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BEHAVIORAL DYNAMICS 1 - Coggle Diagram
BEHAVIORAL DYNAMICS 1
Anxiety Disorders
Separation Anxiety
inappropriate and excessive fear concerning separation from individual attached
3/8: excessive distress while anticipating separation, excessive worry about losing major attachment figure, excessive worry about untoward events, refusal to go out, reluctance to be alone, refuse sleep out, NM, somatic
Selective Mutism
consistent failure to speak in specific social situations
at least one month
Specific Phobia
marked fear about a specific object or situation, actively avoided, anxiety is out of proportion to the actual danger
6 months or longer
Social Anxiety
marked fear about social situations, exposure to scrutiny, being observed, performing in front of others
Panic
surge of intense fear peaks within minutes; abrupt surge can occur from calm state or anxious state
4/13: palpitations, sweating, trembling, SOB, choking, chest pain, nausea, dizzy/lightheaded, chills/heat sensations, paresthesias/numbness, derealization, depersonalization, going crazy, fear of dying
at least one of the attacks followed by one month of persistent concern or worry about additional panic attacks or consequences
female>male
increased risk of suicidal thoughts/acts
risk of coronary disease doubled in pts with PD
Panic Attack Specifier
NOT a mental disorder and cannot be coded
can occur in the context of any anxiety disorder or other mental disorders or medical conditions
Agoraphobia
marked fear in 2/5 of the following situations: public transportation, open spaces, enclosed spaces, standing in line/being in a crowd, outside of the home alone
escape is difficult or help is not available
agoraphobic situations actively avoided
Generalized Anxiety 3/6
[R]estlessness
[I]rritability
[C]oncentration problems
[S]leep problems
[F]atigue
"Macbeth Frets Constantly Regarding Illicit Sins"
[M]uscle tension
6+ months
Substance/Medication-Induced Anxiety
caffeine, nicotine, withdrawal states, bronchodilators, steroids, weight loss medication, antidepressants, Metoclopramide
Anxiety Disorder due to another medical condition
hyperthyroidism, hypoglycemia, pheochromocytoma, hypoxia, pulmonary embolism, arrhythmias, traumatic brain injury, brain tumor, MS, dementia, lupus
management: CBT, antidepressants, consider BZD/atypical antipsychotics, ACT
Psychotic Disorders
Schizophrenia 2/5
[B]ehavior disorganization
[N]egative symptoms
[S]peech/thought disorganization
"Delusions Herald Schizophrenia's Bad News"
[H]allucinations
6+ months
[D]elusions
management: psychopharmacology, CBT, supportive therapy, family and group therapy
Delusional
at least 1 delusions with a duration of 1 month or longer
criterion A for schizophrenia has never been met
hallucinations, if present, are not prominent and are related to the delusional theme
functioning is not markedly impaired, and behavior is not obviously bizarre or odd
Brief Psychotic
at least one psychotic symptoms with onset & remission <1 month
delusions, hallucinations, disorganized speech, grossly disorganized or catatonic behavior
Schizophreniform
criterion A symptoms of schizophrenia
an episode of the disorder lasts at least 1 month but less than 6 months
Schizoaffective
a major mood episode + criterion A of schizophrenia; must include depressed mood
delusions or hallucinations for at least 2 weeks in the absence of a major mood episode during the lifetime duration of the illness
criteria for a major mood episode met for the majority of the total duration of the active and residual portions of the illness
Schizotypal PD
Substance-Induced Psychotic
Psychotic Disorder Secondary to GMC
PTSD
[A]rousal increase such as insomnia, irritability, hypervigilance, startle response, reckless behavior, poor concentration
"Remembers Atrocious Nuclear Attacks"
[N]egative alterations in cognition and mood
1 event, 1 avoidance, 2 negative alterations, 2 arousal increases
[A]voidance of stimuli associated with trauma
[R]e-experiencing events such as intrusive memories, flashbacks, nightmares
1+ month after the event
Somatic Disorders
Somatic Symptom
in DSM-V now covers somatization disorder and pain disorder
Pain
caused by physical factors but greatly exaggerated by psychological symptoms OR with psychological factors alone
Somatization
multiple physical complaints in multiple organ systems
excessive visits to medical providers (esp. family practice)
female>male 10:1
inversely related to socioeconomic status
excessive thoughts, feelings or behaviors related to the somatic symptoms or associated health concerns as manifested by at least one of the following: 1) disproportionate and persistent thoughts about the seriousness of one's symptoms 2) persistently high level of anxiety about health or symptoms 3) excessive time and energy devoted to these symptoms or health concerns
management: single defined clinician, brief clinic visits, avoid excessive labs and procedures, individual/group psychotherapy, psychotropic medications
at least 6 months duration of symptoms
Conversion
one or more neurological complaints, with the exception of pain (blindness/double vision, numbness, paralysis, mutism, deafness, aphonia, difficulty swallowing/lump in throat, urinary retention)
one or more symptoms of altered voluntary motor or sensory function, clinical findings provide evidence of incompatibility between the symptoms and recognized neurological or medical conditions, the symptoms or deficit is not better explained by another medical or mental disorder
with/without psychological stressor?
acute episode vs. persistent
psychological factors exacerbate symptoms
female>male 5:1
no evidence that symptom is feigned or intentionally produced
longer symptom presence = worse prognosis
management: spontaneous resolution, CBT, insight-oriented therapy, hypnosis, parenteral Amytal or Lorazepam, relaxation training
Hypochondriasis
preoccupation with fears of having/belief of having a specific illness or disease
in DSM-V now "Illness Anxiety Disorder"
care-seeking type vs. care-avoidant type
somatic symptoms are not present or if present, are only mild in intensity; examination and reassurance by provider does not relieve concerns of patient
at least 6 months duration of symptoms
management: focus on coping skills and stress reduction, group psychotherapy, CBT, frequent, regular physical exam for reassurance, pharmacology
Body Dysmorphic
exaggerated or false belief of bodily deformity or defective body part
preoccupation with an imagined bodily defect, or exaggerated distortion of a minor defect
female>male
frequently co-exists with MDD, anxiety and psychotic disorders
management: SSRIs, Pimozide, TCAs, dental, medical, surgical, dermatological interventions, treat co-existing disorders, CBT
Factitious
aka Munchausen's syndrome
falsification of physical or psychological signs or symptoms, or induction of injury or disease, associated with identified deception, individual presents him/herself to others as ill, impaired or injured, deceptive behavior is evident even in the absence of obvious external rewards
single episode vs. recurrent
Personality Disorders
Odd-Eccentric Cluster
Paranoid "SUSPECT" 4/7
[U]nforgiving
[S]uspicious of others
[P]erceives attacks
(views everyone as either an) [E]nemy or a friend
[C]onfiding in others feared
[T]hreats perceived in benign events
[S]pousal infidelity suspected
paranoid thinking is inflexible, but not delusional
reality itself is not distorted but the significance of apparent reality or judgements are misconstrued
more common in males
management: individual therapy focused on building a therapeutic alliance
Schizoid "DISTANT" 4/7
[S]exual experiences of little interest
[T]asks performed solitarily
[I]ndifferent to criticism or praise
[A]bsence of close friends
[N]either desires or enjoys close relations
[T]akes pleasure in few activities
[D]etached affect
diagnosed slightly more in males (causes more impairment)
management: individual expressive-supportive therapy, dynamic group therapy, or a combo
Schizotypal "ME PECULIAR" 5/9
[C]onstricted affect
[U]nusual thinking and speech
[E]ccentric behavior or appearance
[L]acks close friends
[P]aranoid ideation
[I]deas of reference
[E]xperiences unusual perceptions
[A]nxiety in social situations
[M]agical thinking or odd beliefs
[R]ule out psychotic disorder and autistic disorder
slightly more common in males
management: individual expressive-supportive therapy, dynamic group therapy, or a combo
Dramatic, Emotional, Erratic Cluster
Borderline "I DESPAIRR" 5/9
(frantic efforts to avoid) [A]bandonment
(recurrent) [S]uicidal behavior
[I]mpulsivity
(chronic feelings of) [E]mptiness
(inappropriate, intense) [R]age
[D]isordered, unstable affect
(a pattern of unstable and intense interpersonal) [R]elationships
[I]dentity disturbance
(transient, stress related) [P]aranoia
most often females (75%)
management: CBT, therapeutic alliance, SSRIs
Antisocial "CORRUPT" 3/7
[R]emorse lacking
[U]nderhanded
[R]eckless disregard for the safety of self or others
[P]lanning insufficient
[O]bligations ignored
[T]emper
[C]onformity to law lacking
more prevalent in males
no effective treatment
Histrionic "PRAISE ME" 5/7
[A]ttention seeking
[I]nfluenced easily
[R]elationships considered more intimate
[S]tyle of speech
[P]rovocative behavior
[E]motions rapidly shifting and shallow
[M]ade up physical appearance
[E]motions exaggerated
diagnosed more often in women (clinician gender bias)
management: individual or group dynamic therapy
Narcissistic "SPEEECIAL" 5/9
[E]ntitlement
[E]xcessive admiration required
[E]nvious
[C]onceited, grandiosity
[P]reoccupied with fantasies
[I]nterpersonal exploitation
[S]pecial
[A]rrogant
[L]acks empathy
prevalence: 50-75% male
many highly successful people display narcissistic personality traits
management: combination of individual and group therapy
Anxious-Fearful Cluster
Avoidant "CRINGES" 4/7
[G]ets around activities that involve interpersonal contact
[I]ntimate relationships avoided
[E]mbarrassment potential prevents new activities
[R]ejection possibly preoccupies thoughts
[S]elf viewed as unappealing, inept, inferior
[C]ertainty of being liked required before involvement
[N]ew relationships avoided
management: expressive-supportive therapy combined with encouragement to expose oneself to feared situations, SSRIs
Dependent "RELIANCE" 5/8
[I]nitiating projects difficult
[A]lone causes discomfort
[L]ife responsibilities assumed by others
[N]urturance needed
[E]xpressing disagreement difficult
[C]ompanionship sought urgently
[E]xaggerated fears of being left to care for self
[R]eassurance required for decisions
diagnosed more frequently in females
management: promote independent thinking and action, utilize time-limited dynamic psychotherapy
Obsessive-Compulsive "LAW FIRMS" 4/8
[F]riendships excluded due to preoccupation with work
[I]nflexible, scrupulous, overconscientious
[W]orthless objects kept
[R]eluctance to delegate
[M]iserly
[S]tubborn and rigid
[A]bility to complete tasks compromised by perfectionism
[L]oses point of activity
diagnosed twice as often in males
OCPD vs. OCD: both have preoccupations with order and organization; OCD rituals are driven by anxiety; little comorbidity
each person has a characteristic manner of thinking, feeling, behaving and relating to others; when these personality traits become to inflexible and impairing it constitutes a personality disorder
Obsessive-Compulsive and Related Disorders
OCD
[C]hecking
[S]traightening
[H]oarding
[W]ashing
"Washing and Straightening Make Clean Houses"
obsessions: recurrent thoughts, urges or images (intrusive and unwanted)
compulsions: debilitative behaviors, mental acts driven to perform in response to obsession
obsessions or compulsions are time-consuming; more than 1 hour per day
management: behavior therapy, pharmacotherapy (SSRIs, SNRIs, MAOIs), atypical antipsychotics, neurosurgery (ablative limbic system procedures)
[M]ental rituals
Hoarding
persistent difficulty discarding or parting with possessions regardless of value
management: CBT, pharmacotherapy
Trichotillomania
recurrent pulling out one hair resulting in hair loss
causes clinically significant distress and impairment in functioning
management: behavior therapy, HRT, pharmacotherapy
Excoriation Skin Picking
recurrent skin picking resulting in skin lessions
causes significant distress and impairment in functioning
management: behavioral therapy, HRT, pharmacotherapy (Fluoxetine)
Mood Disorders
Major Depressive "SIGECAAPS" 5/9
[E]nergy deficit
[A]ppetite issues
[G]uilt
[P]sychomotor retardation or agitation
[I]nterest deficit
[S]uicidality
[S]leep
(depressed) [A]ffect
(decreased) [C]oncentration or thinking, indecisiveness
pervasive for 2 weeks
management: SSRIs, TCAs, psychostimulants, CBT, interpersonal therapy, ECT, TMS
Persistent Depressive "ACHEWS" 2/6
[H]oplessness
[E]nergy deficit
[C]oncentration deficit
[W]orthlessness
[A]ppetite disorder
[S]leep disorder
depressed mood for most of the day, for more days than not, for at least 2 years; no major depressive episode; no manic, mixed or hypomanic episodes
Bipolar "DIGFAST" 3/7
[F]light of ideas
[A]ctivity increase
[G]randiosity
[S]leep deficit (decreased need for sleep)
[I]ndescretion/irritability
[T]alkativeness (pressured speech)
[D]istractibility
Consequences: impaired functioning, disrupted relationships, increased mortality, high suicide rate, financial disasters, alcohol and other substance abuse
persists for at least 1 week
management: mood stabilizers, antipsychotics, ECT, CBT, psychoeducation, family-focused therapy, social rhythm therapy, interpersonal psychotherapy