Criteria for Normality Normality is average. This means that what is accepted by the majority is considered normal. The problem here is that majority behavior is not always acceptable. Normality is Social Conformity. Anyone who conforms to social norms is normal. Normality is Social Comfort. If a person feels comfort or pleasure, then it is normal Normality is Ideal. What is good, what is socially acceptable and something that causes personal comfort. Normality is a Process. No one is instantly normal, we undergo certain processes and undergo adjustment. Example, coping
Cultural Relativism -the view that there are no universal standards or rules for labeling a behavior as abnormal -behaviors can only be abnormal relative to cultural norms
1. Culture and gender can affect ways how people express their symptoms. 2. Culture and gender can influence peoples willingness to admit certain types of behavior. 3. Culture and gender can influence the types of treatments deemed acceptable or helpful for maladaptive behaviors
Unusualness- Behaviors that are deviant, or unusual, are considered abnormal Distress-behaviors should be considered abnormal only if the individual suffers distress and wishes to be rid of the behaviors Mental Illness -Behaviors are not abnormal unless a part of a mental illness.
The Four Ds of Abnormality Dysfunction Distress Deviance Dangerousness
II. Recognizing Psychopathology Typical Signs and Symptoms of Psychopathology
Sign- Objective; Based from a clinicians observation Symptom- Subjective; Experiences of the patient SYNDROME- constellation of signs and symptoms that make up a recognizable condition, is often used to show the overlap of the two
DISTURBANCES OF CONSCIOUSNESS
Consciousness- state of awareness Apperception -perception modified by ones own thoughts and emotions Sensorium- sometimes used as another term for consciousness; refers to the state of functioning of the special senses
Disorientation disturbed orientation regarding time, place, or person. Delirium patient exhibits confusion, restlessness, bewilderment, and a disoriented reaction that is usually associated with hallucinations and fear. Clouding of consciousness a state of perceptual and cognitive confusion.
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Stupor a general condition wherein the patient exhibits extreme unresponsiveness and loss of orientation to the environment. Twilight state a disturbance in consciousness, with hallucinations. Dreamlike state another term for psychomotor epilepsy or complex partial seizure. Distractibility the inability to concentrate or focus attention because patient is easily drawn to irrelevant external stimuli. Selective attention blocking out of anxiety-causing stimuli. Hyper vigilance excessive focus and attention is given to all internal and external stimuli due to paranoia.
DISTURBANCES OF SUGGESTIBILITY
Suggestibility - uncritical and compliant response to influence or an idea.
Folie a deux (or folie a trois) emotional/mental illness shared between two (or three) persons also called shared psychosis between two (or three) persons.
Hypnosis artificially induced consciousness characterized by heightened suggestibility
DISTURBANCES IN EMOTION
Emotion a complex feeling or state related to mood and affect with psychic, somatic, and behavioral components.
Affect the expression or outward manifestation of emotion
Appropriate affect a normal condition wherein emotional tone is in harmony or is consistent with the accompanying thought, idea, or speech. It is also described as broad or full affect wherein a full range of emotions is appropriately expressed.
Inappropriate affect inconsistency between the emotional tone and the idea, thought, or speech accompanying it.
Blunted affect characterized by a severe reduction in the intensity of the externalized feeling tone.
Restricted or constricted affect reduction in the intensity of feeling tone It is less severe than blunted affect. Flat affect the absence or near absence of any signs of affective expression. It can be characterized by an immobile face and a monotonous voice. Labile affect rapid and abrupt changes in the emotional feeling tone which is unrelated to an external stimuli REVIEW CENTER FOR ALLIED PROFESSIONALS PSYCHOMETRICIAN BOARD EXAM REVIEW ABNORMAL PSYCHOLOGY
Euphoria intense elation with feelings of grandeur. Ecstasy feeling of intense rapture or delight. Depression the psychopathological feeling of sadness.
Anhedonia loss of interest and withdrawal from all regular and pleasurable activities. Often associated with depression. Grief or Mourning sadness that is appropriate to a real loss. Alexithymia the inability or difficulty in describing ones moods or emotions.
Anhedonia loss of interest and withdrawal from all regular and pleasurable activities. Often associated with depression. Grief or Mourning sadness that is appropriate to a real loss. Alexithymia the inability or difficulty in describing ones moods or emotions.
Agitation motor restlessness associated with severe anxiety. Tension unpleasant increased motor and psychological activity. Panic acute, episodic, intense anxiety attack associated with overwhelming feelings of dread. Apathy dulled emotional tone associated with indifference or detachment Ambivalence presence of two opposing impulses toward the same thing, in the same person, at the same time.
PHYSIOLOGICAL DISTRUBANCES ASSOCIATED WITH MOOD
Physiological disturbances associated with mood
Signs that refer to the somatic (usually autonomic) dysfunction of a person, which are most often associated with depression; also known as vegetative signs.
Anorexia loss of or decrease in appetite. Hyperphagia increase in appetite and food intake. Hypersomnia excessive sleeping.
Insomnia difficulty or lack the lack of ability to fall asleep. Initial difficulty in falling asleep. (early onset) Middle REVIEW CENTER FOR ALLIED PROFESSIONALS PSYCHOMETRICIAN BOARD EXAM REVIEW ABNORMAL PSYCHOLOGY
difficulty in sleeping through the night without waking up; difficulty in going back to sleep if awaken in the middle of the night. (middle onset) Terminal early morning awakening. (late onset)
Diurnal variation mood is regularly worst in morning, immediately after awakening, and improves as the day progresses.
Diminished libido decreased sexual interest, drive, and performance. Increased libido is usually associated with manic states.
Constipation inability or difficulty in defecating
DISTURBANCES IN MOTOR FUNCTIONING
Echopraxia the persons pathological imitation of movements of another person. Catatonia motor anomalies in non-organic disorders (as opposed to disturbances of consciousness and motor activity secondary to organic pathology) Negativism motiveless resistance to all instructions or to all attempts to be moved.
Catalepsy general term used to describe an immobile position that is constantly maintained. Catatonic Excitement agitated, purposeless motor activity that is uninfluenced by external stimuli. Catatonic Stupor noticeable slowed motor activity, often to a point of immobility and seeming unawareness of surroundings. Catatonic Rigidity voluntary assumption of a rigid posture, held against all efforts to be moved. Catatonic Posturing voluntary assumption of an inappropriate or bizarre posture which is generally maintained for long periods of time. Cerea Flexibilitas (Waxy Flexibility) a condition wherein the person can be molded into a position that is then maintained. When the examiner moves the persons limb, the limb feels as if it were made of wax.
Cataplexy temporary muscle weakness and loss of muscle tone precipitated by a variety of emotional states. Stereotypy repetitive fixed pattern of physical action or speech.
Mannerism deep-seated/ingrained and habitual involuntary movement.
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Automatism automatic performance of an act or acts generally representative of unconscious symbolic activity. Command Automatism automatic following of suggestions. (automatic obedience) Mutism voicelessness that is not caused by structural abnormalities or physical conditions.
Overactivity abnormality in motor behavior that can manifest itself as psychomotor agitation, hyperactivity, tic, sleepwalking, or compulsions Psychomotor Agitation excessive motor and cognitive overactivity, usually nonproductive and in response to inner tension. Hyperactivity (Hyperkinesis) restless, aggressive, and destructive activity, often associated with some underlying organic pathology. Tic involuntary, spasmodic motor movement. Sleepwalking (Somnambulism) motor activity during sleep.
Akathisia subjective feeling of muscular tension secondary to antipsychotic or other medication, which can cause restlessness, pacing, repeated sitting and standing; can be mistaken for psychotic agitation.
Compulsion uncontrollable impulse to perform an act repetitively
Dipsomania compulsion to drink alcohol.
Kleptomania compulsion to steal.
Nymphomania excessive and compulsive need for coitus in a woman.
Satyriasis excessive and compulsive need for coitus in a man. Trichotillomania compulsion to pull out ones hair.
Ritual automatic activity compulsive in nature, anxiety-reducing in origin.
Hypoactivity (Hypokinesis) decreased motor and cognitive activity, as in psychomotor retardation; visible slowing of thought, speech and movements. Mimicry simple, imitative motor activity of childhood. Aggression forceful goal-directed action that may be verbal or physical; the motor counterpart of the affect of rage, anger, or hostility. Acting out direct expression of an unconscious wish or impulse in action; unconscious fantasy is lived out impulsively in behavior.
DISTURBANCES IN THINKING
Thinking the goal-directed flow of ideas. REVIEW CENTER FOR ALLIED PROFESSIONALS PSYCHOMETRICIAN BOARD EXAM REVIEW ABNORMAL PSYCHOLOGY
Symbols and associations initiated by problem or task and leading toward a reality- oriented conclusion.
GENERAL DISTURBANCES IN THE FORM OF THINKING
Mental disorder clinically significant behavioral or psychological syndrome that is associated with distress or disability, and not just an expected response to a particular event. Psychosis inability to distinguish reality from fantasy. Impairment in reality testing, with creation of a new reality. Reality testing the objective evaluation and judgment of the world outside the self.
Formal though disorder
disturbance in the form of thought instead of the content of thought. Thinking is characterized by loosened associations, neologisms, and illogical constructs. Thought process is disordered and the person defined psychotic.
Illogical thinking thinking containing erroneous conclusions or internal contradictions. It is considered psychopathological only when it is marked and when not caused by cultural values or intellectual deficit.
Dereism mental activity not concordant with logic experience.
SPECIFIC DISTURBANCES IN THE FORM OF THOUGHT
Autistic Thinking thinking that gratifies unfulfilled desires but has no regard for reality a preoccupation phase in children in which thoughts, words, or actions assume power. Magical thinking a form of dereistic thought; thinking similar to that of the preoperational phase in children (Jean Piaget), in which thoughts, words, or actions assume power (e.g., to cause or to prevent events). Primary process thinking general term for thinking that is dereistic illogical and magical normally found in dreams, abnormally in psychotics.
GENERAL DISTURBANCES IN THE FORM OR PROCESS OF THINKING
Neologism new word or phrase whose derivation cannot be understood often seen in schizophrenia it has also been used to mean a word that has been incorrectly constructed but whose origins are nonetheless understandable (e.g., headshoe to mean hat), but such constructions are more properly referred to as word approximations. Word Salad incoherent, essentially incomprehensible, mixture of words and phrases commonly seen in far-advanced cases of schizophrenia (See also incoherence.). Circumstantiality REVIEW CENTER FOR ALLIED PROFESSIONALS PSYCHOMETRICIAN BOARD EXAM REVIEW ABNORMAL PSYCHOLOGY
disturbance in the associative thought and speech processes in which a patient digresses into unnecessary details and inappropriate thoughts before communicating the central idea observed in schizophrenia, obsessional disturbances, and certain cases of dementia. Tangentiality oblique, digressive, or even irrelevant manner of speech in which the central idea is not communicated. Incoherence thought that, generally is not understandable patient never gets from desired point to desired goal. Perseveration pathological repetition of the same response to different stimuli, as in a repetition of the same verbal response to different questions persistent repetition of specific words or concepts in the process of speaking. Seen in cognitive disorders, schizophrenia, and other mental illness. Verbigeration meaningless and stereotyped repetition of words or phrases, as seen in schizophrenia also called cataphasia. Echolalia a persons psychopathological repeating of words or phrases of by another tends to be repetitive and persistent Seen in certain kinds of schizophrenia, particularly the catatonic types. Condensation mental process in which one symbol stands for a number of components. Irrelevant answer answer that is not in harmony with question asked.
Loosening of associations characteristic schizophrenic thinking or speech disturbance involving a disorder in the logical progression of thoughts manifested as a failure to communicate verbally adequately unrelated and unconnected ideas shift from one subject to another. Derailment gradual or sudden deviation in train of thought without blocking sometimes used synonymously with loosening of association. Flight of ideas rapid succession of fragmentary thoughts or speech in which content changes abruptly and speech may be incoherent.
Clang association association or speech directed by the sound of a word rather than by its meaning words have no logical connection punning and rhyming may dominate the verbal behavior. Seen most frequently in schizophrenia or mania. Blocking abrupt interaction in train of thinking before a thought or idea is finished after brief pause, person indicates no recall of what was being said or was going to be said. Glossolalia unintelligible jargon that has meaning to the speaker but not to the listener occurs in schizophrenia. Poverty of content thought that gives little information because of vagueness, empty repetitions, or obscure phrases. Overvalued idea REVIEW CENTER FOR ALLIED PROFESSIONALS PSYCHOMETRICIAN BOARD EXAM REVIEW ABNORMAL PSYCHOLOGY
false or unreasonable belief or idea that is sustained beyond the bounds of reason; it is held with less intensity or duration than a delusion, but is usually associated with mental illness. Delusion false belief, based on incorrect inference about external reality, not consistent with patients intelligence and cultural background that cannot be corrected by reasoning
SPECIFIC DISTURBANCES IN THE CONTENT OF THOUGHT
Bizarre delusion false belief that is patently absurd or fantastic (e.g., invaders from space have implanted electrodes in a person's brain), common in schizophrenia. Systematized delusion group of elaborate delusions related to a single event or theme. Mood-congruent delusion delusion with content that is mood appropriate (e.g., depressed patients who believe that they are responsible for the destruction of the world). Mood-incongruent delusion delusion with content that has no association to mood or is mood-neutral. Nihilistic delusion depressive delusion that the world and everything related to it have ceased to exist. Delusion of poverty false belief that one is bereft or will be deprived of all material possessions Somatic Delusion delusion pertaining to the functioning of one's body.
Paranoid delusions includes persecutory delusions and delusions of reference, control, and grandeur Delusion of persecution Delusion of grandeur Delusion of reference
Delusion of self-accusation false feeling of remorse and guilt. Seen in depression with psychotic features.
Delusion of control false belief that a person's will, thoughts, or feelings are being controlled by external forces. Thought withdrawal Thought insertion Thought broadcasting
Delusion of infidelity false belief that one's lover is unfaithful. Sometimes called pathological jealousy. Erotomania delusional belief, more common in women than in men, that someone is deeply in love with them (also known as de Clrembault syndrome). Pseudologia fantastica a type of lying, in which the person appears to believe in the reality of his or her fantasies and acts on them. Preoccupation of thought centering of thought content on a particular idea, associated with a strong affective tone, such as a paranoid trend or a suicidal or homicidal preoccupation. Egomania morbid self-preoccupation or self-centeredness. Monomania REVIEW CENTER FOR ALLIED PROFESSIONALS PSYCHOMETRICIAN BOARD EXAM REVIEW ABNORMAL PSYCHOLOGY
mental state characterized by preoccupation with one subject. Hypochondria exaggerated concern about health that is based not on real medical pathology, but on unrealistic interpretations of physical signs or sensations as abnormal. Obsession persistent and recurrent idea, thought, or impulse that cannot be eliminated from consciousness by logic or reasoning obsessions are involuntary and ego-dystonic.
Compulsion pathological need to act on an impulse that, if resisted, produces anxiety repetitive behavior in response to an obsession or performed according to certain rules, with no true end in itself other than to prevent something from occurring in the future.
Coprolalia involuntary use of vulgar or obscene language. Observed in some cases of schizophrenia and in Tourette's syndrome. Phobia persistent, pathological, unrealistic, intense fear of an object or situation the phobic person may realize that the fear is irrational but, nonetheless, cannot dispel it.
Simple phobia Social phobia Acrophobia Algophobia Claustrophobia Xenophobia Zoophobia
Noesis a revelation in which immense illumination occurs in association with a sense that one has been chosen to lead and command. Unio mystica feeling of mystic unity with an infinite power.
DISTURBANCE IN SPEECH
Speech ideas, thoughts, feelings as expressed through language; communication through the use of words and language.
Pressure of Speech rapid speech that is increased in amount difficult to interpret. Volubility (logorrhea) copious, coherent, logical speech excessive talking observed in manic episodes of bipolar disorder. (also known as tachylogia, verbomania)
Poverty of Speech restriction in the amount of speech used; replies may be mono-syllabic.
Dysarthria difficulty in articulation, not in word finding or in grammar. Excessively loud or soft speech loss of modulation of normal speech volume REVIEW CENTER FOR ALLIED PROFESSIONALS PSYCHOMETRICIAN BOARD EXAM REVIEW ABNORMAL PSYCHOLOGY
may reflect a variety of pathological conditions ranging from psychosis to depression to deafness. Stuttering frequent repetition or prolongation of a sound or syllable, leading to markedly impaired speech fluency. Cluttering erratic and dysrhythmic speech, consisting of rapid and jerky spurts.
APHASIC DISTURBANCES
Dysarthria difficulty in articulation, not in word finding or in grammar. Excessively loud or soft speech loss of modulation of normal speech volume may reflect a variety of pathological conditions ranging from psychosis to depression to deafness. Stuttering frequent repetition or prolongation of a sound or syllable, leading to markedly impaired speech fluency. Cluttering erratic and dysrhythmic speech, consisting of rapid and jerky spurts.
Syntactical Aphasia inability to arrange words in proper sequence. Jargon Aphasia words produced are totally neologistic nonsense words repeated with various intonations and inflections. Global Aphasia combination of a grossly non-fluent aphasia and a severe fluent aphasia.
DISTURBANCES OF PERCEPTION
Perception process of transferring physical stimulation into psychological information; the mental process by which sensory stimuli are brought into awareness.
Illusion misperception or misinterpretation of real external sensory stimuli.
Hallucination false sensory perception not associated with real external stimuli there may or may not be a delusional interpretation of the hallucinatory experience hallucinations indicate a psychotic disturbance only when associated with impairment in reality testing Hypnagogic Hallucination false sensory perception occurring while falling asleep; generally considered a non- pathological phenomenon. Hypnopompic Hallucination false perception occurring while awakening from sleep generally considered non-pathological.
Auditory Hallucination false perception of sound, usually voices but also other noises such as music; most common hallucination in psychiatric disorders.
Visual Hallucination REVIEW CENTER FOR ALLIED PROFESSIONALS PSYCHOMETRICIAN BOARD EXAM REVIEW ABNORMAL PSYCHOLOGY
false perception involving sight consisting of both formed images(e.g. people) and unformed images (e.g. flashes of light) most common in organically determined disorders. Olfactory Hallucination false perception in smell most common in organic disorders. Gustatory Hallucination false perception of taste, such as unpleasant taste caused by an uncinate seizure most common in organic disorders. Tactile (Haptic) Hallucination false perception of touch or surface sensation, as from an amputated limb (phantom limb), crawling sensation on or under the skin (formication).
Somatic Hallucination false sensation of things occurring in or to the body, most often visceral in origin (also known as cenesthetsic hallucination).
Lilliputian Hallucination false perception in which objects are seen as reduced in size (also termed micropsia).
Mood-congruent Hallucination a kind of hallucination wherein the content of which is consistent with either a depressed or manic mood (e.g. a depressed patient hears voices saying that the patient is a bad person a manic patient hears voices saying that the patient is inflated of worth, power, knowledge, etc.)
Mood-incongruent Hallucination Hallucination whose content is not consistent with either depressed or manic mood (e.g. in depression, hallucinations not involving such themes as guilt, deserved punishment, or inadequacy in mania, hallucinations not involving such themes as inflated worth or power)
Hallucinosis Hallucinations, most often auditory, that are associated with chronic alcohol abuse and that occur within a clear sensorium. Trailing Phenomenon perceptual abnormality associated with hallucinogenic drugs in which moving object are seen as a series of discrete and discontinuous stages.
DISTURBANCES ASSOCIATED WITH ORGANIC MENTAL DISORDER
Anosognosia inability to recognize illness as occurring to oneself. Autotopagnosia inability to recognize a body part as ones own. Visual Agnosia inability to recognize objects or persons. Astereognosia inability to recognize objects by touch.
Prosopagnosia inability to recognize faces.
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Apraxia inability to carry out specific tasks.
DISTURBANCES ASSOCIATED WITH CONVERSION AND ASSOCIATIVE DISSOCIATION
Astereognosia -inability to recognize objects by touch.
Prosopagnosia- inability to recognize faces.
Apraxia- inability to carry out specific tasks.
Somatization of repressed material or the development of physical symptoms and distortions involving the voluntary muscle or special sense organs not under voluntary control and not explained by any physical disorder
DISTURBANCES ASSOCIATED WITH CONVERSION AND DISSOCIATIVE PHENOMENA
Hysterical Anesthesia loss of sensory modalities resulting from emotional conflicts. Macropsia state in which objects seem larger than they are. Micropsia state in which objects seem smaller than they are (both macropsia and micropsia can also be associated with clear organic conditions such as complex partial seizures).
Depersonalization a subjective sense of being unreal, strange, or unfamiliar to oneself. Derealization a subjective sense that the environment is strange or unreal a feeling of changed reality. Fugue taking on a new identity with amnesia for the old identity often involves travel or wandering to new environments. Multiple personality one person who appears at different times to be in possession of an entirely different personality and character.
DISTURBANCES OF MEMORY
Memory function by which information stored in the brain is later recalled to consciousness
Amnesia partial or total inability to recall past experiences; may be organic or emotional in origin. Paramnesia falsification of memory by distortion of recall.
Fausse reconnaissance false recognition.
Retrospective falsification REVIEW CENTER FOR ALLIED PROFESSIONALS PSYCHOMETRICIAN BOARD EXAM REVIEW ABNORMAL PSYCHOLOGY
memory becomes unintentionally (unconsciously) distorted by being filtered through patients present emotional, cognitive, and experiential state.
Confabulation unconscious filling of gaps in memory by imagined or untrue experiences that patient believes but that have no basis in fact; most often associated with organic pathology.
Dj vu illusion of visual recognition in which a new situation is correctly regarded as a repetition of a previous memory.
Dj entendu illusion of auditory recognition.
Dj pense illusion that a new thought is recognized as a thought previously felt or expressed.
Jamias vu false feeling of unfamiliarity with a real situation one has experienced.
False memory a persons recollection and belief by the patient of an event that did not actually occur.
Hypermnesia exaggerated degree of retention and recall.
Eidetic image visual memory of almost hallucinatory vividness.
Screen memory a consciously tolerable memory covering for a painful memory.
Repression a defense mechanism characterized by unconscious forgetting of unacceptable ideas or impulses.
Lethologica temporary inability to remember a name or a proper noun. Blackout amnesia experienced by alcoholics about behavior during drinking bouts usually indicates that reversible brain damage has occurred.
LEVELS OF MEMORY
Immediate reproduction or recall of perceived material within seconds to minutes.
Recent recall of events over past few days.
Recent past recall of events over past few months.
Remote recall of events in distant past.
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DISTURBANCES OF INTELLIGENCE
Intelligence
the ability to understand, recall, mobilized, and constructively integrates previous learning in meeting new situations.
Mental Retardation
Lack of intelligence to a degree in which there is interference with social and vocational performance
Mild I.Q. of 50 or 55 to approximately 70 Moderate I.Q. of 35 or 40 to 50 or 55 Severe I.Q. of 20 or 25 to 35 or 40 Profound I.Q. below 20 or 25
Dementia organic and global deterioration of intellectual functioning without clouding of consciousness Pseudodementia clinical features resembling a dementia not caused by an organic mental dysfunction most often caused by depression. Concrete thinking literal thinking limited use of metaphor without understanding of nuances of meaning one dimensional thought. Abstract thinking ability to appreciate nuances of meaning multidimensional thinking with ability to use metaphors and hypotheses appropriately.