Abnormal Psychology

Hellow, future R.P.M!

Doubt is definitely going to eat you this review season. I just want you to know that it is very valid to feel that way. But always remember to go back to the reason why you are doing this.

May this reviewer help you pass the boards like it did to me and to many people that I know less than 3

We will be remembered ✨

Normalcy and Abnormalcy (5)

Recognizing Normal and Abnormal manifestations of behavior

- Psychological Disorder — psychological dysfunction within an individual associated with distress or impairment in functioning and a response that is not typical or culturally expected

○ 4 D's of Psychological Disorder

a. Psychological Dysfunction – refers to a breakdown in cognitive, emotional, or behavioral functioning Interferes daily functioning

b. Distress or Impairment – individual is extremely upset and cannot function properly

- Either to self or to others

c. Atypical or Not Culturally Expected (Deviance) - deviates from the average or the norm of the culture

- Not just to the society but deviation from the person's usual behavior

d. Dangerousness – creates potential harm to self (suicidal gestures) and others (excessive aggression)

e. Duration – how long the mental state has been persisting

■ Constant fluctuation of mood, thoughts, and behaviors is normal, but if changes is sustained, persistent and pervasive, it can be concerning

○ Psychopathology – scientific study of mental disorders

○ Clinical Psychology – applied branch of psychology that seeks to understand, assess, and treat psychological conditions in a clinical setting

○ Abnormal Psychology – branch of psychology that studies unusual patterns of behavior, emotions, and thought which may or may not indicate an underlying condition

- Normal Behavior – one behavior that is like other people in the society

- Normality is social conformity – some behaviors are non-conforming but normal

- Normality is personal comfort

- Normality is a process

- Criteria for determining Abnormal Behavior

- ✓ Norm-violation

- ✓ Statistical rarity

- ✓ Deviation

- ✓ Maladaptiveness

- Clinical Assessment – the systematic evaluation and measurement of psychological, biological, and social factors in an individual presenting with a possible psychological disorder

- Diagnosis – process of determining whether the particular problem afflicting the individual meets all criteria for a psychological disorder

- Epidemiology – study of the distribution of diseases, disorders, or health-related behaviors in a given population

- Prevalence – number of active cases in a population during a given period of time

- Point Prevalence – proportion of actual, active cases of a disorder in a given population at a given point in time

○ 1 Year Prevalence – everyone who experienced depression at any point in time throughout the entire year

- Lifetime Prevalence – estimate number of people who have had a particular disorder at any time in their lives

○ Incidence – number of new cases occur over a given period of time

○ Sign – manifestation of disease that the physicians receive

○ Symptom — subjective representation of the complaints of the patient

- Syndrome – group of symptoms that occur together more often by chance

Table summary: The table lists the different categories of the DSM-IV diagnostic axes, ranging from clinical disorders to psychosocial and environmental problems.

Axis V: Global Assessment of Functioning

Theoretical Approaches in Explaining the Etiology of Psychological Disorders

○ One-Dimensional – looking for a single cause

○ Multidimensional – looking for a systemic cause

Genetic contributions

- Genes – long molecules of D.N.A at various locations on chromosomes, within cell nucleus

■ Chromosomes: the chain-like structures within a cell nucleus that contain the genes

- Genes: carries of the information we inherit from our parents

46 Chromosomes, 23 Pairs, 22 Pairs of Autosomes, 1 pair Sex Chromosomes

○ X.X-female, X.Y-male

- ☐ Dominant and Recessive

○ Phenotypes – observable characteristic

○ Genotypes – unique genetic makeup

○ Polymorphisms – naturally occurring variations of genes

- Polygenic – influenced by multiple genes or by multiple polymorphisms of genes with any one gene having only very small effects

○ Endophenotypes – genetic mechanisms that ultimately contribute to the underlying problems causing the symptoms and difficulties experienced by people with psychological disorders

○ Basic Genetic Epidemiology – statistical analysis of family, twin, and adoption studies; if the disorder can be inherited and how much is attributable to genetics

○ Advanced Genetic Epidemiology – studies the factors that influence the disorder

○ Gene Finding – what gene influences the behavior

○ Molecular Genetics – biological analysis of individual D.N.A samples; biological processes genes affect to produce symptoms of the disorder

○ Family Studies – examine behavioral pattern or emotional trait in the context of the family

- Proband – family member with the trait singled out for study

- The first person in the family to be identified as possibly having genetic disorder and who may receive genetic counseling or testing

○ Adoption Studies – identify adoptees who have a particular behavioral pattern or psychological disorder and attempt to locate first-degree relatives who were raised in different family settings

○ Twin Studies – usually conducted to identical twins because they share genetic makeup'

- Those people who reported more severe stressful life events and had at least one short allele of the 5-H.T.T gene were at greater risk of developing depression (serotonin-transporter gene)

- Epigenetics – factors other than inherited D.N.A sequence, such as new learning or stress, that alter the phenotypic expression of genes

Biological and Neurological Bases

○ Neuroscience — study of the nervous system, especially the brain to understand behavior, emotions, and cognitive processes

Table summary: This table illustrates the relationship between neurotransmitter levels and various psychological or neurological conditions, showing how either an excess or a deficiency of specific chemicals is associated with different disorders.

○ Synapse – a tiny fluid-filled space between the axon endings of one neuron and the dendrites or cell body of another neuron

○ Agonist – effectively increase the activity of the neurotransmitters (Excitatory)

Antagonist – decrease or block neurotransmitter (Inhibitory)

○ Inverse Agonists – produces effects opposite to those produced by the neurotransmitters

○ Reuptake – neurotransmitter is released, quickly broken down and brought back to the synaptic cleft

Hormones – chemical messengers secreted by the endocrine glands in the body

○ Neurotransmitter - chemical messengers of the body

a) Glutamate (E) [ memory ]-most abundant in the brain and plays a key role in thinking, learning, and memory b) gaba (1) [calming] - most common inhibitory neurotransmitter in the brain and regulates mood, irritability, sleep, seizures

c) Serotonin (1) [ mood ]-regulates mood, sleep patterns, sexuality, appetite, and pain

d) Dopamine [ pleasure ]-body reward system, pleasures, achieving heightened arousal and learning

e) Epinephrine [ fight-or-flight ] – responsible for fight-or-flight response

f) Norepinephrine [ concentration ] - alertness, arousal, decision-making, attention, and focus

g) Endorphins [ euphoria ]-natural pain reliever, reduces pain

h) Acetylcholine (E) [learning] - regulates heart rate, blood pressure and gut motility, role in muscle contraction, memory, motivation, sexual desire, sleep, and learning

○ Brain Stem – lower and more ancient part of the brain; essential for autonomic functioning such as breathing, heartbeat, etcetera

- Hindbrain – contains the medulla, pons, and cerebellum; regulates many autonomic activities such as breathing, heartbeat, and digestion

- Cerebellum – controls motor coordination abnormalities associated with autism

- Midbrain – coordinates movements with sensory input and contains parts of reticular activating system (contributes to sleep, arousal and tension)

- Thalamus and Hypothalamus – involves in regulating behavior, emotions, and hormones

- Limbic System – located around the edge of the center of the brain

- Hippocampus, Cingulate Gyrus, Septum, and Amygdala

- Amygdala – emotions

- Hippocampus – shrinks when a person has depression

- Regulate emotional experiences and expressions and, to some extent, our ability to learn and to control impulses

- Basal Ganglia – base of the forebrain, includes caudate nucleus

■ Damage involved changing our posture or twitching or shaking

- Related to Parkinson's Disease

- Cerebral Cortex – provides us with our distinctly human qualities, allowing us to look to the future and plan, to reason, and to create

- Left Hemisphere – responsible for verbal and other cognitive processes

- Right Hemisphere – perceiving the world around us and creating images

- Lobes: Frontal, Parietal, Occipital, Temporal

- Prefrontal Cortex – area responsible for higher cognitive functions

- H.P.A Axis – Hypothalamus, Pituitary Gland, Adrenal Cortex

○ Somatic Nervous System – controls the muscles

○ Autonomic Nervous System – regulate cardiovascular system and endocrine system

- Sympathetic – fight or flight responses

- Parasympathetic - calms the sympathetic nervous system; rest and digest functions

○ Endocrine System – glands produce hormones that is released to the blood streams

- Pituitary – master gland

- Thyroid - controls metabolism and growth (thyroxine)

- Parathyroid – controls the levels of calcium

- Adrenal – controls metabolism, blood pressure, sex development, stress (epinephrine)

- Pineal – releases melatonin

- Pancreas – creates insulin

■ Testes – makes sperm and release testosterone

- Ovaries – releases estrogen, progesterone, and testosterone

Hypothalamic-Pituitary-Adrenal Axis

1. Messages in the form of corticotropin-releasing hormone (C.R.H) travel from the hypothalamus to pituitary gland

2. Pituitary Gland releases adrenocorticotropic hormone (A.C.T.H), which stimulates the cortical part of the adrenal gland (located at the top of the kidney) to produce epinephrine (adrenaline) and cortisol (stress hormone), which is released into the general circulation

3. Cortisol gives negative feedback to the hypothalamus and pituitary to decrease their release of C.R.H and A.C.T.H, which in turn reduces the release of adrenaline and cortisol

o Temperament – refers to a child's reactivity and characteristic ways of self-regulation

As early as 2 to 3 months of age, approximately five dimensions of temperaments can be identified: fearfulness, irritability/frustration, positive affect, activity level, and attentional persistence/effortful control

○ Permissive Hypothesis – when serotonin (norepinephrine) levels are low, other neurotransmitters are permitted to range more widely, become dysregulated, and contribute to mood irregularities

Table summary: The table maps various brain structures to their corresponding behavioral functions, illustrating the specialized roles of different regions in managing cognitive processes, emotional regulation, sensory integration, and vital physiological operations.

Learning

- Classical Conditioning – type of learning in which neutral stimulus is paired with response until it elicits that response

- Unconditioned Stimulus – natural stimulus

- Unconditioned Response – natural or unlearned response

- Conditioned Stimulus - newly conditioned event introduced

■ Conditioned Response – response from the conditioned stimulus

- Extinction – without C.S showed long enough, the behavior could be eliminated

- Stimulus Generalization – strength of the response to similar objects or people is usually a function of how similar these objects or people are

E.g., You are afraid of fury dogs because they once attacked you. Now, whenever you see something fury, your body trembles, you cannot breathe properly and wanted to go away.

○ Introspection – Edward Titchener; subjects report their inner thoughts and feelings after experiencing certain stimuli

○ John B. Watson – founder of behaviorism Little Albert

○ Systematic Desensitization – patients were gradually introduced to the objects or situations they feared so that their fear could extinguish

- Operant Conditioning – behavior changes as a function of what follows the behavior (rewards or punishment)

B.F. Skinner

- Edward Thorndike – Law of effect (behavior can be strengthened or weakened)

- Reinforcement – reward

■ Shaping – process of reinforcing successive approximations to a final behavior or set of behaviors

Social Learning – Albert Bandura

Modeling/observational learning: process of learning in which an individual acquires responses by observing and imitating others

Observational learning

■ Social Cognitive Theory: people observe models, learns chunks of behavior, and mentally put chunks together into complex new behavior patterns

Albert Bandura

Hitting Doll experiment

Self-Efficacy – person's confidence in their own abilities to accomplish their goals

Learned Helplessness – when rats or other animals encounter conditions over which they have no control, they give up attempting to cope and seem to develop the animal equivalent of depression

Martin Seligman and colleagues

People make an attribution that they have no control, and become depressed

■ Causes: coercive, ineffective, inconsistent parents, media violence, peer rejection

Internal: negative effects due to internal failings

Stable: even after a particular negative events pass, additional bad things will “always be my fault” remains

Global: attributions extend across a variety of issues

Learned Optimism – if people faced with considerable stress and difficulty in their lives, nevertheless, display optimistic, upbeat attitude, they are likely to function better psychologically and physically

Positive Psychology

○ Prepared Learning – we have become highly prepared for learning about certain types of objects or situations over the course of evolution because this knowledge contributes to the survival of the species

Learning from ancestors

○ Hopelessness Theory – desirable outcomes will not occur, and that the person has no responses available to change this situation

Cognitive theories with Psychoanalytic

○ Fear – fight or flight response

Evolutionary adaptation

White with fear, trembling, faster breathing, increase in glucose, pupil dilate, hearing become more acute, digestive system stops, pressure to urinate, defecate, vomit to reduce waste materials

○ Introjection – direct all their feelings for the loved one, including sadness and anger, toward themselves

Symbolic or Imagined Loss – person equates other kinds of events with the loss of a loved one

Does not necessarily involve death of a person

E.g., an athlete got injured and can no longer do the sport they have been doing for a long time

☑ Introjected Loss: actual death of a person

Attributional Style – ways in which people explain the cause of events within their lives

Internal-External – who or what is responsible for the event

- whether something unique about the person (internal) or something about the situation caused the event (external)

Stable-Unstable – perceived permanence of the cause

- an event can be viewed as constant and likely to happen again (stable) or it only happens once (unstable)

Global-Specific – universal throughout your life (global) or specific to a part of your life (specific)

○ Cognitive Theory of Depression - persons susceptible to depression develop inaccurate/unhelpful core beliefs about themselves, others, and the world as a result of their learning histories

- Depressed people consistently think in illogical ways and keep arriving at self-defeating conclusions

- Tends to Overgeneralize (draw broad negative conclusions on the basis of single insignificant event) [ Cognitive Bias ]

- Depressive Cognitive Triad: depressed people make cognitive errors in thinking negatively about themselves, immediate world, and their future

- Beck Hopelessness Scale

- Negative Schema: an enduring negative cognitive system about some aspects of life

- Self-Blame Schema: people feel personally responsible for every bad happenings

- Negative Self-Evaluation Schema: “can never do anything correctly”

- False Consensus Effect/False Consensus Bias: people tend to overestimate the extent to which their opinions, beliefs, preferences, values, and habits are normal and typical of the others ("Everyone shares the same opinion as me.")

Table summary: The table outlines various types of negative cognitive styles, providing definitions and illustrative examples for patterns such as extreme thinking, overgeneralization, egocentric interpretation of events, selective focus on negatives, and drawing conclusions without factual evidence.

-/passed, "chamba",/negative "kasalanan ko kasi"

Labeling and Mislabeling

- portraying one's identity on the basis of imperfections and mistakes made in the past and allowing them to define one's true identity

- /bullied for being dark-skinned, "I am ugly."

Minimization

- downplaying the significance of an event or emotion

- common strategy in dealing with feelings of guilt

- “Parang nakakarami ka na ah,”

- “Luh parang tanga, sampung bote pa lang”

Magnification

- effects of one's behaviors are magnified

-/may konting mantsa sa damit, “Iniisip siguro nila hindi ako naglalaba,”

○ General Adaption to Stress Theory – understanding the relationship between stressful events and the body's response to stress

- Alarm: fight-or-flight response

- Resistance: coping mechanisms

- Exhaustion: body defenses resources are depleted

- Hans Selye

○ Stress-Appraisal/Cognitive Appraisal Theory – stress is a two-way process, it involves a production of stressors and the response of an individual subjected to these stressors

- Primary Appraisal: an individual tends to ask questions like, “What does this stressor and/or situation mean?”, and “How can it influence me?”

- Understanding the stressor

○ Secondary Appraisal: involves those feelings related to dealing with the stressor or the stress it produces

- Deals with the stressor

- Starts to assess internal and external resources available to solve the problem

- Positive: “I can do it if I do my best,”

- Negative: “I cannot do it.” ☐ Types of Amnesia:

Table summary: The table provides a comprehensive list of various memory disorders, detailing different types of memory impairment, distortions, and abnormalities.

1. Biogenic-caused by brain damage or disease

- Retrograde – inability to retrieve information that was acquired before (remote memory loss)

- Anterograde – inability to transfer new information from the short-term store to long-term store (recent memory loss)

2. Psychogenic or Dissociative or Functional – caused by psychological trauma, repressed memories

Generalized – origin is rare psychological disorder and spontaneous recovery from amnesia in a comparatively short period of time

Localized – no memory of specific events

Selective – can only recall only small parts of the events

Situation-Specific – result of severely stressful event, as part of P.T.S.D

Global – cannot recall both past and present; total memory loss

Memory – the process by which we encode, store, and retrieve information

Declarative: factual information

Procedural: skills and habits

Semantic: general knowledge and facts, logic

■ Episodic: events that occur in a particular time, place, or context

○ Three-System Approach to Memory – information must travel if it is to be remembered

Sensory: initial storage of information, perceived by the senses

Short-Term Memory: holds info for 15 to 20 seconds

Long-Term Memory – stores on a relatively permanent basis, although, at times, it can be difficult to retrieve

� Chunks – meaningful grouping of stimuli that can be stored as a unit in S.T.M

Rehearsal – repetition of information that has entered the S.T.M

Repetitive: as long as it is repeated, it states in the S.T.M

Elaborative: transfers info to L.T.M

Tip-Of-The-Tongue Phenomenon – inability to recall information that one realizes one knows

○ Retrieval Cue – allow us to recall more easily

Recall: memory task in which specific information is retrieved

■ Recognition: individual is presented with a stimulus and asked whether they have been exposed to it in the past or to identify it from the list of alternatives

- Levels-Of-Processing Theory – degree to which new materials is mentally analyzed

- Implicit Memory: can be recalled automatically without thinking

- Explicit Memory: requires conscious retrieval of information

○ Constructive Processes – memories are influenced by the meaning we give to them

- Autobiographical: episodes from our own lives

- Flashbulb Memories: specific or surprising events that are so vivid in memory it as if they represented a snapshot of the event

- Forgetting – permits us to form general impressions and recollections

- Helps us avoid being burdened and distracted by trivial stores of meaningless data

- Failure of Encoding: failure to pay attention and place information in memory

- Decay: loss of information due to non-use

- Cue-Dependent Forgetting: insufficient retrieval cues

- Proactive Interference: learned earlier disrupts the recall of newer material; you forget the new info

- Retroactive Interference: difficulty in recalling info learned earlier because of later exposure to different material; you forget the old info

- Learned Helplessness (Martin Seligman) – if they learn that nothing they do helps them avoid the shocks, they eventually become helpless, give up, and manifest an animal equivalent of depression

- Anxiety is the first response to a stressful situation

- The depressive attributional style is internal, (2) stable, (3) global

- O Aaron T. Beck suggested that depression may result from a tendency to interpret everyday events in a negative way

- Depressive Cognitive Triad – they make cognitive errors in thinking negatively about themselves, their immediate world, and their future

- Series of negative events in childhood, individuals may develop deep-seated negative schema, an enduring negative cognitive belief system about some aspect of life

- Lewinsohn's Behavioral Theory - depression is caused by a combination of stressors in a person's environment and a lack of personal skills

diathesis-stress model

- Diathesis-Stress Model – individuals inherit tendencies to express certain traits or behaviors, which may then be activated under conditions of stress (Eric Kandel)

- Diathesis – a condition that makes someone susceptible to developing disorder (vulnerability)

- Stress – the response or experience of an individual to demands that he or she perceives as taxing or exceeding his or her personal resources

- The higher vulnerability, the lesser life stress needed to trigger traits

- Disturbances stem from a genetic predisposition triggered by stress

Predisposing Factor – cause of a disorder (i.e., situations that trigger the development of the disorder)

Precipitating Factor – factors that allow the disorders to develop (i.e., factors that could contribute to the development of a disorder)

Protective Factor – reduces the severity of the problems

Perpetuating Factor – factors that maintain the problem once established

Gene-Environment Interaction

○ Gene-Environment Correlation Model – people might have genetically determined tendency to create the environment risk factors that trigger a genetic vulnerability

o In most cases, genetic factors are not necessary and sufficient to cause mental disorders but instead can contribute to a vulnerability or diathesis to develop psychopathology that only happens if there is a significant stressor in the person's life

○ Epigenetics – study how your behavior and environment can cause changes that affect your genes work

Reciprocal Gene-Environment Model – claims that people with a genetic predisposition to a disorder may also have a genetic tendency to create environmental factors that promote the disorder

3 kinds of Gene-Environment Correlations

Passive Gene-Environment – parent provide for their children is influenced partly by the parents' genotypes Evocative Gene-Environment – child's genotype evokes certain kind of reactions from other people - Genetic makeup may affect the reactions of other people to a child and, hence, the kind of social environment that the child will experience

Active Gene-Environment - children's genotype influence the kinds of environment they seek

Role of culture, social interactions, and interpersonal factors in the development

○ Sociogenic Factors:

a. Unemployment

b. Poverty

c. Crime

d. Poor Educational Level

- People who are isolated and lack social support or intimacy in their lives are more likely to become depressed when under stress and to remain depressed longer than people with supportive spouses or warm friendships.

- People's online relationships tend to parallel their offline relationships

- Family Systems Theory – family is a system of interacting parts who interact with one another in consistent ways and follow rules unique to each family

■ Structure and communication patterns of some families actually force individual members to behave in a way that otherwise seems abnormal

○ An individual's behavior, whether normal or abnormal, is best understood in the light of the individual's unique cultural context

- o Multicultural Perspective – each culture within large society has a particular set of values and beliefs, as well as special external pressures, that help account for the behavior and functioning of its members (Culturally Diverse Perspective)

Suicide

Suicide – self-inflicted death in which the person acts intentionally, directly, and consciously

Death Seekers – clearly intend to end their lives at the time they attempt suicide

May last only a short time

Death Initiators – clearly intent to end their lives, but they act out of a belief that the process is already under the way and that they are simply hastening the process

○ Death Ignorers – do not believe that their self-inflicted death will mean the end of their existence

o Death Darers – experience mixed feelings, or ambivalence, about their intent to die, even at the moment of their attempt, and they show this ambivalence in the act itself

Their risk-taking behavior does not guarantee death

○ Subintentional Death – a death in which the victim plays an indirect, hidden, partial, or unconscious role ○ Suicide is officially the 11th cause of death in U.S

Suicidal Ideation – thinking seriously about suicide

○ Suicidal Plans – formulation of a specific method for killing oneself

○ Suicidal Attempts – the person survives from attempts

○ Emile Durkheim's Suicide Types:

a. Altruistic – formalized suicides; dishonor to self, family, or society

b. Egoistic – loss of social supports as an important provocation for suicide

c. Anomic – result of marked disruptions, such as sudden loss of job

d. Fatalistic – loss of control over one's own destiny Freud believed that suicide indicated unconscious hostility directed inward to the self rather than outward to the person or situation causing the anger

○ If a family member committed a suicide, there is an increased risk that someone else will also

Low levels of serotonin is associated with suicide and with violent suicide attempts (low levels of serotonin is linked with impulsivity, instability, and the tendency to overreact to situation)

The stress of a friend's suicide or some other major stress may affect several individuals who are vulnerable because of existing psychological disorders

Hopelessness – pessimistic belief that one's present circumstances, problems, or mood will not change

Dichotomous Thinking – viewing problems and solutions in rigid either/or terms

○ Common triggering factors:

✓ Stressful events

✓ Mood and thought changes

✓ Alcohol and other drug use

✓ Mental disorders

✓ Modeling

One of the signs of suicides is when the client are giving away their prized possessions

Psychological Disorders and Specific Symptoms based on D.S.M-5 (50)

○ Ego-Syntonic – actions that align with the client's personal goals, values, and beliefs

○ Ego-Dystonic – actions that are inconsistent with the client's ego

○ Primary Gain-psychological disorder manifesting physically

○ Secondary Gain – they act sick because they want external reinforcement (malingering)

Table summary: The table outlines the distinguishing clinical characteristics, durations, and comorbidities of Separation Anxiety Disorder and Selective Mutism, highlighting that the former centers on attachment fears and has broad comorbidity, while the latter involves situational speech deficits in children often linked to social anxiety.

Specific Phobia ( greater than or equal to 6 months)

Table summary: The table outlines the diagnostic characteristics, durations, and risk factors for Specific Phobia, Social Anxiety Disorder, and Panic Disorder, highlighting differences in gender prevalence, common comorbidities, and the specific triggers or physiological responses associated with each condition.

Table summary: This table outlines the diagnostic characteristics and clinical features of several anxiety and trauma-related disorders, highlighting the specific behavioral patterns, duration requirements, biological associations, and comorbidities associated with agoraphobia, generalized anxiety disorder, reactive attachment disorder, and disinhibited social engagement disorder.

Table summary: The table outlines the diagnostic criteria and characteristics for several trauma- and stressor-related disorders, distinguishing them primarily by the nature of the triggering event, the duration of symptoms, and specific clinical presentations.

Table summary: This table differentiates between various OCD-related disorders by outlining their unique clinical characteristics. It contrasts the intrusive thoughts and ritualistic behaviors of Obsessive-Compulsive Disorder with the appearance-focused preoccupations and negative self-perception found in Body Dysmorphic Disorder, while noting the specific difficulty with discarding possessions associated with Hoarding.

Table summary: The table outlines diagnostic criteria and distinguishing features for various psychiatric conditions, including hoarding disorder, trichotillomania, excoriation disorder, and somatic symptom disorder, while highlighting key comorbidities and differential diagnoses to ensure accurate clinical identification.

Table summary: This table provides a comparative overview of various somatic and dissociative disorders based on DSM-V TR and Psych Pearls, detailing the defining characteristics, diagnostic criteria, and distinguishing features of conditions such as Somatic Symptom Disorder, Factitious Disorder, Depersonalization-Derealization Disorder, Illness Anxiety Disorder, Dissociative Amnesia, and Conversion Disorder.

- switch: transition from one personality to another - extreme subtype of P.T.S.D

- Hypnotic Trance: tend to be focused on one aspect of their world and they become vulnerable to suggestions by the hypnotist

- present with comorbid depression, anxiety, substance abuse, self-injury, or another common symptom

- early life trauma represent as risk factor

- several brain regions have been implicated in the pathophysiology of D.I.D, including the orbitofrontal cortex, hippocampus, parahippocampal gyrus, and amygdala

- does not have a classic bipolar sleep disturbance - Individuals with schizophrenia have low hypnotic capacity, whilst, individuals with D.I.D have highest hypnotic capacity among all clinical groups - appear to encapsulate a variety of severe personality disorder features

- comorbid with P.T.S.D, depressive disorders, substance-related disorders, feeding and eating disorders, etcetera

- most common forms of functional neurological symptom disorder include nonepileptic seizures, gait disturbances, and paralyses

Disruptive Mood Dysregulation Disorder (3x or more/week, greater than or equal to 12 months)

- recurrent temper outburst (verbally or behaviorally) that are grossly out of proportion

- 3 or more times/week

- irritable or angry most of the day

- 12 or more months, at least 2 settings

- onset should be after 6 yrs-18yrs

- factors associated with disrupted family life

- family history of depression may be a risk factor

- do not occur exclusively during M.D.E

- bipolar = episodic, D.M.D.D = persistent

- diagnosis cannot be assigned to a child who has ever experienced full-duration hypomanic or manic episode (irritable or euphoric) or who has ever had a manic or hypomanic episode lasting more than 1 day

- presence of severe and frequently recurrent outburst and persistent disruption in mood between outburst

- severe in at least one setting and mild to moderate to second setting

Table summary: This table outlines the diagnostic criteria, durations, and clinical characteristics for various depressive and mood disorders, highlighting the hierarchical rules for diagnosis and common comorbidities.

○ Complicated Grief – this reaction can develop without preexisting depressed state

Bipolar disorder may simply be a more severe variant of mood disorders

Depression and mania appear to be the world's first documented mental illnesses

○ Aretaeus of Cappadocia – combined these two groups of symptoms into bipolar disorder by stating that mania was a worsened state of melancholia

○ Theophile Bonet – began using the term melancholicus mania in 1679

○ Willis - described Melancholia and Mania as distempers of raving in his writing

○ Emil Kraeplin – employed a unifying approach to the classification of mood disorders, resulting in bipolar disorder being subsumed within the category of manic-depressive insanity (M.D.I)

Individuals with this diagnosis experienced mild residual states after recovery from individual episodes and mild fluctuations between episodes

Adolf Meyer, Karl Abraham, and Melanie Klein, were some of the first to make references to manic-depressive symptoms in children

Things to consider in the Dx of Depressive Disorder due to another med condition:

✓ No depressive prior to the onset of medical condition (e.g., before Manny was diagnosed with cancer, he never experienced depressive episodes)

✓ the probability that a medical condition has a potential to cause a depressive disorder

Bipolar Disorders

Bipolar I (Manic, greater than or equal to 1 week)

- at least 1 manic episode (elation and euphoria) - children should be judged according to his or her own baseline in determining whether a particular behavior is normal or evidence of manic episode - first ep usually M.D.E

- factors that should be considered: family history, onset, medical history, presence of psychotic symptoms, history of lack of response to antidepressant treatment or the emergence of manic episode during antidepressant treatment

- The diagnosis is “Bipolar I disorder, with psychotic features” if the psychotic symptoms have occurred Exclusively during manic and major depressive episodes

- Symptoms of mania in B.P.1 occur in distinct episodes and typically begin in late adolescence or early adulthood

Table summary: The table outlines the clinical characteristics and diagnostic distinctions between different types of bipolar spectrum disorders in youth, highlighting that Bipolar I involves significant functional impairment and distinct behavioral changes, Bipolar II is characterized by recurrent depressive and hypomanic episodes with frequent comorbidities, and Cyclothymic Disorder represents a milder yet more chronic form of mood instability.

- M.D.D, B.P.1, and B.P.2 are more common among first degree biological relatives of indivs with cyclothymic disorder

- substance-related disorders and sleep disorders may be present in individuals with cyclothymic disorder

○ Adolescents with Mania often have complex presentations that include psychotic symptoms

○ Adolescents may have prolonged early course and a poorer response to treatment

○ Children often seem to exhibit a very rapid fluctuation in mood symptoms, especially when such symptoms are co-morbid with other disorders

○ Irritability in children with B.D is very severe, persistent, highly disabling, and often associated with violence

○ Clients experience difficulties in emotion regulation

○ Emotional Overregulation also is related to behavioral inhibition and may lead to internalizing problems in children

○ Emotion Reactivity – refers to individual differences in the threshold and intensity of emotional experience, which provide clues to an individual's level of distress and sensitivity to the environment

- Increased in children with bipolar disorder

○ Emotion Regulation – involves enhancing maintaining, or inhibiting emotional arousal, which is usually done for a specific purpose or goal

- Dysregulation - means that existing control structures operate maladaptively

○ Emotions help young children learn more about themselves and their surroundings, as part of learning to identify and monitor their feelings and behavior

Explaining Eating and Sleeping Disorders

Eating Disorders

Pica (greater than or equal to 1 month)

- eating of non-nutritive, nonfood substances for at least 1 month

- no biological abnormalities found

- neglect, lack of supervision, and developmental delay can increase the risk for this condition

- inappropriate to the developmental age

- co-morbid with A.S.D, I.D, and to some degree, schizo and O.C.D

- can be associated with trichotillomania and excoriation, which the skin or hair is typically ingested

Rumination Disorder (greater than or equal to 1 month)

- repeated regurgitation of food for at least 1 month

- infants with rumination disorder display characteristic position of straining and arching the back with head held back, making sucking movements with their tongue (give an impression of pleasure or satisfaction)

- irritable and hungry between episodes

- features: weight loss and failure to make expected weight gains

- re-chewed, re-swallowed, or spit-out

- not attributable to gastrointestinal or other medical condition

- self-soothing or self-stimulating

- can occur in the context of a concurrent medical condition or another mental disorder

Avoidant/Restrictive Food Intake Disorder

- eating or feeding disturbance

- lack of interest in eating food

- dependence on enteral feeding or nutritional supplements

- risks: familial anxiety

- A/R.F.I.D co-morbid with A.S.D has male predominance

- requires that the disturbance of intake is beyond that directly accounted for by physical symptoms consistent with medical condition; the eating disturbance may also persist after being triggered by medical condition and following resolution of the medical condition

- if eating problems is the focus, then A/R.F.I.D, if weight, then Anorexia Nervosa

- might precede the onset of Anorexia Nervosa

- Food Avoidance Emotional Disorder

- co-morbid with Anxiety disorders, A.D.H.D, I.D

Anorexia Nervosa

- fear of gaining weight

- subtypes: binge-eating/purging type and restricting type

- associated with stressful life event

- additional diagnosis of B.D.D may be considered if the distortion is unrelated to body shape and size (there is a separation distortion in mind happening)

- amenorrhea and cardiovascular problems

- very underweight

- Bipolar, Depressive, and anxiety disorders commonly co-occur with Anorexia Nervosa

- Alcohol use Disorder and other substance disorder may also be co-morbid with Anorexia, especially those with binge eating/purging type

Table summary: The table outlines the diagnostic criteria, physical and psychological manifestations, and subtypes for various eating disorders, specifically Bulimia Nervosa and Binge-Eating Disorder, as well as elimination disorders, including Enuresis and Encopresis.

Without constipation and overflow incontinence Sleeping Disorders

○ Dyssomnias – difficulties in getting enough sleep, problems with sleeping when you want to and complaints about the quality of sleep

○ Parasomnias – characterized by abnormal behavior or physiological events that occur during sleep

r.e.m Sleep – during which the majority of typical story-like dreams occur (20 percent to 25 percent of total sleep)

n.r.e.m Sleep Stage 1 (N.1) – transition from wakefulness to sleep and occupies about 5% of time spent asleep in healthy adults

n.r.e.m Sleep Stage 2 (N.2) – characterized by specific electroencephalographic waveforms (sleep spindles and K complexes), occupies about 50% of time spent sleep

n.r.e.m Sleep Stage 3 (N.3) – slow wave sleep; deepest level of sleep

○ Sleep Continuity – overall balance of sleep and {wakefulness} during night of sleep

- Sleep Latency – amount of time required to fall asleep Wake after Asleep onset – the amount of awake time between initial sleep onset and final awakening

Number of awakening

Sleep Efficiency – ratio of actual time spent asleep to time spent in bed

■ Measures the amount of r.e.m sleep and each n.r.e.m sleep stage, relative amount of r.e.m sleep and n.r.e.m sleep stages, and latency between sleep onset and the first r.e.m period

Insomnia (3 nights/week, greater than or equal to 3 months)

- difficulty initiating and maintaining sleep

- early-morning awakening with inability to return to sleep

- at least 3 nights/week, for at least 3 months

- Rebound Insomnia: sleep problems re-appearing, but sometimes worst

- situational, persistent, or recurrent, episodic

- excessive sleepiness despite having at least 7 hours of main sleep

- recurrent periods of sleep or lapses into sleep within the same day

- take longer naps, have trouble waking from naps, and do not feel alert afterward

- at least 3x/week, for at least 3 months

Table summary: This table outlines the diagnostic criteria and defining characteristics for various sleep disorders, including narcolepsy, different types of sleep apnea, hypoventilation, circadian rhythm disruptions, and several parasomnias such as sleep arousal, nightmare, and REM sleep behavior disorders.

Table summary: The table outlines diagnostic criteria and clinical characteristics for various sleep and sexual dysfunctions, detailing the specific symptoms, durations, and psychological impacts associated with Restless Legs Disorder, Delayed Ejaculation, Erectile Disorder, and Female Orgasmic Disorder.

Table summary: The table outlines the diagnostic criteria and common associated symptoms for several sexual dysfunctions in both males and females, noting that these conditions must persist for a minimum duration and are often linked to other psychological, medical, or sexual difficulties.

Paraphilic Disorders

Table summary: This table outlines the diagnostic criteria for various paraphilic disorders, highlighting a consistent requirement for prolonged periods of intense sexual arousal linked to specific behaviors or objects, often involving nonconsensual acts or specific age gaps.

Table summary: The table outlines the diagnostic criteria and associated characteristics of Gender Dysphoria, highlighting the duration of gender incongruence, biological factors related to sex characteristics and hormone levels, and a tendency toward increased psychological distress and behavioral disorders.

Explaining Substance-Related and Addictive Disorder

○ Substance – chemical compounds that are ingested to alter mood or behavior

○ Psychoactive substances – alter mood, behavior, or both

○ Substance Use — ingestion of psychoactive substances in moderate amounts that does not significantly interfere with social, educational, or occupational functioning

○ Substance Intoxication – physiological reaction to ingested substances

○ Substance Use Disorders – how much of a substance is ingested is problematic

○ Physiological Dependence – meaning the use of increasingly greater amounts of the drug to experience the same effect (tolerance) and a negative physical response when the substance is no longer ingested (withdrawal)

Alcohol – produced when certain yeast react with sugar and water, then fermentation takes place - depressant

- depressant

- inhibitions are reduced and we become more outgoing

- with more drinking, alcohol depresses the brain which impedes the functioning

- Withdrawal Delirium (Delirium Tremens): condition that can produce frightening hallucinations and body tremors

- Breathalyzer: measures levels of intoxication

- gaba seems to be particularly sensitive to alcohol

- The Glutamate system is involve why alcohol affects our cognitive abilities

- Two types of organic brain syndromes may result from long-term alcohol use: Dementia and

Wernicke-Korsakoff Syndrome ( Confusion, loss of muscle coordination. and unintelligible speech , believed to be cause by a deficiency of thiamine)

- Fetal Alcohol Syndrome

- Alcohol Dehydrogenase: metabolize alcohol

- Korsakoff syndrome: is a chronic memory disorder caused by severe deficiency of thiamine (vitamin B-1).

- Korsakoff syndrome is most caused by alcohol misuse, but certain other conditions also can cause the syndrome

Four-Stage Model for the progression of {Alcoholism} :

1. Pre-Alcoholic Stage – drinking occasionally with few serious consequences

2. Prodromal Stage – drinking heavily but with few outward signs of a problem

3. Crucial Stage – loss of control, with occasional binges

4. Chronic Stage – primary daily activities involve getting and drinking alcohol

Caffeine - most common psychoactive substance

- “gentle stimulant”

- found in tea, coffee, soda, and cocoa products

Cannabis (Marijuana) – reactions include mood swings or even dream-like experiences

- chronic and heavy users report tolerance, especially to euphoric high: they are unable to reach the levels of pleasure they experienced earlier

Hallucinogens – most common, “L.S.D” produced synthetically in the laboratory

- others: psilocybin (mushroom), lysergic acid amide (seeds of morning glory plant), dimethyltryptamine (D.M.T), and mescaline

- Phencyclidine (P.C.P) is snorted, smoked, or injected intravenously, and it causes impulsivity and aggressiveness

Inhalant – solvents, aerosol sprays, gases, nitrites, usually found at home or workplace

Opioid – natural chemicals in the opium poppy that have narcotic effect ( relieves pain and induce sleep)

- includes natural opiates, synthetic variation, and the comparable substances that occur naturally in the brain

- also includes Heroin

Sedative-, Hypnotic-, or Anxiolytic-- calming, sleep-inducing. and anxiety-reducing

- includes barbiturates and benzodiazepines

- barbiturates and benzodiazepines relax the muscles and can produce mild feeling of well being

- combining alcohol with these substances can be fatal (Manilyn Monroe case)

Stimulant – most commonly consumed psychoactive drugs in U.S

- includes caffeine, nicotine, amphetamineines, and cocaine

- Amphetamine: can induce feelings of elation and vigor and can reduce fatigue; prescribed to people with narcolepsy and A.D.H.D

- another variants of Amphetamine are Methylene-dioxymethamphetamine or ecstasy club drug (makes you feel euphoric) and methamphetamine (crystal meth)

- Cocaine: increases alertness, produces euphoria, increases blood pressure and pulse, and causes insomnia and loss of appetite

- Intranasal use and oral use of substances result in more gradual progression occurring over months to years

Tobacco – contains nicotine

- linked with signs of negative affect such as depression, anxiety, and anger

- being depressed increases your risk of becoming dependent on nicotine and, at the same time, being dependent will increase your risk of becoming depressed

○ Acute alcohol withdrawal occurs as an episode usually lasting 4 to 5 days and only after extended periods of heavy drinking

○ Withdrawal is rare for individuals younger than 30 years

The symptoms of an alcohol-induced mental disorder are likely to remain clinically relevant as long as the individual continues to experience severe intoxication or withdrawal

○ Genetic factors may affect how people experience and metabolize certain drugs

○ Positive and Negative Reinforcement

Opponent-Process Theory – an increase in positive feelings will be followed shortly by an increase in negative feelings and vice versa

○ Expectancy Effect – expectancies develop before people actually use drugs, perhaps as a result of loved one's use, advertising, etcetera

○ Treatment: Nicotine replacement therapy, Bupropion, Naltrexone, Acamprosate, Disulfiram, Methadone, Buprenorphine, Aversion Therapy, Inpatient treatments, Aversion Therapy, etcetera

○ Cross-Tolerance – tolerance for a substance has not taken before as a result of using another substance similar to it

○ Synergistic Effect – an increase of effects that occurs when more than one substance is acting on the body at the same time

Gambling Disorder (within 12 months)

- persistent and recurring gambling behavior

- at least 4-symptoms within 12 months

- Onset can occur during adolescence or young adulthood but in other individuals it manifests during middle or even older adulthood

- Progression appears to be more rapid in women than in men

Table summary: This table outlines the diagnostic criteria and clinical characteristics of various disruptive, impulse-control, and conduct disorders, specifically detailing the behavioral patterns, comorbidities, and neurological associations for Oppositional Defiant Disorder and Intermittent Explosive Disorder, while providing differential diagnosis guidance for gambling disorder.

Table summary: The table outlines the diagnostic characteristics and clinical distinctions for several behavioral disorders, highlighting the specific onset ages, behavioral patterns, and comorbidity relationships for Disruptive Mood Dysregulation Disorder, Conduct Disorder, and Pyromania.

- arousal before the act

- fascination to fire and its situational context

- not done for monetary gain or etcetera

- separate diagnosis is not given when fire setting occurs as part of C.D, manic episode, or antisocial personality disorder

- high co-occurrence of substance-use disorders, gambling, depressive and bipolar disorders, and other disruptive impulse-control, and conduct disorders

Kleptomania

- failure to resist impulses to steal objects that are not need for personal use

- increase tension before committing the theft

- pleasure after committing the theft

- often feels depressed or guilty about the thefts

- associated with compulsive buying and depressive, bipolar, anxiety, eating, personality, substance-use and other disorders

Cluster A

Paranoid

- excessively mistrustful and suspicious of others, without justification

- problems with close relationships

- overt argumentativeness, in recurrent complaining, or by hostile aloofness

- need to have a high degree of control over those around them

- rigid, critical of others, and unable to collaborate,

although they have great difficulty accepting criticism themselves

- more common among relatives who have schizophrenia

- maybe due to early mistreatment or traumatic childhood experiences

- associated with prior history of childhood mistreatment, externalizing symptoms, bullying, and adult appearance of interpersonal aggression

- "I cannot trust people"

- too much use of projection

- Males = Females

- may experience brief psychotic episodes

- may develop M.D.D, Agoraphobia, and O.C.D

- most common co-occurring P.D appear to be schizotypal, schizoid, narcissistic, avoidant, and borderline

Table summary: The table outlines the characteristic traits and behavioral patterns of various personality disorders. Cluster A disorders, including Schizoid and Schizotypal, are characterized by social isolation, emotional detachment, and odd beliefs, with a higher prevalence in males. In contrast, Cluster B disorders include Histrionic, which involves exaggerated emotional expression and social dominance and is more common in females, and Borderline, which is marked by instability in moods, relationships, and self-image, alongside a high risk of self-harm.

Table summary: The table outlines the defining characteristics, gender prevalence, and clinical features of different personality disorders, noting that certain types are more common in males while others show equal distribution between genders, and highlighting specific behavioral patterns such as emotional instability, grandiosity, and a disregard for social norms.

Cluster C

Avoidant

- extremely sensitive of the opinion of others and although they desire social relationship, their anxiety leads them to avoid

- they are likely to misinterpret social responses as critical, which in turn confirms their self-doubts - low self-esteem and hypersensitivity to rejection - have insecure attachment style characterized by desire for emotional attachment

- extremely low self-esteem cause them to be limited with friendships and dependent to those they feel comfy with

- feel chronically rejected by others and pessimistic about their future

- negative self-concept

- Social Anxiety Disorder – negative evaluations

- "If they knew the real me, they would reject me"

- Females greater than Males

Dependent

- rely on others to make ordinary decisions and even important ones which results in an unreasonable fear of abandonment

- characterized by pessimism and self-doubt and tend to belittle their abilities and assets

- take criticism and disapproval as proof of their worthlessness and lose faith in themselves

- agree with other people's opinion just to be not rejected

- feel uncomfortable or helpless when alone

- “I need people to survive and be happy”

Obsessive-Compulsive

- perfectionist

- fixation on things being done “the right way”

- this preoccupation with details prevents them from completing much of anything

- need to control

- when criteria for both O.C.D and O.C.P.D are met, both can be given

- “I am perfectionist, everything should be done under my control and liking”

Illustrating Schizophrenia

○ John Haslam – superintendent of a British Hospital who outlined a description of the symptoms of Schizophrenia in his book Observations on Madness and Melancholy

○ Philippe Pinel – French physician who described cases of schizophrenia

○ Benedict Morel – used the term demence precoce meaning early or premature loss of mind to describe schizophrenia

○ Emil Kraepelin – unified the distinct categories of schizophrenia under the name Dementia Praecox

Combined several symptoms of insanity that had usually been viewed as reflecting separate and distinct disorders:

a. Catatonia – alternating immobility and excited agitation

b. Hebephrenia – silly and immature emotionality

c. Paranoia – delusions of grandeur or persecution

Distinguished dementia praecox

Also noted the numerous symptoms in people with dementia praecox, including hallucinations, delusions, negativism, and stereotyped behavior

○ Eugen Bleuler – introduced the term schizophrenia (“splitting of mind”)

Associative Splitting

○ Positive Symptoms:

1. Delusions – misrepresentation of reality (disorder of thought content) whom she considers to be of higher social and/or professional standing is in love with her

Table summary: The table provides a comprehensive list of various types of delusions and syndromes, defining the specific nature of the false beliefs associated with each category.

Fregoli Syndrome – a person holds a delusional belief that different people are in fact a single person who changes his or her appearance or is in disguise

■ Motivational View of Delusions – look at these beliefs as attempts to deal with and relieve anxiety and stress

Deficit View of Delusions – sees these beliefs as a resulting from brain dysfunction that creates these disordered cognitions or perceptions

2. Hallucinations – experience of sensory events without any input from the surrounding environment

Auditory Hallucination – most common form experienced by people with schizophrenia

Autoscopic Hallucination - individual experiences, all or part of the person's own body appeared within the external space, viewed from his/her physical body

Hypnagogic Hallucination – happens during sleep

Ictal Hallucination – associated with temporal lobe foci

Hypnopompic Hallucinations – happens when waking up

Most active part during Hallucination is Broca's Area (speech production)

○ Negative Symptoms – usually indicate absence or insufficiency of normal behavior

Avolition – inability to initiate and persist activities

Anhedonia – lack of pleasure

Asociality – lack of interest in social interactions

Flat Affect/Affective Flattening – do not show emotions when you would normally expect them to

○ Disorganized Symptoms

- Disorganized Speech – individual may switch from one topic to another (derailment or loose associations) or answers to questions may be related or completely unrelated (tangentiality)

- Circumstantiality: excessive and irrelevant detail in descriptions with the person eventually making his/her point

"Kumuha ako ng Koko Crunch sa sm, katabi ng honey gold flakes, nasa taas niya yung kellogs, color green yung milo.. masarap yung Koko Crunch,"

- Concrete Thinking: unable to abstract and speaks in concrete, literal terms

Kapag sinabihan mo siya ng "Break a leg", iisipin niya na babaliin niya dapat ang legs niya - Clang Associations: are groups of words chosen because of the catchy way they sound, not because of what they mean

"Gusto ko ng arrozcaldo, na apurado pero bugbog sarado na may champorado at biglang dehado,"

- Loose Association: a loose connection between thoughts that are often unrelated

"Umuwi ako ng probinsya. Favorite ko ang Speak Now T.V. Ay! Malamig pala sa North Pole. Eto nga pala anak ko. Ang sakit mo naman sa puso,"

- Neologism: creating a new word meaning only to that person

Lathyzoid. Oh, hindi mo alam meaning diba? that's the point.

- Word Salad: combination of words that have no meaning

"Mine enchanted why sparks fly grow superman,"

Inappropriate Affect – laughing or crying at improper times

Grossly Disorganized or abnormal motor behavior

– childlike silliness to unpredictable agitation

○ Neologisms – construction of new words in order to communicate with schizophrenia thoughts

○ More severe symptoms of schizophrenia first occur in late adolescence or early adulthood

○ Prodromal Stage – 1 to 2 year period before the serious symptoms occur but when less severe yet unusual behaviors start to show themselves

○ Schizophrenia is partially the result of excessive stimulation of striatal dopamine d2 receptors

○ It appears that several brain sites are implicated in the cognitive dysfunction observed among people with schizophrenia, especially prefrontal cortex, various related cortical regions and subcortical circuits, including thalamus and the striatum

○ Schizophrenogenic Mother – used for a time to describe a mother whose cold, dominant, and rejecting nature was thought to cause schizophrenia in her children

○ Double bind communication – used to portray communication style that produced conflicting messages, which caused schizophrenia to develop

o Families with high expressed emotion view the symptoms of schizophrenia as controllable and that the hostility arises when family members think that patients just do not want help themselves

Delusional Disorder ( greater than or equal to 1 month)

- one or more delusions for at least 1 month

- persistent belief that is contrary to the reality in the

- tend not to have flat affect, anhedonia, or other negative symptoms

- socially isolated due to being suspicious

- Shared Psychotic Disorder (Folie a Deux): condition in which an individual develops delusions simply as a result of a close relationship with a delusional individual

- Erotomanic, Grandiose, Jealous, Persecutory, Somatic, Mixed, Unspecified

- functioning is better than what is observed in Schizophrenia

- eventually develop schizophrenia

- absence of active phase of schizophrenia (Attenuated Psychosis Syndrome)

Brief Psychotic Disorder (1 day less than or equal to infinity less than or equal to 1 month)

- presence of one of the ff: delusions, hallucinations, disorganized speech, catatonic behavior for at least 1 day but less than 1 month, with eventual full return to premorbid level of functioning

- typically experience emotional turmoil or overwhelming confusion

- can experience relapse

- if psychotic symptoms persist for at least 1 day in P.D, an additional diagnosis of Brief Psychotic

Disorder may be appropriate

Schizophreniform Disorder (1 month ≤ ∞ less than or equal to 6 months)

- two or more of the following, present during a 1-month period: delusions, hallucinations, disorganized speech, catatonic behavior, negative symptoms

- development similar to schizophrenia

Schizophrenia ( greater than or equal to 6 months)

- two or more of the following, present during 1-month period: delusions, hallucinations, disorganized speech, catatonic behavior, negative symptoms - disturbance in one or more major areas

- at least 6 months

- abrupt or insidious

- prognosis is influenced both by duration and by severity of illness and gender

- possible reduced psychotic experience during late life

- too much use of regression

Schizoaffective Disorder (greater than or equal to 2 weeks)

- major mood episode plus delusions or hallucinations for 2 or more weeks

- some individuals tend to change diagnosis into mood disorder or to schizophrenia over time

- Anosognosia (poor insight) common in

schizoaffective but less severe than in schizophrenia

Neurodevelopmental Disorders

Intellectual Developmental Disorder

- includes both intellectual and adaptive functioning

- deficits in conceptual, social, and practical domains - difficulties with day-to-day activities to an extent that reflects both severity of their cognitive deficits and the type and amount of assistance their receive

- difficulties in conceptual, social, and judgement - causes: deprivation, abuse, neglect, exposure to disease or drugs during pre-natal, difficulties during labor and delivery, infections, and head injury

- Phenylketonuria, Lesch-Nyhan Syndrome, Down Syndrome, Fragile X Syndrome

- generally nonprogressive, there are period of worsening, then stabilization, and in others progressive of intellectual function in varying degrees - 2 standard deviations below the mean

- lifelong

- most common co-occurring neurodevelopmental and other mental disorders are A.D.H.D, Depressive and Bipolar disorder, anxiety disorders, A.S.D, stereotypic movement disorder, impulse-control disorders, and major neurocog. disorders

Components of Intellectual Functioning

1. Verbal Comprehension

2. Working Memory

3. Perceptual Reasoning

4. Quantitative Reasoning

5. Abstract Thought

6. Cognitive Efficacy

D.S.M-I.V Criteria Intellectual Disability Severity

1. I.Q 50 to 69 Mild – can live independently; intermittent support needed

intermittent support needed

2. I.Q 36 to 64 Moderate – moderate levels of support; limited support needed in daily situations

I.Q 20 to 35 Severe – requires daily assistance; extensive support needed

I.Q less than 20 Profound – requires 24-hour care; pervasive support needed for every aspect

- often have congenital syndrome

Global Developmental Delay

Table summary: The table provides diagnostic criteria and differential characteristics for various communication and developmental disorders, highlighting the distinguishing features of Autism Spectrum Disorder compared to ADHD, Intellectual Developmental Disorder, and Social Communication Disorder, while also outlining the specific deficits associated with Language Disorder, Speech Sound Disorder, Childhood-Onset Fluency Disorder, and Social Pragmatic Communication Disorder.

Table summary: The table provides diagnostic distinctions and characteristic features for various neurodevelopmental and motor disorders, contrasting the generalized restlessness of ADHD with the repetitive nature of stereotypic movement and tic disorders, while outlining the specific academic and motor skill deficits associated with learning and coordination disorders.

○ Diffuse – widespread damage

○ Focal – involve circumscribed areas of abnormal change in brain structure

Delirium

- characterized by impaired consciousness and

- appear confused, disoriented, and out of touch with their surroundings

- often associated with disturbance in sleep-wake cycle (daytime sleepiness, nighttime agitation, difficulty falling asleep, excessive sleepiness, or wakefulness at night)

- effects may more lasting

- can be experienced by children who have high fevers or taking certain medication

Table summary: The table provides a comparative overview of various neurocognitive disorders, distinguishing between reversible conditions and progressive disorders. It contrasts major and mild neurocognitive disorders based on the severity of cognitive decline and impact on daily functioning, while detailing the specific pathological markers and primary deficits associated with Alzheimer's disease, vascular injury, and frontotemporal degeneration.

Table summary: The table outlines the defining characteristics, symptoms, and neurological causes of various neurocognitive and neurodegenerative disorders, highlighting a common pattern of cognitive impairment combined with distinct motor dysfunctions or physiological brain changes across different conditions.

Table summary: The table provides a conceptual overview of neurological disorders and psychological treatment modalities, detailing the genetic and protein-based causes of specific brain diseases and outlining various psychodynamic therapeutic techniques and clinical terminology.

Table summary: The table provides a categorized list of various psychotherapeutic approaches, detailing specific modalities within psychodynamic and humanistic frameworks, as well as other specialized interventions and group-based therapies.

11. Parent Management Training – combine family and cognitive-behavioral interventions to improve family functioning and help parents deal with their children more effectively

12. Gestalt Therapy – clinicians actively move clients toward self-recognition and self-acceptance by using techniques such as role playing and self-discovery exercises

13. Interpersonal Social Rhythm Therapy – derived from interpersonal psychotherapy for depression and behavioral intervention for social rhythm and sleep-wake regulation

- focus on the difficulties that children and adolescents with B.D have with the rhythmicity of their behaviors

1. Cognitive-Behavioral Therapy – seek to help clients change both counterproductive behaviors and dysfunctional ways of thinking

- Rational-Emotive Behavioral Therapy: change and identify irrational assumptions

- Mindfulness-Based C.B.T (Acceptance and Commitment Therapy): “thoughts are mere events of mind”

- Behavioral Activation: therapy for depression in which the client is guided systematically increase the number of constructive and pleasurable activities and events in his or her life

- Cognitive Remediation: focuses on the cognitive impairments that often characterize people with schizophrenia, particularly their difficulties in attention, planning, and memory

- Panic Control Treatment: clients are educated about the nature of anxiety and panic and involves teaching people with panic disorder to control their breathing, then people are taught about the logical errors that people who have panic disorders are prone to making and learn to subject their own automatic thoughts to logical re-analysis

- Enhanced C.B.T (C.B.T-E): focuses on addressing, disrupting, and modifying the factors that maintain the eating disorders

- Hallucination Reinterpretation and Acceptance: designed to help how people view and react to their hallucinations, so they will not suffer the fear and confusion produced by their delusional misinterpretations

- Dialectical Behavior Therapy: can help people who have difficulty with emotional regulation or are exhibiting self-destructive behaviors; accept the reality of their lives and their behaviors

2. Neutralizing – attempting to eliminate thoughts that one finds unacceptable by thinking or behaving in ways that make up for those thoughts and so put right internally

3. Exposure and Response (Ritual) Prevention – treatment of O.C.D that exposes client to anxiety-arousing thoughts or situations and then prevents the client from performing his or her compulsive acts

4. Beck's Cognitive Therapy – people identify and change the maladaptive assumptions and ways of thinking that help cause their psychological disorders

5. Aversion Therapy – client is repeatedly presented with unpleasant stimuli while performing undesirable behavior such as taking drug

6. Relapse-Prevention Training – treatment for alcohol use disorder in which clients are taught to keep track of their drinking behavior, apply coping strategies in situation that typically trigger excessive drinking, and plan for risky situations and reactions

7. Cognitive Processing Therapy – intervention for people with P.T.S.D in which therapist guide individuals to examine and change the dysfunctional attitudes and styles of interpretation they have developed as a result of their traumatic experiences, thus, enabling them to deal with difficult memories and feelings

8. Mentalization – uses therapeutic relationship to help patients develop the skills they need to accurately understand their own feelings and emotions, as well as the feelings and emotions of others

9. Affectual Awareness – help identify and counter negative attitudes that one holds toward sex

10. Positive Family Interaction Therapy – involves both individual C.B.T with the client as well as additional family sessions

Biological

1. Sedative-Hypnotic Drugs – also called as anxiolytic, produce feelings of relaxation and drowsiness

- Benzodiazepines: sedative that slow down body and brain's function (depressant)

- Barbiturates: medication that causes relaxation and drowsiness (depressant)

2. Antidepressant – improve the mood of people with depression

- increase the activity of serotonin and norepinephrine

3. Antipsychotic – correct grossly confused or distorted thinking

- relieve anxiety by altering the activity of dopamine

4. Vagus Nerve Stimulation – treatment for depression in which implanted pulse generator sends regular electrical signals to a person's vagus nerve, then stimulates the brain

5. Electroconvulsive Therapy – electrodes attached to patient's head and send an electrical current through the brain, causing seizure

6. Transcranial Magnetic Stimulation – electromagnetic coil, which placed on or above a person's head sends a current into the person's brain

7. Mood Stabilizers – stabilize the moods of people suffering from bipolar disorder - also known as antipipolar drugs

- Lithium: metallic element that occurs in nature as mineral salt and is an effective treatment for bipolar disorders

8. Detoxification – systematic and medically supervised withdrawal from a drug

- Disulfiram: causes violent vomiting when followed by ingestion of alcohol

9. Antagonist Drug – block or change the effects of an addictive drug

10. Antianxiety – also called as minor tranquilizers, help in reducing tension and anxiety

11. S.S.R.I's – treat depression by increasing the levels of serotonin in the brain - block reabsorption of serotonin into neurons

Behavioral

1. Exposure Treatment – behavior-focused intervention in which fearful people are repeatedly exposed to the objects they dread

- Virtual Therapy/Virtual Reality Treatment: cognitive-behavioral intervention that uses V.R as an exposure tool

- Prolonged Exposure: clients confront not only trauma-related objects and situations, but also their painful memories of traumatic experiences

- Eye Movement Desensitization and Reprocessing (E.M.D.R): clients move their eyes in a rhythmic manner from side to side while flooding their minds with images of objects and situations they ordinarily avoid

- Participant Modeling: therapist calmly models ways of interacting with the phobic stimulus or situation

Table summary: This table defines various behavior-based exposure and reinforcement therapies and maps specific psychological interventions, including therapeutic techniques and pharmacological treatments, to several types of anxiety disorders.

Table summary: This table lists various psychological disorders and the corresponding therapeutic interventions used to treat them, showing a combination of pharmacological treatments, cognitive behavioral approaches, and psychodynamic therapies across different mental health conditions.

Table summary: The table provides a comprehensive mapping of various mental health conditions and psychological disorders to their corresponding therapeutic interventions, including pharmacological treatments, behavioral therapies, and psychosocial supports.

Table summary: The table outlines various therapeutic interventions and pharmacological treatments recommended for a range of personality disorders, behavioral disorders, and developmental disabilities, showing a reliance on a combination of psychotherapy and medication for complex conditions while utilizing specialized training or education for developmental and behavioral issues.

○ Psychodynamic therapy seems to help most in cases of depression that are modest or moderate in severity and that involve clear history of childhood loss or trauma

○ Short-term psychodynamic therapies have performed better than long-term approaches,

D.S.M-V-T.R, Psych Pearls especially when they are combined with psychotropic medications Most patients have fewer new episodes of manic episodes by taking lithium and other mood stabilizers Antipsychotic drugs reduced positive symptoms in around 70% of patients diagnosed with schizophrenia Exposure therapies are effective with phobias Benzodiazepines can be effective in many cases of panic disorder, although they are used less often than depressants C.B.T are equally effective as antidepressant drugs in the treatment of panic disorders Antidepressant drugs bring improvement to between 50 and 60 percent of those with obsessive-compulsive disorder Structures in the circuit do indeed seem to interconnect more appropriately after individuals with O.C.D respond successfully to antidepressant treatment Long-term psychodynamic therapy is only occasionally helpful in cases of unipolar depression (short-term >>>>) Culture-Sensitive approaches increasingly are being combined with traditional forms of psychotherapy to help minority clients overcome their disorders E.C.T has apparent effectiveness with severe depression, especially when patients follow up the initial cluster of sessions with continuation or maintenance therapy, either ongoing antidepressant medications or periodic E.C.T sessions C.B.T, Interpersonal, and Biological Therapies are all effective treatment for unipolar depression However, drug therapy reduced depressive symptoms more quickly than C.B and Interpersonal therapies, but these psychotherapies had matched the drugs in effectiveness by the final 4 weeks of treatment C.B.T and Interpersonal Therapies lower the likelihood of relapse Token Economies help reduce psychotic and related behaviors, however, its uncontrolled Drugs appear more effective treatment for schizophrenia than any other approaches used alone, such as psychotherapy, milieu therapy, or electroconvulsive therapy

○ Psychotherapy is successful in many more cases of schizophrenia these days (C.B.T, Family Therapy, Social Therapy)

For people with schizophrenia, cognitive remediation brings about moderate improvements in attention, planning, memory, and problem-solving

○ C.B.T's often help people with schizophrenia feel more control over their hallucinations and reduce their delusional ideas

For certain phobia, such as small-animal phobia, flying phobia, claustrophobia, B.I phobia, exposure therapy is often highly effective when administered in a single long session

Medication treatments are ineffective by themselves, and there is even some evidence that anti-anxiety medications may interfere with beneficial effects of exposure therapy

○ D-Cycloserine can enhance the effectiveness of exposure therapy for fear of heights in a virtual reality environment

o In the long-term, after medication for panic disorder has been tapered, clients who have been on medication with or without cognitive or behavioral treatment seem to show a greater likelihood of relapse

○ C.B.T has been found to be useful in helping people who have used benzodiazepines for over a year to successfully taper their medications

○ A major disadvantage of medication treatment for O.C.D is that when the medication is discontinued relapse rates are generally very high

○ Family therapy is more helpful for some patients with Anorexia Nervosa then for others

○ D.B.T, the most effective treatment for Borderline Personality Disorder

Positive Family Interaction Therapy demonstrated 70% response rate compared to more traditional model of individual C.B.T with psychoeducation

Socio-Cultural Factors and Ethics (5)

Identifying Socio-Cultural factors

- Stigma – a strong lack of respect for a person or a group or a bad opinion of them because they have been something society does not approve off

- O Ataque de Nervous – syndrome among individuals of Latino Descent, characterized by symptoms of intense emotional upset, including acute anxiety. anger, or grief; screaming; attacks of crying; trembling; heat in the chest rising into the head; and becoming verbally and physically aggressive

- Dhat Syndrome – coined in South Asia (India) characterized by young male patients who attributed their symptoms to semen loss

○ Koro - acute anxiety and a deep-seated fear of shrinkage of the penis and its ultimate retraction into the abdomen, which will cause death

○ Khyal Cap-syndrome found among Cambodians characterized by panic attacks

○ Kufungisisa – overthinking; idiom of distress and cultural explanation among the Shona of Zimbabwe

- Maladi Moun – Haiti; sent sickness; interpersonal envy and malice cause people to harm their enemies by "sending illness"

○ Nervios – among Latinos; general state of vulnerability to stressful life experiences and to difficult life circumstances

○ Shenjing Shuairuo – syndrome composed of weakness, emotions, excitement, nervous pain, and sleep

○ Susto – distress and misfortune prevalent among some Latinos in U.S, attributed to a frightening event that causes the soul to leave the body and results to unhappiness and sickness, as well as functioning in key social roles

■ Cause: induvial believes that he or she has become the subject of black magic

○ Taijin Kyufusho - an intense fear that one's body parts or functions displease, embarrass or are offensive to others

○ Amok - syndrome or pattern of behavior acknowledged in Southeast Asia (Malaysia, Philippines, Indonesia) characterized by sudden outbursts and frenzied violent behaviors after a period of brooding and quiet

○ The likelihood of having a particular phobia is powerfully influenced by gender

- Males are more likely than females to self-medicate their fear and panic with alcohol and in so doing start down the slippery slope to addiction

- B.N, A.N, and B.D.D is common to females

- Well-established ability of women to recall emotional memories somewhat better than men may facilitate emotional processing and long-term treatment gains

○ Dissociative Trance – counterpart of D.I.D in eastern countries; sapi

- Experiences during different periods of development may influence our vulnerability to other types of stress or to differing psychological disorders

Ethics

○ If mistakes were made, they should do something to correct or minimize the mistakes

○ If an ethical violation made by another psychologist was witnessed, they should resolve the issue with informal resolution, as long as it does not violate any confidentiality rights that may be involved

When they are tasked to provide services to clients who are deprived with mental health services (e.g., communities far from the urban cities), however, they were still not able to obtain the needed competence for the job, they could still provide services A.S long A.S they make reasonable effort to obtain the competence required, just to ensure that the services were not denied to those communities.

During emergencies, psychologists provide services to individuals, even though they are yet to complete the competency/training needed just to ensure that services were not denied. However, the services are discontinued once the appropriate services are available.

○ Informed Consent:

✓ When conducting research, providing assessment, therapy, counseling, or consultation

✓ For legally Incapable, they must provide appropriate explanation, assent, consider the client's preferences and best interests, and obtain permission from a legally authorized person

✓ If Court Ordered, they must inform the nature of the services, whether it is court order or mandated, as well as, its limits of confidentiality before proceeding

✓ Must document written or oral consent, permission, and assent

o In case of interruption of services (such as death, relocation, illness, retirement), psychologists must make reasonable efforts to plan for continuing services

Unless stated in the contract

○ Psychologists should discuss the limits of confidentiality, uses of the information that would be generated from the services to the persons and organizations with whom they establish a scientific or professional relationships

Before recording voices or images, they must obtain permission first from all persons involved or their legal rep

Only discuss confidential information with persons clearly concerned/involved with the matters

○ Disclosure is allowed with appropriate consent

No consent is not allowed unless mandated by the law

○ No disclosure of confidential information that could lead to the identification of a client unless they have obtained prior consent or the disclosure cannot be avoided

Only disclose necessary information

○ Exemptions to disclosure:

✓ If the client is disguised/identity is protected

✓ Has consent

✓ Legally mandated

○ Opinions written on recommendations, reports, and diagnostic or evaluative statements must be based and sufficient to their findings

○ Only provide statements after conducting examinations to support their statements

o Informed Consent, except:

✓ Mandated by law

✓ Routine

✓ Evaluating decisional capacity

If the person has a questionable capacity to consent, it must be obtained using the language that is reasonably understandable to the person being assessed

○ In the absence of client/patient release, psychologists must provide test data only as required by law

○ Psychological assessment techniques done by unqualified persons, except during training purposes, given it is supervised

When conducting or providing services to several persons who have a relationship, they should clarify which of them is the clients and the relationship he/she will have with each person

If conflicting roles would arise, he/she must clarify, modify, or withdraw from roles appropriately

○ Psychologists do not engage in sexual intimacies with former clients/patients for at least two years after termination of therapy

○ Terminate therapy when the client no longer needs the service, is not likely to benefit, or is being harmed by continued service

Also, when threatened or endangered by the client

Must provide pretermination counseling and suggest alternative service providers as appropriate

○ Telepsychology – provision of psychological services using telecommunication technologies

Must ensure competence with both the technologies used and the potential impact of technologies on clients/patients, supervyzeez or other professionals

Ensure ethical and professional standards of care and practice

Informed consent must still be obtained, which specifically addresses the unique concerns related to the telepsychology services they provide

Should include the manner of telecommunication, the boundaries they will establish, and the procedures for responding to electronic communications

When necessary, psychologists obtain the appropriate consultation with technology experts to augment their knowledge of telecommunication technologies in order to apply security measures in their practices that will protect and maintain the confidentiality of data and information related to their clients/patients.

Some of the potential risks to confidentiality include considerations related to uses of search engines and participation in social networking sites.

Psychologists are encouraged to weigh the risks and benefits of dual relationships that may develop with their clients/patients, due to the use of telecommunication technologies, before engaging in such relationships

Psychologists who use social networking sites for both professional and personal purposes are encouraged to review and educate themselves about the potential risks to privacy and confidentiality and consider utilizing all available privacy settings to reduce these risks

Psychologists are encouraged to create policies and procedures for the secure destruction of data and information and the technologies used to create, store and transmit the data and information.

Psychologists are thus encouraged to be knowledgeable about, and account for, the unique impacts, suitability for diverse populations, and limitations on test administration and on test and other data interpretations when these psychological tests and other assessment procedures are considered for and conducted via telepsychology

Global Health Crisis and Mental Health Law

Different Issues and Concerns on the Impact of covid-19 on the Mental Health of people

After acquiring covid-19 (or even prior), a person may experience cognitive and attention deficits (brain fog), anxiety and depression, psychosis, seizures, and even suicidal behavior

Data suggests that people are more likely to develop mental illness or disorders in the months following infection, including symptoms of P.T.S.D

People who are more likely to experience the symptoms of mental illnesses or disorders during the pandemic:

a) People from racial and ethnic minority

b) Mothers and pregnant people

c) People experiencing poverty

d) Children

e) P.W.D's

f) People with pre-existing mental illnesses

g) Health Care Workers

Online Classes

- Online learning in nursing education is not significantly different from blended or face-to-face learning in terms of its impact on knowledge acquisition and attitudes toward learning

- Online Learning caused by the covid-19 Pandemic brought negative learning attitudes and poorer learning performance compared to classroom learning, especially during the early days of the pandemic

- Learning in the new normal has been a challenge to institutions, more particularly to students and educators

- Not all institutions have the capability to deliver online classes due lack of equipment, technical know-how

- o In the Philippines, children in vulnerable groups have no access to quality education. They also struggle to find distance learning opportunities. According to unesco, about 28 million learners are affected by school closures. Unfortunately, the covid-19 pandemic will severely affect their learning quality without the help of government and nongovernment organizations.

- The findings revealed that the online learning challenges of college students varied in terms of type and extent. Their greatest challenge was linked to their learning environment at home, while their least challenge was technological literacy and competency. The findings further revealed that the covid-19 pandemic had the greatest impact on the quality of the learning experience and students' mental health.

Frontliners

○ Insomnia was found to be the most common mental health problem, followed by anxiety, P.T.S.D, depression and stress in healthcare workers in the face of the covid-19 pandemic

Post-traumatic stress disorder was the most common mental health disorder reported by healthcare workers during the covid-19 pandemic, followed by anxiety, depression, and distress

Besides the lack of personal protective equipment, our frontliners are underpaid and do not get the respect they deserve. They answer “to the call of duty while battling fear and anxiety”.7 Aside from this, they also experience pressure, stress, insomnia, denial, anger, and fear

According to W.H.O, Exposure to excessive stress, for prolonged periods can have many harmful consequences on the emotional and mental well-being of frontline workers. It can:

✓ lead to burnout.

☑ trigger the onset of common mental disorders such as depression and anxiety or post-traumatic stress disorder (P.T.S.D).

result in unhealthy behaviours like using tobacco, alcohol or other substances, which may lead to substance use disorders.

result in frequent absence from work or reduced productivity while at work.

✓ increase the risk of suicide among frontline workers, particularly health care workers

Vaccination

- covid-19 vaccination is associated with larger reductions in anxiety or depression symptoms among individuals with lower education levels, who rent their housing, who are not able to telework, and who have children in their household

- The results of the present study showed that the mental health of young people did not significantly improve in the time period after vaccinations became widely available and promoted in Austria and Turkey

- The impact of age may be related to more pronounced uncertainty and anxiety among younger groups, as unpredictable pandemic circumstances make it even more difficult for them to plan their future, as they cross the threshold to adulthood and independence.

- a number of recent studies have confirmed that younger adults and females in particular suffered from the adverse outcomes associated with the covid-19 pandemic

- An overwhelming majority of Filipinos surveyed (over 15,600 participants) currently distrust available vaccines, their efficacy against the original and emerging strains, the cost of being vaccinated, and the authenticity of vaccine samples available in the country.

Lockdown

- Anxiety, depression, irritability, boredom, inattention and fear of covid-19 are predominant new-onset psychological problems in children during the covid-19 pandemic. Children with pre-existing behavioral problems like autism and attention deficit hyperactivity disorder have a high probability of worsening of their behavioral symptoms.

- The review highlights the need for mental health services to address the increased mental health symptoms in people with pre-existing mental illnesses during a pandemic

- Students and unemployed respondents are highly vulnerable to covid stress and its mental health implications. Men and women did not significantly differ in distress

- Cluster analysis revealed two age clusters—those between 16 and 35 years and those 36 years and above. The younger group reported greater depression, anxiety, and stress symptoms and poorer psychological well-being compared to the older group. The younger group also reported less resilience, nonreactivity, and use of spiritual coping compared to the older group. The results suggest that the young are most vulnerable during the pandemic, and findings suggest what might be done to provide them mental health psychosocial support.

Teleconsultation

- Telephone-delivered psychotherapy has increased utility as a method of service delivery in the current world, where several barriers, including economic hardships and limited access to care, may prevent people from receiving the treatment they need

- telemedicine is perfectly suitable to treat the mental health problems of the people in this pandemic situation without increasing the risk of infection, promoting health and prolonging life as well.

Work From Home

- The top factors that contribute to people's stress, anxiety, and depression are financial considerations, health concerns, and inconsistencies in the workplace setup

- When experienced with frequency, these result in burnout, loss of drive and focus, and struggles with work-life balance

- The switch to a work from home status has contributed to the higher critical levels in our workforce's mental health. Those who are working from home are 3.7 times more likely to have critical anxiety levels and 6 times more likely to have critical depression levels.

- Another survey by Lenovo Philippines as early as April reported that up to 87% employees were ready to shift to W.F.H when required. "Our survey suggests that the employee experience was already changing before the pandemic hit," said Michael Ngan, president and general manager of Lenovo Philippines, reported Business Mirror.

- On top of the mental health issues that W.F.H employees are now facing are logistical concerns surrounding the adjustment to the telecommuting scheme. A B.P.O Industry Employees Network survey revealed common issues faced by W.F.H employees, including: "lack of logistical assistance (such as delivery of equipment)," "longer working hours," "unpaid wages due to poor or no Internet connection," "unjust sanctions due to technical problems," and "shouldering of Internet and utility expenses by employees." Up to 77% of respondents say that they've been shouldering their own Internet costs while 54% did not receive Internet allowance and 20% did not receive work laptops.

- Dr. Agnes Casino of the National Center for Mental Health (N.C.M.H) said maintaining work-life balance in a work from home setup is hard especially when one has to take on different roles at different times in the same place.

- Employees pointed out that with the new work arrangement, they still find satisfaction, enjoyment, and fulfilment given the necessary condition at home. However, detrimental factors like balancing work and family, difficulty focusing on work tasks and collaborating with colleagues, poor working environment, and slow internet connectivity lead to isolation, stress, and anxiety.

- women experienced higher stress and exhaustion with working from home compared to men due to familial and domestic responsibilities.

Children

- Learning deficits are particularly large among children from low socio-economic backgrounds

- “In 2020, schools globally were fully closed for an average of 79 teaching days, while the Philippines has been closed for more than a year, forcing students to enroll in distance learning modalities. The associated consequences of school closures – learning loss, mental distress, missed vaccinations, and heightened risk of drop out, child labour, and child marriage – will be felt by many children, especially the youngest learners in critical development stages,” unicef Philippines Representative Oyunsaikhan Dendevnorov says.

- While children are more vulnerable to these detriments, there remains the absence of unified and comprehensive strategies in mitigating the deterioration of the mental health of Filipino children

Evaluating the Impact of Global Health Crisis and Other Mental Health Conditions on the Implementation of R.A 11036

- Dr. Razel Nikka Hao, D.O.H Disease Prevention and Control Bureau director, reported to the committee that since R.A 11036 was passed, 62 of their personnel were trained on Basic Institutional Review Board (I.R.B); 51 as future trainers for I.R.B; 1,556 completed the World Health Organization Quality Rights e-training; 28 with Lived Experiences completed the course on mental health advocacy and leadership (pilot implementation); and over about 40 media practitioners were trained on responsible and ethical reporting and portrayal of suicide (pilot implementation).

- DepEd officials noted that after the pandemic lockdowns, the transition from blended learning to in-person classes also created new pressures on students. But there are no programs specifically designed to promote mental health for any age group. Bullying has been a serious problem in schools even before the pandemic, with social media facilitating the abuse, and DepEd officials believe bullying cases are also underreported.

- Despite passing the Philippine Mental Health Act, access to mental health care remains limited. Most pediatricians, adolescent medicine specialists, and psychiatrists practice in urban areas in the country. Moreover, payment for mental health consultation remains an out-of-pocket expense for Filipinos

- o Rep. Florida Robes said that aside from minimum health standards and protocols aimed at halting the spread of covid-19 in communities, local government units (L.G.U's) should also establish mental help desks in every barangay to address those suffering from anxiety or depression as a result of the pandemic

- o In a statement on Monday, Deputy Speaker Loren Legarda said that the government must work to address the mental health issues of Filipinos, who have struggled to cope with the demands and the problems brought by the covid-19 pandemic.

- Legarda, who was co-author of Republic Act No. 11036, was referring to a Philippine Statistics

Authority (P.S.A) data that showed suicide incidents increasing by 57 percent for 2020, compared to 2019.

- She said she is seeking a policy measure dedicated to “enhancing the delivery of mental health services to the people,” especially since recent studies showed that only around five percent of the whole health budget was allocated to mental health concerns.

- The D.O.H has launched a multi-sectoral approach for mental health with programs and interventions across a variety of settings (e.g. workplaces, schools, communities) aimed at high-risk groups. The commemoration of World Suicide Prevention Day also calls attention to the plight of those who are undergoing severe forms of depression.

- Another project is the development of a multisectoral National Suicide Prevention Strategy, which includes psychosocial services such as the N.C.M.H's Crisis Hotline "Kamusta Ka? Tara Usap Tayo," launched on 2 May 2019. The hotline is available 24/7 for prompt psychological first aid. The U.P Diliman Psychosocial Services (U.P.D PsychServ) has also provided free counseling via telephone for front liners. R.A 11036 or the ("Mental Health Act") mandates the provision of comprehensive suicide prevention services encompassing crisis intervention, and a response strategy on a nationwide scale.

Additional Notes

○ Leta Hollingworth – believed that many mentally defective children were actually suffering from emotional and behavioral problems primarily due to inept treatment by adults and a lack of appropriate intellectual challenge

○ Monomania – partial delusion

Neurasthenia – characterized by persistent and distressing complaint of increased fatigue after mental effort or persistent and distressing complaints of bodily weakness and exhaustion after minimal effect

○ Psychasthenia – anxiety, excessive worrying and doubting

Phonasthenia – weakness or hoarseness of voice

○ Jean Esquiroł – first to describe a medical disorder quite similar to contemporary O.C.D and classified it as monomania

○ Freud and Pierre Janet isolated O.C.D from neurasthenia

Pierre Janet – proposed that obsessional patients possessed an abnormal personality (psychasthenia) with features such as anxiety, excessive worrying and doubting, and described the successful treatment of compulsions and rituals with techniques that are similar to the ones used currently in behavioral therapy

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