Lecture 17

Question 1

Viewing addiction through a public health perspective and biopsychosocial model would prioritize what?

Answer 1

comprehensive responses to address systemic or social drivers (causes) of addiction, medical issues, reduce harm, and promote treatment access and recovery

Question 2

define nosology

Answer 2

the study of how medicine classifies illness

Question 3

what is one method of classification

Answer 3

by cause
- often used for physical/medical illnesses (ex. tuberculosis), but difficult to use in mental health

Question 4

What does the DSM concentrate on?

Answer 4

• symptoms and clusters or symptoms (atypical in medicine)

Question 5

according to what are mental disorders classified to

Answer 5

• according to symptoms that people exhibit
• the patterns of thoughts, moods and behaviours

Question 6

What is the descriptive or symptom-based approach?

Answer 6

• assumption is that typical symptoms of a particular disorder stem from the same underlying condition

Question 7

What is the symptom-based classification

Answer 7

two key issues that represent a challenge to this approach to classification include:

• symptom overlap
• heterogeneity

Question 8

define symptom overlap

Answer 8

• some symptoms (ex. anhedonia) are common to many mental illnesses (ex. MDD and schizophrenia) - some are especially common (anxiety/tension)

Question 9

define heterogeneity

Answer 9

• individuals with the same diagnosis may have very different symptoms and present differently (wide variety of symptoms for each disorder)
• DSM criteria usually require only some of the noted criteria (Major Depressive Disorder diagnosis based on 5 of 9 potential markers)

Question 10

What are the implications of the symptom-based classification, symptom overlap?

Answer 10

• a challenge in discerning the dividing lines between different mental disorders (are the distinctions accurate?)

Question 11

What are the implications of the symptom-based classification, heterogeneity?

Answer 11

• Makes it difficult to explain behaviours and determine the best treatments
• diagnoses are short-hand and sometimes approximate: given range of symptoms and variation, are these two cases or individuals experiencing the same disorder? is it a subtype or an entirely different disorder?

Question 12

What are the implications of the symptom-based classification, heterogeneity?

Question 13

How can OCD be described as?

Answer 13

as a manifestation of anxiety revolving around obsessive and intrusive thoughts

Question 14

define obsessions

Answer 14

disruptive, anxiety producing thoughts and/or mental images

• uncontrollable thoughts

Question 15

What are the two things OCD can be?

Answer 15

Obsession or (either or) compulsion

Question 16

define compulsions

Answer 16

repetitive actions or thoughts which are performed in order to help relieve anxieties

• these could be repetitive cleaning, counting, checking on things, etc.

Question 17

describe OCD

Answer 17

• estimated to affect 1-3% of US population
• OCD often thought of as chronic (or persistent), lasting throughout a person’s lifetime (but OCD can be treated) (the thoughts are just still there)
• people with OCD may avoid people, places, things that trigger obsessive thoughts

Question 18

describe PTSD

Answer 18

• typically arises following a single traumatic event or repeated trauma over a period of weeks, months or years
• these events involve experiencing or witnessing severe harm, injury, danger, or death
• symptoms brought on by trauma
• we are familiar with combat-related PTSD, but accidents, abuse, and violent crime can also trigger PTSD (a wider range of experiences are now understood to be traumatic)

Question 19

What are the symptoms of ptsd?

Answer 19

• dissociative episodes (flashbacks) associated with triggers
• nightmares
• negative moods
• sleep disruption
• tension

reliving trauma

Question 20

What are some shared symptoms and treatments of ocd and ptsd

Answer 20

• anxiety
• attempts to avoid triggers
• ocd may also manifest following experiences of trauma
• similar treatments (CBT and exposure-based therapies)

Question 21

What are some differences between OCd and PTSD

Answer 21

• obsessions and compulsions are very different experiences than flashbacks
• ocd is not always triggered by a traumatic incident

Question 22

One such group of disorders are referred to as somatic symptom and related disorders, several diagnoses that involve concerns about one’s health

Historically, individuals who presented with mysterious symptoms (ex. unexplained paralysis or sudden blindness) were classified as having conversion disorder and deemed to have distress or internal conflict that had been “converted” into physical dysfunction

Meanwhile those who were intensely preoccupied with the possibility of being or becoming ill were said to be suffering from hypochondriasis

In DSM-5, these terms have been replaced with what new categories?

Answer 22

• somatic symptom disorder and illness anxiety disorder

Question 23

define somatic symptom disorder (textbook)

Answer 23

• used to describe individuals who exhibit significant anxiety and fixation on somatic (physical) symptoms, such as pain, headaches, or exhaustion
• unlike hysteria and conversion disorder, which assumed that individuals were not in fact ill, people diagnosed with somatic symptom disorder may or may not have a diagnosed medical condition
• what makes them mentally ill, if they have a recognized medical condition, is that their reaction to their physical symptoms is excessive and abnormal

Question 24

in other cases, individuals who do not exhibit any somatic symptoms worry excessively about what?

Answer 24

• the possibility of becoming ill
• this is a condition described by DSM-5 as illness anxiety disorder

Question 25

people diagnosed with illness anxiety disorder are said to be what?

Answer 25

- "easily alarmed about personal health status" and to perform excessive health-related behaviours, such as checking for signs of illness such individuals might read a newspaper story about someone falling ill and immediately begin to sense the symptoms themselves, conducting extensive internet searches to learn as much about the illness as possible

Question 26

review about somatic symptoms and related disorders

Answer 26

- while people diagnosed with somatic symptom disorder and illness anxiety disorder may make excessive use of the healthcare system, the DSM notes that their concerns are rarely alleviated by visits to physicians - such individuals may be extra-sensitive to their bodily sensations, and the DSM suggests that they are more likely than others to report feeling side effects to medications - moreover, "some feel that their medical assessment and treatment have been inadequate" - somatic symptom disorder and illness anxiety disorder highlight the complexity of the relationship between mental and physical health. In doing so, they also encourage us to consider difficult questions. ex. who gets to determine whether concerns over a person's health status are excessive should a clinician, who obviously has less at stake in the matter than the patient themselves, be able to determine whether anxieties about a symptom of a medically explained illness are excessive? Could such diagnose, while likely warranted much of the time, inadvertently pathologize those with medically unexplained illness simply because medical science has not yet found a cause>

Question 27

define somatic symptom disorder (lecture)

Answer 27

- describes individuals who have anxiety and/or a fixation on somatic symptoms such as headache and pain - replaced the term "conversion disorder" - people may or may not have a diagnosis for a physical illness that is causing their symptoms - the diagnosis of this disorder is related to an "excessive and abnormal" psychological reaction tot he physical symptoms

Question 28

Define illness anxiety disorer

Answer 28

- this disorder is characerised by excessive worry about the possibility of becoming ill, previously known as "hypochondriasis" - for both disorders, individuals may extensively and excessively utilize the healthcare system but this doe snot lessen concerns

Question 29

what are the 4 common symptom dimensions

Answer 29

- cleanin/contamination - symmetry - forbidden/taboo thoughts - harm

Question 30

What is body dysmorphic disorder characterized by?

Answer 30

- preoccupation with one or more perceived defects or flaws in physical appearance that are not observable or appear only slight to others, and by repetitive behaviours (ex. mirror checking, excessive grooming, skin picking, or reassurance seeking) or mental acts (ex. comparing one's appearance with that of other people) in response to the appearance concerns - the appearance preoccupation are not better explained by concerns with body fat or weight - muscle dysmorphia is a form of body dysmorphic disorder that is characterized by the belief that one's body build is to small or is insufficiently muscular

Question 31

What is hoarding disorder characterized by?

Answer 31

- persistent difficulty discarding or parting with possessions, regardless of their actual value, as a result of a strong perceived need to save the items and to distress associated with discarding them - differs from normal collection ex. symptoms result in the accumulation of a large number of possessions that contest and clutter active living areas to the extent that their intended use is substantially compromised - the excessive acquisition form of heading disorder, which characterized most but not all individuals with hoarding disorder, consists of excessive collecting, buying, or stealing of items that are not needed or for which there is no available space

Question 32

What is Trichotillomania (hair-pulling disorder_ characterized by?

Answer 32

- recurrent pulling out of one's hair resulting in hair loss, and repeating attempts to decrease or stop hair pulling - excoriaation (skin-picking) disorder is characterized by recurrent picking of one's skin results in skin lesions and repeating attempts to decrease or stop skin picking. - these two are not triggered by obsessions or preoccupations - however may be preceded or accompanied by various emotion states such as anxiety or boredom - sensation may lead to gratification, pleasure, or a sense of relief when the hair or skin is pulled or picked - varying degrees of conscious awareness of the behaviour while engaging in it

Question 33

What do substance/medication-induced obsessive-compulsive and related disorder consist of?

Answer 33

- consists of symptoms that are due to substance intoxication or withdrawal or to a medication