duration of approximately 5 C. 2 year eriod (1 year for years in adults children and adolescent) of the disturbance, no *Specifiers may or may not disturbances in criteria A and accompany depressive B for more than 2 months. disorders. D. Criteria for MDD may be 1. With psychotic features continiously present for 2 - Hallucinations and years. delusions. E. No or never have been a - Somatic delusions manic or hypomanic epsiode and and auditory criteria have never been met hallucinations. for cyclothymic disorder (called mood F. The disturbance is not congruent because better explained by a related to persistent schizoaffective depression) disorder, schizophrenia, - Delusions of delusional disorder, or other grandeur (mood specified or unspecified incongruent schizophrenia spectrum and hallucination or other psychotic disorder. G. delusion). If The symptoms are not accompanied by attributable to the manic epsiode (mood physiological effects of a congruent) substance 35 2. With anxious distress (mild to severe) e presence and severity of schizophrenia. accompanying anxiety, - End state reaction to whether in the form of imminent doom. comorbid anxiety 7. Peripartum onset disorders (anxiety - (pregnancy and the 6 symptoms meeting the full month period criteria for an anxiety immediately disorder) or anxiety following symptoms that do not meet childbirth), early all the criteria for recognition of disorders. Most possible psychotic important. Suicide is depressive (or likely (determined) manic) episodes i 3. Mixed features - *“baby - Several (at least 3) blues”—typically symptoms o last a few days and mania. occur in 40% to 80% 4. Melancholic Features - of women between 1 Applies only if full and 5 days aer criteria for a delivery. major depressive 8. Seasonal pattern. episode have been - It accompanies met. episodes that occur 5. Atypical features during certain - Individuals seasons (for oversleep and example, winter overeat during depression). e most depressision. usua pattern is a - More symptoms or depressive episode more severe, more that begins in the suicide attempts. late fall and ends 6. Catatonic features with the beginning - Rare and rarer in of spring Mania. Absent of - In bipolar disorder, movement or individuals may CATALEPSY. Arms and become depressed legs remains in the 36 position where they are placed. during the winter and manic during the summer.) Excessive but - ese episodes must random movement. have occurred for - More common in at least two years depression than in with no evid ence of nonseasonal psychological and social major depressive factors related to mood episodes occurring disorders in general, during that period including a history of past of time. is depressive episodes, also condition is called predicts this seasonal affective disorder (SAD) Persistent Complex Bereavement *apply on to MDD but some to Disorder both MDD and PDD PREMENSTRUAL DYSPHORIC DISORDER Acute grief to INTEGRATED Criteria GRIEF- finality of death and 37 its consequences are acknowledged and the A. Atleast 5 symptoms in the final in the final week before menses. individual adjusts to the Starts to improve few loss. Positive memories of the days after the mens. deceased B. One or more of the person that are no longer following symptoms must dominating or interfering with be present: functioning are then 1. Marked affective incorporated into memory lability (mood swings) COMPLICATED GRIEF- Many of the 2. Irritability or anger or increased activities, or relationship interpersonal with others. conflicts. E. Not caused by the symptoms 3. Depressed mood, of other disorders. feelings of F. Criterion A should be hopelessness or confirmed by prospective daily self-deprecating ratings during at least two thoughts. symptomatic cycles. 4. Anxiety, tension, G. Not due to physiological and or feeling of effects of a substance. being keyed up or on edge. The general conclusion is that C. One or more of the depressive disorders occur following symptoms must less often in prepubertal additionally be present children than in adults but combine to make 5 in the rise dramatically in criterion B: adolescence. 1. Decreased interest in usual activity Children both male and female 2. Subjective difficulty in 50 50 concentration 3. Lethargy, easy The overall prevalence of fatigability, lack of major depressive disorder for energy individuals over 65 is about 4. Change in appetite: half that of the general overeating or specific population food cravings 38 5. Hypersomia or insomnia Other Specified Depressive Disorder 6. Sense of being - Depressive disorder that overwhelmed or out of causes impairment but do control. not meet the full 7. Breast tenderness or criteria for any swelling, joint or muscle depressive disorders. pain, bloating or weight 1. Recurrent Brief gain. Depression: 4 symptoms of A-C must have been met for depression in 2-13 days most menstrual cycles at least per month in 12 that occurred. months. D. Associated with clinically 2. Short-duration significant distress or depressive episode- 4 out interference with work, of 8 symptoms persist school, usual social more than 4 days but less than 14 days. 3. Depressive episode with diagnosis. insufficient symptoms: at least one out of 8 Mindfulness-based symptoms of MDE for at Therapy is effective least two weeks. in treating depression and Unspecified Depressive preventing future Disorder depressive relapse and - Clinician does not recurrence specify the reason for Interpersonal Psychotherapy - the criteria. Do not have Focuses on resolving problems enough information to in existing relationships and make a specific 39 learning to form important new interpersonal relationships - Usually takes 15 to 20 session, usually scheduled oncea week 4 interpersonal issues that needs to be identified: dealing with interpersonal role disputes, adjusting to the loss ofa relationship, acquiring new relationships and identifying it correcting deficits in social skills Types of Suicide 1. Altruistic- sacrifice life to fulfill some obligation for the group 2. Egoistic- absence of social integration 3. Anomic- lack of social regulation that occurs during high level of stress 4. Fatalistic- individuals are placed under extreme rules or high expectations INDICES OF SUICIDE 1. Suicidal Ideation- thoughts about death 2. Suicidal Plans 3. Suicidal Attempts - Shadow of Intelligence ANXIETY (Howard Liddell)- ability to plan for the future is due to the feeling that - Complex and Mysterious 40 (Sigmund Freud) - Most of us feel anxiety things could go wrong and almost everyday. we should be prepared for it. (Anxiety is - A NEGATIVE MOOD STATE future-oriented mood) characterized by bodily - Too much anxiety can cause symptoms of physical negative effects. E.g tension and apprehension instead of performing well (uneasiness) of the in an exam, students might future. fail. - Somatic symptoms of tension - Severe anxiety although - Feeling of not or cannot the person is aware that predict or control there is nothing to be upcoming events. afraid of, they still remain anxious. - Possible Symptoms: Looking worried or fidgeting, ANXIETY DISORDERS elevated heart rate and muscle tension. - Anxiety is closely related List of disorders under to depression. anxiety: - Anxiety is good in MODERATE AMOUNTS because 1. Generalized Anxiety humans will perform Disorder better. 2. Panic Disorder - Social, Physical, and 3. Agoraphobia Intellectual Performance 4. Specific phobia are driven and enhanced by 5. Social Anxiety Disorder anxiety. Adding TWO NEW disorders: 6. Separation Anxiety difficulty in sleeping. 7. Selective Mutism 3.1% of the population meets Generalized Anxiety Disorder the criteria for GAD during a 1 year period.5.7% during Focus is generalized to lifetime events of everyday life. Adolescent 13-17 : 1.1% 41 Can’t decide on what to do about an upcoming situation, also can’t stop twice as many individuals with GAD are female than male worrying about it even South Africa more common though they know that it in male will do them no good and GAD is prevalent among older make others around them adults (Common in 45 y/o miserable. and 15 to 24) 6 months of excessive Criteria For GAD anxiety and worry (uneasiness about expectation/future). More A. Excessive anxiety and days of this than not. worry (apprehensive Worrying is about daily MINOR expectation) occurring THINGS. Children: acads, more days than not for at sports, social, and family least 6 months about a issues. Adult: number of events or Health and difficulty of activities (school or sleeping. work) It is difficult to turn B. Finds difficulty in off or control the worry controlling the worry process. C. Anxiety and worry are Pathological Worry: Worry associated with at least about things to prepare THREE or MORE of the for an event. GAD: After following six symptoms. the crisis is resolved (Present most days than (the other worry) another not): crisis will be the focus. 1. Restlessness or IT NEVER STOPPED. feeling keyed up or Physical Symptoms: Muscle on edge Tension. Mental Agitation, 2. Being easily fatigued susceptibility to fatigue 3. Difficulty (result of chronic muscle concentrating or mind tensions, some going blank irritability, and 4. Irritability 5. Muscle tension 6. Sleep disturbance 1. Benzodiazepines most (falling or staying often prescribed (relief asleep) altho for short term) - Prescribed not more than a week or two D. Cause significant distress - Risks: Impair or impairment in social, cognitive and motor occupational, and other areas functioning of functioning. 2. Paroxetine or Paxil E. Not due to the direct Antidepressant. physiological effects of a 3. CBT- evoke the SUBSTANCE. worrying process. (using F. Not better explained by coping another mental disorder. techniques) long term CAUSES For GAD effect 4. Tolerance to uncertainty of the Generalized biological future vulnerability (inherited (meta-cognitions tendency to become beliefs about worrying) anxious) Concept Check Anxiety Sensitivity True (T) or false (F)? Tendency to become 1. T GAD is characterized by distressed in response to muscle tension, mental arousal related sensation agitation, irritability, from the beliefs that sleeping difficulties, and anxiety have a harmful susceptibility to fatigue consequences) 2. F Most studies show that Low cardiac vagal tone in the majority of cases (the vagus nerve is the of GAD, onset is early in largest parasympathetic adulthood as an immediate nerve innervating the response to a life heart and decreasing its stressor. activity), leading to 3. T GAD is prevalent in autonomic inflexibility, the elderly and in because the heart is less females in our society. responsive to certain 4. F GAD has no genetic tasks. basis. Treatment for GAD 5. T Cognitive-behavioral treatment and other 42 psychological treatments for GAD are probably during which FOUR (OR MORE) of the following symptoms better than drug therapies occur: 1. Palpitations, in the long run. Pounding heart, or FEAR accelerated heart rate 2. Sweating - An IMMEDIATE alarm 3. Trembling or Shaking reaction to danger. 4. Sensations of shortness - Alerts sympathetic branch of breath or smothering of ANS to increase heart (suffocation) rate and blood pressure 5. Feeling of choking along with subjective 6. Chest pain or terror that allows us discomfort 7. Nausea or to react to stimuli. abdominal (Fight or Flight) distress 8. Feeling Dizzy, PANIC ATTACKS unsteady, lightheaded, or faint 9. Chills or heat - An ABRUPT experience of sensations 10. Paresthesias intense fear or acute (numbness or tingling discomfort with symptoms sensations ) like heart palpitations, 11. Derealization (feelings chest pains, shortness of of unreality) or breath, and dizziness. depersonalization (being - Fear occuring at an detached from oneself) INAPPROPRIATE TIME 12. Fear of losssing - Experience an alarm control or going crazy response of fear when 13. Fear of Dying there is NOTHING to be Two Basic Types of PANIC afraid called PANIC. ATTACKS (related to autonomic arousal) 1. Expected (cued) panic attacks Criteria for a PANIC ATTACK - Awareness of fear or where the next attack An ABRUPT surge of INTENSE FEAR will likely occur. or INTENSE DISCOMFORT that - E.g fear of long reaches a peak within minutes, bridges which can 43 trigger panic attacks but only if the Prepubescent children also person is in the experience panic attacks vicinity of the fear. but QUITE RARE - More common in In general, the prevalence specific phobias or of PD or comorbid panic social anxiety disorder and agoraphobia disorder. decreases among the 2. Unexpected (uncued) elderly, from 5.7% at ages panic attacks 30–44 to 2.0% or less - No clue on where or after age 60 when the next attack most (75% or more) of will occur. those who suffer from - Important in PANIC agoraphobia are women. DISORDER. (due to culture, PANIC DISORDER acceptable for woman to report fear) Men result in drinking Experience severe, alcohol to cope with panic unexpected panic attacks, attacks. (prone to in which they think addiction) they’re dying or losing CULTURAL DIFFERENCES control. (NOT ALL) Anxiety and Panic are combined Latin America To meet the criteria for PD Susto- characterized by they must experience an sweating, increased heart UNEXPECTED panic attack rate, and insomnia but not and develop substantial by fear or anxiety or even anxiety over the possible a severe fright. implications of the Hispanic Americans attacks. (Death or (Caribbean) Incapacitation. Ataques de nervios - 2.7% meet the criteria for similar to panic attack pd during 1 year period but manifestation is 4.7% at some point in life through shouting Usually occurs in early uncontrollably or bursting adulthood to about 40 y/0. into tears. (ataque than Median age is between 20 to panic) 24. 44 45 Khmer (Cambodian) and Vietnamese refugees in the by 1 month or more of one United States or both of the following : - High rate of panic A. Persistent concern or disorder associated worry about additional with orthostatic panic attacks or their dizziness (standing consequences (losing qucikly) and sore control, having a heart neck. attack, or going crazy) or - kyol goeu or “wind B. A significant overload” (too much maladaptive change in wind or gas in the behavior related to the body, which may cause attacks (avoidance of blood vessels to exercise or unfamiliar burst) situations) Nocturnal Panic C. Not attributable to the physiological effects of a substance or another medical condition 60% of people with panic D. Not explained by disorder experience another mental disorder. nocturnal attacks. Most occur Between 1:30 am Suicide to 3:30 am nocturnal panic attacks occur during delta wave or 20% of patients with panic slow wave sleep (meaning disorder attempted not nightmare but attacks) suicide. Most people think they are Risk for someone to dying. attempt suicide in panic They might have a sleeping disorder is similar to disorder called sleep those with major apnea which is an depression. 46 interruption of breathing during sleep that may feel like suffocation. (mostly Those with panic disorder found in overweight without the comorbidity of people) Agoraphobia Criteria for PANIC DISORDER depression were still at A. Recurrent unexpected risk for suicide. panic attacks are present Having anxiety or related B. At least one of the disorder increase the attacks has been followed chances of having thoughts of suicide. (suicidal unable to escape in the ideation) event of a developing panic or panic-like Concept Check symptoms. 1. A Panic Attack is an Develops because they abrupt experience of NEVER KNOW what symptoms intense fear or acute might occur. discomfort accompanied by Severe cases: Unable to physical symptoms, such as leave the house for years. chest pain and shortness Individuals who have no of breath. panic attacks for years can 2. An expected panic still have an attack occurs in certain agoraphobia. situations but not Coping Method: Alcohol and anywhere else. use of drugs and avoid 3. Anxiety is associated those situations. with specific brain circuits (for example, behavioral inhibition Panic Disorder with system or Agoraphobia altho one can fight/ flight system) and have panic disorder Neurotransmitter systems without the latter and (for example, vice versa. noradrenergic Interoceptive avoidance, 4. The rates of comorbidity or avoidance of internal among anxiety and related physical sensation (found disorders are high because in pd and agoraphobia) they share the common 47 features of anxiety and panic. 5. Stressful life events can trigger biological and Criteria for Agoraphobia psychological vulnerabilities to anxiety G. Causes clinically significant The term agoraphobia was distress or coined in 1871 by Karl Westphal, a German physician, and, in the A. Marked fear or anxiety original Greek, refers to about TWO OR MORE of the fear of the marketplace following five Agora- Busy bustling area situations: 1. Public Fear and avoidance of transpo, 2. open spaces, situations in which a 3. enclosed places, 4. person feels unsafe or standing in line or being in a crowd, 5. by another mental being outside the home disorder. alone. B. Fears or avoid these situations due to thoughts that escape might be difficult or help might not be available in events of developing panic-like symptoms or incapacitating or embarrassing symptoms. C. Agoraphobic situations almost provoke fear or anxiety D. Agoraphobic situations are actively avoided, require the presence of companions, or are endured with intense fear or anxiety. E. The fear or anxiety is CAUSES 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 impairment in social, occupational, and others H. If another medical condition is present, fear, anxiety, or avoidance is clearly excessive I. Not better explained of the population meets the criteria for panic disorder at some point in life. 3. True Some individuals with panic disorder are suicidal, have nocturnal panic, and/or are agoraphobic. 4. True Psychological treatments like PCT or CBT are highly effective for treating panic disorder. Specific Phobia Median age of onset is 7 years. An irrational fear of a specific object or situation that interferes with the ability to function. Categorized as SIMPLE PHOBIA
