Adult Psychopathology: 5-2-2012 Verbigeration: Meaningless and stereotyped repetition of words or phrases, as seen in schizophrenia.

Also called cataphasia Echolalia: Psychopathological repeating of words or phrases of one person by another; tends to be repetitive and persistent. Seen in certain kinds of schizophrenia, particularly the catatonic types. Neologism: a newly developed word or phrase by Pt. Echopraxia: pathologic imitation of others action Common Defense mechanisms characteristic for personality disorders Paranoid personality disorder Projection Schizoid and Schizotypal personality disorders Fantasy Borderline personality disorder Splitting Projective identification Passive aggression Histrionic personality disorder Repression Denial Dissociation Narcissistic personality disorder Idealization Obsessive-compulsive personality disorder Isolation Antisocial personality disorder Acting out Impulse-Control Disorders Not Elsewhere Classified Six conditions comprise the category of impulse-control disorders, not elsewhere specified. They include (1) intermittent explosive disorder, (2) kleptomania, (3) pyromania, (4) pathological gambling, (5) trichotillomania, and (6) impulse-control disorder not otherwise specified (NOS). Female orgasmic disorder Lack of orgasm though with normal sexual excitement phase Diagnosis is based on the clinicians judgment considering the facts of age, sexual experience, and the adequacy of sexual stimulation Female sexual arousal disorder Inability to reach or maintain adequate physical response during sexual activity, such as lubrication and swelling of vagina The condition is persistent or recurrent and causes significant distress and difficulty Sexual masochism

recurrent intense sexually arousing fantasies, sexual urges, or behaviors involving act of being humiliated, beaten, bound, or otherwise made to suffer Sexual sadism Recurrent intense sexually arousing fantasies, sexual urges, or behaviors involving acts in which psychological or physical suffering of victim is sexually exciting to the person Gender identity disorder Strong cross-gender identification Persistent discomfort with current sex Not because of an under lying physical condition, e.g., pseudohermaphroditism Most commonly presents in childhood; however, adulthood is possible a rare condition May have comorbidity with cluster B personality traits, and substance abuse Gender identity, gender role, and sexual orientation Gender identity Internal self-perception, developed by age 3 years Gender role External manifestation or social role Sexual orientation Erotic attractions Hypoactive sexual desire disorder Lack of sexual desire and fantasies Marked distress or interpersonal difficulty Diagnosis is based on the clinicians judgment Hypoactive sexual desire disorder: medical evaluation Renal disease Liver disease Chronic infection HIV, other sexually transmitted diseases (STDs) Endocrinopathy low testosterone, high prolactin, thyroid disturbance, adrenal Insufficiency Medicines serotonin-selective reuptake inhibitor (SSRI), corticosteroids, estrogen Hypoactive sexual desire disorder: treatment Treatment for correctable medical conditions Couples therapy Behavioral therapy sensation focusing exercises Androgenic agent

Acute stress disorder Dissociative symptoms

 Numbing Reduction of awareness Derealization Depersonalization Dissociated amnesia Other symptoms similar to PTSD Symptoms last for 2 days to 4 weeks Posttraumatic stress disorder Increase in norepinephrine turnover in the locus coeruleus, limbic regions, and cerebral Cortex Abnormalities of hypothalamus-pituitary-adrenal (HPA) axis Hyper-reactive in limbic/paralimbic structures amygdala, hippocampus, anterior cingulated cortex. Features Exposure to traumatic stressors Reexperiencing intrusive thoughts and perceptions Avoidance avoidance of thoughts and situations, withdrawal, detachment Arousal poor sleep, hypervigilance Acute PTSD symptoms present for less than 3 months Chronic PTSD symptoms for more than 3 months Delayed PTSD onset delayed for more than 6 months following the stressor Somatization disorder vs. hypochondriasis Symptoms Hypochondriasis is about the concern of a disease Somatization disorder is about many symptoms Age of onset Somatization disorder has an onset before age 30 Hypochondriasis has no specific age of onset Gender Somatization disorder is more common in women Hypochondriasis is not affected by gender Somatization disorder: diagnosis Symptoms at any time during the course of the disease Four pain symptoms Two gastrointestinal symptoms One sexual symptom One pseudoneurological symptom

No organic base for the symptoms, or excessive symptoms related to medical conditions Onset before 30 years Symptoms cause Treatment seeking or Functional impairment

DSM-IV-TR Diagnostic Criteria for Factitious Disorder A. Intentional production or feigning of physical or psychological signs or symptoms. B. The motivation for the behavior is to assume the sick role. C. External incentives for the behavior (such as economic gain, avoiding legal responsibility, or improving physical well-being, as in malingering) are absent. Code based on type: With predominantly psychological signs and symptoms: if psychological signs and symptoms predominate in the clinical presentation With predominantly physical signs and symptoms: if physical signs and symptoms predominate in the clinical presentation With combined psychological and physical signs and symptoms: if both psychological and physical signs and symptoms are present but neither predominates in the clinical presentation Pseudologia fantastica In Pseudologia fantastica, limited factual material is mixed with extensive and colorful fantasies. The listener's interest pleases the patient and, thus, reinforces the symptom. The history or the symptoms are not the only distortions of truth. Patients often give false and conflicting accounts about other areas of their lives (e.g., they may claim the death of a parent, to play on the sympathy of others). Ganser syndrome Characterized by the giving approximate answers (paralogia) together with a clouding consciousness and frequently accompanied by hallucinations and other dissociative, somatoform or conversion symptoms. Ganser syndrome is a controversial condition most typically associated with prison inmates, is characterized by the use of approximate answers. Pt responds to simple questions with astonishingly incorrect answers. Ganser syndrome may be a variant of malingering to avoid punishment or responsibility. It is classified into Dissociative disorder NOS in DSN IV-TR.

Chronic Factitious Disorder with Predominantly Physical Signs and Symptoms (Munchausen Syndrome) Factitious disorder with predominantly physical signs and symptoms is the best known type of Munchausen syndrome. The disorder has also been called hospital addiction, polysurgical addiction producing the so-called washboard abdomen, and professional patient syndrome, among other names.

A. B. C. D.

DSM-IV-TR Research Criteria for Factitious Disorder by Proxy Intentional production or feigning of physical or psychological signs or symptoms in another person who is under the individual's care. The motivation for the perpetrator's behavior is to assume the sick role by proxy. External incentives for the behavior (such as economic gain) are absent. The behavior is not better accounted for by another mental disorder.

Diagnostic Criteria for Conversion Disorder A. One or more symptoms or deficits affecting voluntary motor or sensory function that suggest a neurological or other general medical condition. B. Psychological factors are judged to be associated with the symptom or deficit because the initiation or exacerbation of the symptom or deficit is preceded by conflicts or other stressors. C. The symptom or deficit is not intentionally produced or feigned (as in factitious disorder or malingering). D. The symptom or deficit cannot, after appropriate investigation, be fully explained by a general medical condition, or by the direct effects of a substance, or as a culturally sanctioned behavior or experience. E. The symptom or deficit causes clinically significant distress or impairment in social, occupational, or other important areas of functioning or warrants medical evaluation. F. The symptom or deficit is not limited to pain or sexual dysfunction, does not occur exclusively during the course of somatization disorder, and is not better accounted for by another mental disorder. Common Symptoms of Conversion Disorder Sensory Deficits Anesthesia, especially of extremities Midline anesthesia Blindness Tunnel vision Deafness

Motor Symptoms Involuntary movements Tics Blepharospasm Torticollis Opisthotonos

Seizures Abnormal gait Falling Astasia-abasia Paralysis Weakness Aphonia

Visceral Symptoms Psychogenic vomiting Pseudocyesis Globus hystericus Swooning or syncope Urinary retention Diarrhea

Atypical depression Mood reactivity (as compared to usual depression s lack of response to positive events) Overeating Oversleeping Leaden paralysis Sensitivity to interpersonal rejection SSRIs and monoamine oxidase inhibitors (MAOIs) seem to show some specificity for such patients. Others are helped by psychostimulants, such as amphetamine. Melancholic features A. Either of the following, occurring during the most severe period of the current episode: 1. loss of pleasure in all, or almost all, activities 2. lack of reactivity to usually pleasurable stimuli (does not feel much better, even temporarily, when something good happens) B. Three (or more) of the following: 1. distinct quality of depressed mood (i.e., the depressed mood is experienced as distinctly different from the kind of feeling experienced after the death of a loved one) 2. depression regularly worse in the morning 3. early morning awakening (at least 2 hours before usual time of awakening) 4. marked psychomotor retardation or agitation 5. significant anorexia or weight loss 6. excessive or inappropriate guilt Capgras syndrome Joseph Capgras (18731950) was a French psychiatrist. Delusion of believing someone, usually a close relative or family member, has been replaced by an impostor Fregoli syndrome A person holds a delusional belief that different people are in fact a single person who changes appearance or is in disguise. The syndrome may be related to a brain lesion, and is often of a paranoid nature with the delusional person believing themselves persecuted by the person they believe is in disguise. Doppelganger syndrome (Syndrome of subjective doubles)

A person experiences the delusion that he or she has a double or Doppelganger with the same appearance, but usually with different character traits and leading a life of its own. Sometimes the patient has the idea that there is more than one double. The syndrome is usually the result of a neurological disorder, mental disorder or some form of brain damage, particularly to the right cerebral hemisphere. Catalepsy Maintaining the body position as been placed into Also known as waxy flexibility Seen in catatonia Cataplexy Sudden loss of muscle tone Seen in narcolepsy

Hallucinogen Persisting Perception Disorder (Flashbacks) A. The reexperiencing, following cessation of use of a hallucinogen, of one or more of the perceptual symptoms that were experienced while intoxicated with the hallucinogen (e.g., geometric hallucinations, false perceptions of movement in the peripheral visual fields, flashes of color, intensified colors, trails of images of moving objects, positive afterimages, halos around objects, macropsia, and micropsia). B. The symptoms in Criterion A cause clinically significant distress or impairment in social, occupational, or other important areas of functioning. C. The symptoms are not due to a general medical condition (e.g., anatomical lesions and infections of the brain, visual epilepsies) and are not better accounted for by another mental disorder (e.g., Delirium, Dementia, Schizophrenia) or hypnopompic hallucinations. Brain volume reduction in Schizophrenia Reduced volume in Prefrontal cortex Thalamus Hippocampus Superior temporal cortex Presumably result from reduced density of the axons, dendrites, and synapses Brain volume increase in Schizophrenia Increased volume in Lateral and third ventricles Basal ganglia (only in patients treated with neuroleptics) Freuds formulation of schizophrenia Fixation developmental fixations produce defects in ego development Regression ego disintegration represents a regression to the time when the ego was not yet established

 Intrapsychic conflict from the developmental fixations and the ego regression result in Withdrawal of cathexis (psychic charged attention) from the environment Reconstruction of reality (delusions and hallucinations) Prognosis of Schizophrenia Good prognostic indicators Female Later age of onset Married status Negative family history of schizophrenia Absence of perinatal complications Acute onset Predominance of positive symptoms Obvious precipitating factors Affective symptoms Confusion or other organic symptoms Paranoid subtype Family history of affective disorder Good premorbid functioning High intelligence quotient (IQ) Poor prognostic indicators Male Younger age of onset Never married Family history of schizophrenia History of perinatal complications High expressed emotion Insidious onset Negative symptoms No precipitating factors Absence of affective symptoms

Late-Onset Schizophrenia Onset after age 45 More frequently in women Tends to be characterized by a predominance of paranoid symptoms The prognosis is favorable, and these patients usually do well on antipsychotic medication. Cenesthetic hallucinations -Cenesthesia: change in the normal quality of feeling tone in a part of the body -Synesthesia: condition in which the stimulation of one sensory modality is perceived as sensation in a different modality, as when a sound produces a sensation of color. Diagnostic Criteria for Dissociative Identity Disorder A. The presence of two or more distinct identities or personality states (each with its own relatively enduring pattern of perceiving, relating to, and thinking about the environment and self). B. At least two of these identities or personality states recurrently take control of the person's behavior. C. Inability to recall important personal information that is too extensive to be explained by ordinary forgetfulness. D. The disturbance is not due to the direct physiological effects of a substance (e.g., blackouts or chaotic behavior during alcohol intoxication) or a general medical condition (e.g., complex partial seizures). Note: In children, the symptoms are not attributable to

imaginary playmates or other fantasy play. Stockholm Syndrome An apparently paradoxical psychological phenomenon in which hostages express empathy and have positive feelings towards their captors, sometimes to the point of defending them. These feelings are generally considered irrational in light of the danger or risk endured by the victims, who essentially mistake a lack of abuse from their captors for an act of kindness.[1][2] The FBIs Hostage Barricade Database System shows that roughly 27% of victims show evidence of Stockholm Syndrome Twilight state Disturbed consciousness with hallucination Trance Narrow of awareness of immediate surroundings or unusual narrow and selective focusing on Environmental stimuli.