updated April 17, 2011 [Review Sheet 210 Final exam] Anything on the previous exams is fair game, anything in italic is NOT on Test III 1. Describe the essential features of personality disorders according to the DSM-IV and why they are listed on Axis II A personality disorder is enduring, it cannot go away and it is a patter of inner experience and behavior that is not normal for one’s cultural expectations. They are pervasive, inflexible, is stable over time, leads to stress and impairment, and is onset early in childhood. 2. Describe the essential characteristics of each personality disorders Paranoid Personality Disorder is a pattern of distrust and suspiciousness such that others' motives are interpreted as malevolent. Schizoid Personality Disorder is a pattern of detachment from social relationships and a restricted range of emotional expression. Antisocial Personality Disorder is a pattern of disregard for, and violation of, the rights of others. Borderline Personality Disorder is a pattern of instability in interpersonal relationships, self-image, and affects, and marked impulsivity. Histrionic Personality Disorder is a pattern of excessive emotionality and attention seeking. Narcissistic Personality Disorder is a pattern of grandiosity, need for admiration, and lack of empathy. Avoidant Personality Disorder is a pattern of social inhibition, feelings of inadequacy, and hypersensitivity to negative evaluation. Dependent Personality Disorder is a pattern of submissive and clinging behavior related to an excessive need to be taken care of. Obsessive-Compulsive Personality Disorder is a pattern of preoccupation with orderliness, perfectionism, and control. 3. Distinguish between Paranoid personality disorder and schizophrenia, paranoid type Paranoid Personality disorder may not occur exclusively during the course of Schizophrenia and is not due to the direct physiological effects of a general medical condition. 4. Be certain to be able to know the difference between antisocial and avoidant and personality disorders Antisocial- pattern of disregard for, and violation of the rights of others. They may be reckless, deceitful, impulsive, irresponsible, and lack remorse. Avoidant- pattern of social inhibition, feelings of inadequacy, and hypersensitivity to negative evaluation. Avoids new jobs, friends, relationships, etc. because of fear of rejection or failure. 5. Define schizophrenia and explain the difference between schizophrenia and psychosis Characteristic symptoms: Two (or more) of the following, each present for a significant portion of time during a 1-month period (or less if successfully treated): delusions hallucinations disorganized speech (e.g., frequent derailment or incoherence) grossly disorganized or catatonic behavior negative symptoms, i.e., affective flattening, alogia, or avolition Social/occupational dysfunction: For a significant portion of the time since the onset of the disturbance, one or more major areas of functioning such as work, interpersonal relations, or self-care are markedly below the level achieved prior to the onset (or when the onset is in childhood or adolescence, failure to achieve expected level of interpersonal, academic, or occupational achievement). Duration: Continuous signs of the disturbance persist for at least 6 months. This 6-month period must include at least 1 month of symptoms (or less if successfully treated) that meet Criterion A (i.e., active-phase symptoms) and may include periods of prodromal or residual symptoms. During these prodromal or residual periods, the signs of the disturbance may be manifested by only negative symptoms or two or more symptoms listed in Criterion A present in an attenuated form (e.g., odd beliefs, unusual perceptual experiences). Schizoaffective and Mood Disorder exclusion: Schizoaffective Disorder and Mood Disorder With Psychotic Features have been ruled out because either (1) no Major Depressive, Manic, or Mixed Episodes have occurred concurrently with the active-phase symptoms; or (2) if mood episodes have occurred during activephase symptoms, their total duration has been brief relative to the duration of the active and residual periods. Substance/general medical condition exclusion: The disturbance is not due to the direct physiological effects of a substance (e.g., a drug of abuse, a medication) or a general medical condition. Relationship to a Pervasive Developmental Disorder: If there is a history of Autistic Disorder or another Pervasive Developmental Disorder, the additional diagnosis of Schizophrenia is made only if prominent delusions or hallucinations are also present for at least a month (or less if successfully treated). 6. Distinguish between positive and negative symptoms of schizophrenia positive symptoms add things i.e. delusions, hallucinations, disorganized speech, etc. negative symptoms take things away like affective flattening (), alogia (loss of speech), avolition (lack of drive). Or anhedonia (inability to experience pleasure). 7. Describe the clinical features of schizoaffective, delusional disorder, and brief psychotic disorder Schizophrenia is a disorder that lasts for at least 6 months and includes at least 1 month of active-phase symptoms (i.e., two [or more] of the following: delusions, hallucinations, disorganized speech, grossly disorganized or catatonic behavior, negative symptoms). Definitions for the Schizophrenia subtypes (Paranoid, Disorganized, Catatonic, Undifferentiated, and Residual) are also included in this section. Schizophreniform Disorder is characterized by a symptomatic presentation that is equivalent to Schizophrenia except for its duration (i.e., the disturbance lasts from 1 to 6 months) and the absence of a requirement that there be a decline in functioning. Schizoaffective Disorder is a disorder in which a mood episode and the activephase symptoms of Schizophrenia occur together and were preceded or are followed by at least 2 weeks of delusions or hallucinations without prominent mood symptoms. Delusional Disorder is characterized by at least 1 month of nonbizarre delusions without other active-phase symptoms of Schizophrenia. Brief Psychotic Disorder is a disorder that lasts more than 1 day and remits by 1 month. 8. Describe biological treatments of schizophrenia including the short and long-term side effects of neuroleptic medications typical antipsychotics- first generation- Haloperidol (Haldol), atypical antipsychotics- first generation- Risperidone (Risperidol) 9. Be able to diagnose an adjustment disorder 10. Understand the difference between an adjustment disorder and no disorder within 3 months of the stressor, goes away after 6 months of no stressor. Causes marked distress, excess of what is expected, problems social/occupational 11. Be able to identify the major parts of a psychological intake report and know what information goes in which section (presenting problem, signs and symptoms, history of present illness, biopsychosocial history, mental status exam) 12. Compare and contrast generalized anxiety disorder, agoraphobia, specific phobia, and social phobia at the level of symptoms generalized anxiety disorder- worrying about basically everything for 6 months causing 3 or more of: restlessness, sleep disturbance, easily fatigued, muscle tension, irritability, mind going blank/lack of concentration. agoraphobia- fear of panic attacks specific phobia- fear of a specific thing. Many kinds social phobia 13. Describe the symptoms and defining characteristics of posttraumatic stress disorder and obsessive compulsive disorder and why they are considered maladaptive PTSD- after a trauma (fits trauma criteria), the patient OCD14. Describe the defining features of somatoform disorders and be able to distinguish the central diagnostic and etiological features of somatoform disorders- BDD, Pain disorder, Conversion Disorder, Somatization Disorder, hypochondriasis- thinking one has a specific disease for more than 6 months. somatization disorder- history of many physical complaints before age 30 not for medical reasons 4 pain 2 gastro-intestinal 1 sexual 1 pseudonerological 15. Describe the major manifestations of conversion disorder Something you can’t handle psychologically converts into some physica pain. This suggests some sort of neurological/general medical disorder, but with a motor or sensory deficit, but there is some sort of odd indifference to the pain. Woman had to testify in a case, nervous, goes blind, but is just like “huh, I’m blind” 16. Understand malingering and factitious disorders and their relation to the diagnosis of somatoform disorders Malingering- intentional production of an illness or exaggerating an illness or faking an illness for SECONDARY gain- like to get out of something Factitious disorder- intentional production of an illness, exaggerating an illness or faking an illness for PRIMARY gain- go get sympathy. 17. Differentiate a depressive episode from a manic and Hypomanic episode Manic=gets you in trouble Hypomanic= does not get you in trouble Depressive episode= D+SIGECAPS 18. Describe the clinical symptoms of major depression Depressed mood Sleep- insomnia/hypersomnia Interest- anhedonia- lack of interest Guilt- inappropriate guilt Energy- lack of energy Concentration- lack of concentration Appetite- increase or decrease Psychosocial issues- regardation/agitation Suicidal thoughts 19. describe the clinical symptoms of bipolar disorder, including mania Bipolar I- Mania + ANYTHING Bipolar II- Depression + Hypermania Mania- better than good self-esteem, decreased need for sleep, more talkative, thoughts racing, distracted easily, excessive involvement in pleasurable activities, etc. MUST GET YOU INTO TROUBLE 20. differentiate major depression from dysthymic disorder Major depressive= D+5 SIGECAPS Dysthymic disorder= D+2 SIGECAPS- for 2 years 21. differentiate bipolar disorder from cyclothymic disorder Cyclothymic- 2 years and not all the way to depression, just dysthymia and hypomania 22. describe the medical treatments that have been useful in treating mood disorders 23. explain the nature and purposes of psychiatric diagnosis and how the DSM manual is used to help therapists and counselors make an accurate diagnosis of mental illness 24. Compare and contrast generalized anxiety disorder, specific phobia, and social phobia at the level of symptoms and etiological models 25. describe the symptoms, defining characteristics of posttraumatic stress disorder and obsessive compulsive disorder and why they are considered maladaptive 26. Describe the symptoms, defining characteristics of substance intoxication vs. substance abuse vs. substance dependence. Some Key Terms ● Affect ● alogia ● anhedonia ● Animal phobia ● Antisocial personality disorder ● Anxiety ● Avoidant personality disorder ● avolition ● Behavior therapy ● Behaviorism ● Bipolar disorders ● Bipolar I ● Bipolar II ● Blood-injection-injury phobia ● Body dysmorphic disorder ● Borderline personality disorder ● Brief psychotic disorder ● catatonia ● Classical conditioning ● Clinical assessment ● Cognitive behavioral therapy ● Compulsions ● Cyclothymic disorders ● Defense mechanism ● delusion ● Delusional disorder Non bizarre delusions that involve situations that happen in real life such as being followed, poisoned, disease etc. for at least one month. Criteria for schizophrenia have never been met. ● Dependent personality disorder ● Diagnosis ● disorganized speech ● Double depression ● Dysthymic disorder ● Ego ● Etiology ● Factitious disorders ● flat affect ● Free association ● hallucination ● Histrionic personality disorder ● Hypochondriasis ● Hypomanic episode ● Id ● inappropriate affect ● Major depressive episode ● Malingering ● Mania ● Mental status exam ● Mood ● Mood disorders ● narcissistic personality disorder ● Natural environment phobia ● negative symptoms ● Neurons ● Obsessions ● Obsessive compulsive disorder ● Obsessive-compulsive personality disorder ● OCD ● Pain disorder ● Panic ● Panic attack ● Paranoid personality disorder ● Phobia ● positive symptoms ● Posttraumatic stress disorder ● Presenting problem ● Prevalence ● Prognosis ● Projective tests ● Psychopathology ● psychotic ● PTSD ● Reinforcement ● Reuptake ● schizoaffective disorder ● Schizoid personality disorder ● schizophrenia ● Schizotypal personality disorder ● Situational phobia ● Social anxiety disorder ● Social phobia ● Somatization disorder ● Specific phobia ● Suicidal ideation ● Synaptic cleft ● Systematic desensitization ● unconscious List of disorders ● Acute Stress Disorder exposed to a traumatic event 3 or more dissociative symptoms o subjective sense of numbing, detachment or absence of emotional response o reduction in awareness of his/her surroundings “in a daze” o derealizatoin o depersonalization o dissociative amnesia (cannot recall an important aspect of the trauma) reexperienced trauma in at least one of the following ways: recurrent images, thoughts, dreams, illusions, flashbacks, sense of reliving the experience, distress on exposure to reminders of the event marked avoidance of stimuli that arouses recollections of the trauma marked symptoms of anxiety or increased arousal (difficulty sleeping, irritability, poor concentration, hypervivilance, exaggerated startle response, motor restlessness) disturbance cases clinically significant stress or impairment in social or occupational functioning. Gets in the way of everyday life lasts at least 2 days-4 weeks occurs within 4 weeks of trauma not because of anything else- drugs, general medical condition, brief psychotic disorder, etc. ● Adjustment Disorder Unspecified development of emotional or behavior symptoms in response to an identifiable stressor(s) occurring within 3 months of the stressor either has marked distress that is in excess of what would be expected from exposure to the stressor, or significant impairment in social or occupational functioning stress-related disturbance does not meet the criteria for another Axis I disorder and is not an exacerbation of a preexisting Axis I or Axis II disorder not bereavement once the stressor is gone, the symptoms do not persist for more than 6 months ● Adjustment Disorder With Anxiety when the predominant manifestations are symptoms such as nervousness, worrying, jittering ● Adjustment Disorder With Depressed Mood when the predominant manifestations of symptoms are depressed mood, tearfulness, hopelessness ● Adjustment Disorder With Disturbance of Conduct the predominant manifestation of symptoms is a disturbance in conduct in which there is a violation of the rights of others or of major age-appropriate societal norms and rules (truancy, vandalism, reckless driving, fighting, etc) ● Adjustment Disorder With Mixed Anxiety and Depressed Mood the predominant manifestation of symptoms combines anxiety and depression ● Adjustment Disorder With Mixed Disturbance of Emotions and Conduct manifestation of symptoms are both emotional (depression/anxiety) and disturbance of conduct ● Antisocial Personality Disorder since age 15, pervasive pattern of disregard for and violation of the rights of others by showing 3 of the following: o failure to conform to social norms with respect to lawful behaviors by repeatedly performing acts that are grounds for arrest o deceitfulness as indicated by repeatedly lying, use of aliases, or conning others for personal profit or pleasure o impulsivity or failure to plan ahead o irritability and aggressiveness, as indicated by repeated physical fights or assaults o reckless disregard for safety of self or others o consistent irresponsibility, as indicated by repeated failure to sustain constant work behavior or honor financial obligations o lack of remorse, as indicated by being indifferent to or rationalizing having hurt, mistreated, or stolen from another at least 18 years old evidence of conduct disorder occurrence of antisocial behavior is not exclusively during the course of schizophrenia or a manic episode. ● Anxiety Disorder Due to General Medical Condition ● Avoidant Personality Disorder A pervasive pattern of social inhibition, feelings of inadequacy, and hypersensitivity to negative evaluation, beginning by early adulthood and present in a variety of contexts, as indicated by four (or more) of the following: o avoids occupational activities that involve significant interpersonal contact, because of fears of criticism, disapproval, or rejection o is unwilling to get involved with people unless certain of being liked o shows restraint within intimate relationships because of the fear of being shamed or ridiculed o is preoccupied with being criticized or rejected in social situations o is inhibited in new interpersonal situations because of feelings of inadequacy o views self as socially inept, personally unappealing, or inferior to others o is unusually reluctant to take personal risks or to engage in any new activities because they may prove embarrassing ● Bereavement ● Bipolar I Disorder Most Recent Episode Depressed ● Bipolar I Disorder Most Recent Episode Hypomanic ● Bipolar I Disorder Most Recent Episode Manic ● Bipolar I Disorder Single Manic Episode ● Bipolar II Disorder ● Body Dysmorphic Disorder ● Borderline Personality Disorder instability of interpersonal relationships, self-image, and affects, and marked impulsivity beginning in early adulthood and present in a variety of contexts as indicated by 5 or more: o frantic efforts to avoid real or imagined abandonment. Note: Do not include suicidal or self-mutilating behavior covered in Criterion 5. o a pattern of unstable and intense interpersonal relationships characterized by alternating between extremes of idealization and devaluation o identity disturbance: markedly and persistently unstable self-image or sense of self o impulsivity in at least two areas that are potentially self-damaging (e.g., spending, sex, substance abuse, reckless driving, binge eating). Note: Do not include suicidal or self-mutilating behavior covered in Criterion 5. o recurrent suicidal behavior, gestures, or threats, or self-mutilating behavior o affective instability due to a marked reactivity of mood (e.g., intense episodic dysphoria, irritability, or anxiety usually lasting a few hours and only rarely more than a few days) o chronic feelings of emptiness o inappropriate, intense anger or difficulty controlling anger (e.g., frequent displays of temper, constant anger, recurrent physical fights) o transient, stress-related paranoid ideation or severe dissociative symptoms ● Brief Psychotic Disorder features of psychosis that are brief presence of at least one: o delusions o hallucinations o disorganized speech o grossly disorganized or catatonic behavior at least a day but less than a month with return to premorbid function. Specify if with/without a marked stressor or with postmotum onset. ● Conversion Disorder ● Cyclothymic Disorder ● Delusional Disorder ● Dependent Personality Disorder ● Dysthymic Disorder ● Exhibitionism ● Factitious Disorder ● Fetishism ● Frotteurism ● Generalized Anxiety Disorder ● Histrionic Personality Disorder A pervasive pattern of excessive emotionality and attention seeking, beginning by early adulthood and present in a variety of contexts, as indicated by five (or more) of the following: is uncomfortable in situations in which he or she is not the center of attention interaction with others is often characterized by inappropriate sexually seductive or provocative behavior displays rapidly shifting and shallow expression of emotions consistently uses physical appearance to draw attention to self has a style of speech that is excessively impressionistic and lacking in detail shows self-dramatization, theatricality, and exaggerated expression of emotion is suggestible, i.e., easily influenced by others or circumstances considers relationships to be more intimate than they actually are ● Hypochondriasis ● Major Depressive Disorder ● Malingering ● Mood Disorder Due to General Medical Condition mood disorder with psychotic features psychotic features only when you have the mood disorder ● Narcissistic Personality Disorder A pervasive pattern of grandiosity (in fantasy or behavior), need for admiration, and lack of empathy, beginning by early adulthood and present in a variety of contexts, as indicated by five (or more) of the following: o has a grandiose sense of self-importance (e.g., exaggerates achievements and talents, expects to be recognized as superior without commensurate achievements) o is preoccupied with fantasies of unlimited success, power, brilliance, beauty, or ideal love o believes that he or she is "special" and unique and can only be understood by, or should associate with, other special or high-status people (or institutions) o requires excessive admiration o has a sense of entitlement, i.e., unreasonable expectations of especially favorable treatment or automatic compliance with his or her expectations o is interpersonally exploitative, i.e., takes advantage of others to achieve his or her own ends o lacks empathy: is unwilling to recognize or identify with the feelings and needs of others o is often envious of others or believes that others are envious of him or her o shows arrogant, haughty behaviors or attitudes ● No Diagnosis or Condition on Axis I or Axis II ● Obsessive-Compulsive Disorder Either obsessions or compulsions: o OBSESSIONS: o recurrent and persistent thoughts, impulses, or images that are experienced, at some time during the disturbance, as intrusive and inappropriate and that cause marked anxiety or distress o the thoughts, impulses, or images are not simply excessive worries about reallife problems o the person attempts to ignore or suppress such thoughts, impulses, or images, or to neutralize them with some other thought or action o the person recognizes that the obsessional thoughts, impulses, or images are a product of his or her own mind (not imposed from without as in thought insertion) o COMPULSIONS: o repetitive behaviors (e.g., hand washing, ordering, checking) or mental acts (e.g., praying, counting, repeating words silently) that the person feels driven to perform in response to an obsession, or according to rules that must be applied rigidly o the behaviors or mental acts are aimed at preventing or reducing distress or preventing some dreaded event or situation; however, these behaviors or mental acts either are not connected in a realistic way with what they are designed to neutralize or prevent or are clearly excessive At some point during the course of the disorder, the person has recognized that the obsessions or compulsions are excessive or unreasonable. The obsessions or compulsions cause marked distress, are time consuming (take more than 1 hour a day), or significantly interfere with the person's normal routine, occupational (or academic) functioning, or usual social activities or relationships. If another Axis I disorder is present, the content of the obsessions or compulsions is not restricted to it (e.g., preoccupation with food in the presence of an Eating Disorder; hair pulling in the presence of Trichotillomania; concern with appearance in the presence of Body Dysmorphic Disorder; preoccupation with drugs in the presence of a Substance Use Disorder; preoccupation with having a serious illness in the presence of Hypochondriasis; preoccupation with sexual urges or fantasies in the presence of a Paraphilia; or guilty ruminations in the presence of Major Depressive Disorder). The disturbance is not due to the direct physiological effects of a substance (e.g., a drug of abuse, a medication) or a general medical condition. ● Obsessive-Compulsive Personality Disorder ● Pain Disorder ● Paranoid Personality Disorder A pervasive distrust and suspiciousness of others such that their motives are interpreted as malevolent, beginning by early adulthood and present in a variety of contexts, as indicated by four (or more) of the following: o suspects, without sufficient basis, that others are exploiting, harming, or deceiving him or her o is preoccupied with unjustified doubts about the loyalty or trustworthiness of friends or associates o is reluctant to confide in others because of unwarranted fear that the information will be used maliciously against him or her o reads hidden demeaning or threatening meanings into benign remarks or events o persistently bears grudges, i.e., is unforgiving of insults, injuries, or slights o perceives attacks on his or her character or reputation that are not apparent to others and is quick to react angrily or to counterattack o has recurrent suspicions, without justification, regarding fidelity of spouse or sexual partner Does not occur exclusively during the course of Schizophrenia, a Mood Disorder With Psychotic Features, or another Psychotic Disorder and is not due to the direct physiological effects of a general medical condition. ● Pedophilia ● Personality Disorder Due to General Medical Condition ● Posttraumatic Stress Disorder ● Psychotic Disorder Due to [General Medical Condition] ● Schizoaffective Disorder ● Schizoid Personality Disorder ● Schizophrenia ● Sexual Masochism ● Sexual Sadism ● Social Phobia ● Somatization Disorder ● Specific Phobia ● Substance Intoxication ● Substance Abuse ● Substance Dependence ● Induced Sexual Dysfunction ● Transvestic Fetishism ● Voyeurism exhibitionism- exposure of one’s gentiles to an unsuspecting stranger fetishism- involving the use of non-living objects. Fetish articles are not limited to articles of female clothing, or masturbatory devices. Frotteurism- involving touching and rubbing against a non-consenting person. Pedophilia- involving sexual activity with a pre-pubescent child or children. The person is at least 16 and at least 5 years older than their victim. Masochism- involving the act of real (not simulated) of being humiliated, beaten, bound or otherwise made to suffer Sadism- involving acts (real not simulated) in which the psychological or physical suffering is sexual exciting to the person. transvestic fetishism- heterosexual male recurrent intense sexual arousing fantasies, sexual urges or behaviors involving cross-dressing. Voyeurism- involving the act of observing an unsuspecting person who is naked in the process of disrobing or engaging in sex. 0620