Psychological Disorders DSM Parts 1 and 2 PDF

Psychological Disorders (Psychopathology and the DSM)  Class Objectives Define psychopathology and comorbidity; appreciate the historical conceptions of psychological disorderd Identify the main differences between the DSM-5 and the previous versions, provide examp...

Psychological Disorders (Psychopathology and the DSM)  Class Objectives Define psychopathology and comorbidity; appreciate the historical conceptions of psychological disorderd Identify the main differences between the DSM-5 and the previous versions, provide examples, and explain the consequences of such changes Explain the role of assessment and process of diagnosis by professionals and identify the combined role of the psychologist and psychiatrist in combined treatment Know and distinguish between the clinical presentation, underlying etiology (including neuropathology), and theories of the below disorders and identify Anxiety Disorders Obsessive Compulsive and Related Disorders (OCD) Trauma and Stressor Related Disorders (PTSD) Depressive Disorders Bipolar Related Disorders Schizophrenia Spectrum and Other Psychotic Disorders Dissociative Disorders (DID) Somatic Symptom and Related Disorders (Illness Anxiety Disorder) Personality Disorders Identify the impact of substance use and repeated substance use on the pathophysiology of psychological disorders Define and understand the terms in yellow and green Defining Psychological Disorders 3  Defining Psychological Disorders Psychological Disorders – Behavioral, psychological, or biological dysfunctions that are culturally atypical and associated with present distress and/or impairment in functioning, or increased risk of suffering, death, pain, or impairment. 4-Ds Deviant (atypical), Distressing (discomfort), Dysfunctional (interference), Dangerous (towards 4 self or others)  Psychopathology Psychopathology – the scientific study of psychological dysfunction Neural dysfunction – aberrant neural functioning Pathophysiology – how neural dysfunction results in physiological changes leading to psychopathology Historical Conceptions Supernatural Tradition Psychological Tradition Biological Tradition Integrative Approach Psychological, (neuro)biological, sociocultural, developmental, interpersonal and other factors 5  Basic Principles of Assessment and Diagnosis Who, How, and With What? 6  Basic Principles of Assessment and Diagnosis Psychologists v. Psychiatrists Integrative approach; “combined treatment” Other mental health professionals Assessments Clinical interviews, physical exam, psychological testing, neuropsychological testing, behavioral observations DSM 5-TR (2022) DSM functions, to 1) provide descriptions, symptoms, clarified criteria, and criteria for diagnosing psychological disorders and updated symptom 2) ensures a common language for clinicians and codes, text, terms, researchers data; new diagnosis (Prolonged grief DSM-5, DSM-5TR disorder) DSM-IV → 5 = Major revisions Elimination of the (5 tiered) multiaxial system Focus on neuroscience/biology/pathophysiology Reorganization and reclassification of disorders. Changes to the names of some disorders Categorical v. Dimensional approach is acknowledged but still a limitation  Anxiety Disorders Trauma- and Stressor-Related Disorders Obsessive-Compulsive and Related Disorders 8 Defining Anxiety  Defining Anxiety Fear v. Anxiety Immediate v. Future threat Natural, adaptive v. maladaptive Stress v. Anxiety Stressor-induced v. stressor-related Acute v. chronic Pathological Anxiety Etiology (causal factors): biological, psychological, and social factors Hallmark features: Agitation, apprehension, nervousness Defining Anxiety  Defining Anxiety Cognitive Biological Component Component Physiological Emotional Component Component  Defining Anxiety Cognitive Signs/Symptoms Concentration Attention Learning/Memory  Defining Anxiety Emotional Signs/Symptoms Nervousness Apprehension Agitation  Defining Anxiety Physiological Signs/Symptoms Nausea Increase heart rate Rapid breathing Shakiness, chest pain  Defining Anxiety Physiological component (neuro)Biological Correlates Pathophysiology Overactivation of the sympathetic nervous system Too much NE Overactivation of the amygdala Not enough GABA https://www.youtube.com/watch?v=wP9QD-5FL5U  Anxiety Disorders DISORDER SYMPTOM Generalized Characterized by 6 months of General Anxiety Disorder anxiety disorder excessive apprehensive expectation that must be Social Anxiety Disorder ongoing more days than not Panic disorder Recurrent episodes of fear Panic Disorder (often occurring at inappropriate times accompanied by) Agoraphobia accompanied by concern about Specific Phobias additional episodes or by maladaptive behavior related to Separation Anxiety Disorder* the episodes Selective Mutism* Agoraphobia Marked fear or anxiety about situations like public transportation, open spaces, enclosed places, standing in line or being in a crowd, and/or being outside the home alone Social anxiety Marked fear or anxiety about disorder one or more situations in which the person is exposed to possible scrutiny by others 17  Anxiety Disorders “World’s most common psychological disorder” (World Health Organization; approximately 300 million/4% of global population affected) If sex differences exist, F>M Comorbidity Anxiety and depression Anxiety and insomnia Anxiety/Depression and substance use  Trauma- and Stressor-Related Disorders Posttraumatic Stress Disorder Traumatic event → re-experiencing the trauma, avoidance of reminders, emotional numbing, impaired memory, and chronic arousal ~6% of pop; Family Hx of anxiety disorder increases risk (neuro)biological correlates of anxiety Acute Stress Disorder Reactive Attachment Disorder Disinhibited Social Engagement Disorder Adjustment Disorders Other Specified Trauma- and Stressor-Related Disorder Unspecified Trauma-and Stressor-Related Disorder 19  Obsessive-Compulsive and Related Disorders Obsessive-Compulsive Disorder – Intrusive, distressing thoughts (obsessions) and actions or thoughts (compulsions) performed to alleviate the distress; ~3% of pop – Family Hx increases risk; maladaptive learning thought-action fusion – Pathophysiology?? Body Dysmorphic Disorder* Hoarding Disorder Trichotillomania (hair pulling) Excoriation (skin picking) Substance/Medication-Induced Obsessive-Compulsive and Related Disorder Obsessive-Compulsive and Related Disorder Due to Another Medical Condition Other Specified Obsessive-Compulsive and Related Disorder Unspecified Obsessive-Compulsive and Related Disorder  Anxiety Disorders Trauma- and Stressor-Related Disorders Obsessive-Compulsive and Related Disorders Anxiety Disorders General anxiety disorder, Social Phobia, Agoraphobia Trauma- and Stress-Related Disorders Post-traumatic Stress Disorder Obsessive-Compulsive Related Disorders Obsessive Compulsive Disorder Depressive Disorders  Depressive Disorders Major Depressive Hallmark Features Disorder (DSM-5TR) Substance/Medication-Induced Depressive Disorder Persistent Depressive Disorder Disruptive Mood Dysregulation Disorder* Premenstrual Dysphoric Disorder Depressive Disorder Due to Another Medical Condition Other Specified Depressive Disorder Unspecified Depressive Disorder 23  Defining Depression Cognitive Biological Component Component Physical Emotional Component Component  Defining Depression Cognitive Biological Component Component Physical Emotional Component Component Defining Depression Cognitive Signs/Symptoms Defining Depression Emotional Signs/Symptoms Defining Depression Physical Signs/Symptoms Defining Depression (neuro)Biological Correlates Pathophysiology  Defining Depression Biological Component (neuro)biological correlates Pathophysiology Monoamine Theory of Depression Imbalance of monoamines Reduction in Norepinephrine Reduction of energy = lethargy Reduction in Serotonin Reduction of happiness = sadness Reduction in Dopamine Reduction of feeling pleasure = anhedonia Bipolar and Related Disorders  Bipolar and Related Disorders Fundamental Experiences Depression (x>2 weeks; cognitive, behavioral, emotional, physical dysfunctions) Mania (x>1 week; abnormally exaggerated elation, joy, or euphoria) Hypomania (x2 weeks; cognitive, behavioral, emotional, physical dysfunctions) Mania (x>1 week; abnormally exaggerated elation, joy, or euphoria) Hypomania (xM) Malingering and stigma are concerning “Meet Seven”: http://youtu.be/_vYQ6pbJt2k Somatic Symptom and Related Disorders  Somatic Symptom and Related Disorders Overview Intense focus on physical symptoms or maladaptive response to physical symptoms or health concerns. Etiology and Influencing Factors Unclear, stressful, traumatic childhood, disproportionate incidence of illness in the family, conditioned effect of perceived reward of being ill, symptoms may or may not have known medical causes Increased sympathetic response is noted Considerations may result from or concurrent with personality disorders, psychosocial stressors 56 Somatoform Disorders ? Somatoform Disorders Illness Anxiety Disorder ? Personality Disorders  Personality Disorders Overview Definition/Characteristics Persistent pattern of emotions, cognitions, and behaviors that induce significant impairment with relative poor insight 10 disorders; 3 clusters Categorical v. dimensional approach (“kind v. degree”) Development and Course Chronic Nature DSM-5 Alternative Model (AMPD): Begins in childhood, can remit or change over Introduces six trait domains: time, impacts life functioning Prevalence: ~10-15% adults with at least 1 PD Comorbidity Sex differences Cluster A Theme: Odd or Eccentric Social Awkwardness and Withdrawal Suspicion: Pervasive distrust Paranoid Personality and suspicion of others such that their motives are interpreted as Disorder malevolent; leading to arguments or withdrawal Schizoid Personality Isolation: Detachment from social relationships, limited emotional Disorder expression, appearing aloof and indifferent Bizarre Schizotypal Personality Thoughts/Beliefs: Social Disorder isolation, odd beliefs, and suspicious behavior; considered a mild form of 61 schizophrenia Cluster B Theme: Dramatic, Emotional, Erratic Impulsive, Emotion-Based Behavior Pervasive pattern of cognizant Antisocial Personality disregard: Persistent violation of social norms, Disorder deceitfulness, lack of remorse, often linked with criminal behavior (M>F) Histrionic Personality Shallow emotions/relationships: Exaggerated emotional expression, need for Disorder attention, seductive behavior (F>M) Fear of abandonment: Intense Borderline Personality emotional instability, impulsivity, self- Disorder mutilation, and difficulty maintaining relationships. (F>M) Narcissistic Personality Powerful sense of entitlement: Grandiosity, lack of empathy, need for Disorder admiration, and exploitative behavior (M>F) 62 Cluster C Theme: Anxious and Fearful Anxiety Avoidant Personality Social isolation: low self esteem (what people may refer to Disorder as “antisocial”) Dependent Personality Over reliance: Submissiveness and clinging to relationships. Disorder Dependency on others for reassurance. Extreme general Obsessive Compulsive perfectionism: Preoccupation Personality Disorder with orderliness and perfectionism,; poor interpersonal relationships; poor insight63  Key Concepts Psychopathology is the study of psychological disorders, which are diagnosed by mental health professionals, based on the severity (distress, deviant, dysfunctional and dangerous) of symptoms and signs. Anxiety is defined as the persistent physiological response to a stressor. Evidence suggests that a decrease in GABA to the amygdala accounts for clinical presentation. It is more severe than stress but less than phobia. Depressive disorders demonstrate physical, psychological, emotional and biological dysfunction. Evidence suggests an imbalance in monoamine neurotransmission. A single manic episode distinguishes Bipolar Disorder from the Depressive Disorders  Key Concepts An imbalance in circulating monoamines throughout the brain accounts for the clinical presentation (positive, negative and cognitive symptoms) of schizophrenia. Once termed multiple personality disorder, dissociative identity disorder is typically developed and expressed as a coping mechanism, resulting from childhood trauma. Somatic symptom disorders (including hypochondriasis, body dysmorphic disorder and muscle dysmorphia) are difficult to treat because these disorders do not have a pathological basis. There are 10 personality disorders that are classified into 3 clusters: Cluster A isassociated with social withdrawal and awkwardness, while Clusters B and C are associated with dramatic/eccentric and anxious/fearful thoughts and behaviors, respectively.