Psychological Disorders and Anomalies - MCAT Psychological and Social Foundations

In the context of obsessive compulsive disorder, an obsession refers to "persistent or recurrent involuntary thoughts and/or images which are intrusive and cause marked distress or anxiety." These thoughts often lead to compulsions, or repetitive behavior that an individual feels driven to perform according to rigid rules or rituals.

While it may occur in children under five, obsessive compulsive disorder generally presents either in childhood (age 10-12) or in early adulthood (ages 18-22). Onset after age 25 is less common, and onset in middle age is rare.

Dissociative disorders are characterized by periods of altered mental status (e.g. disruptions in memory, perception, self-identity, and/or awareness) that occur frequently enough to disrupt a person's ability to function normally. They are thought to be potential results of psychological trauma, but may also result from medication and/or drug use. Dissociative identity disorder, dissociative amnesia, and depersonalization disorder are all considered dissociative disorders.

On the other hand, schizophrenia is a psychotic disorder; although it may include occasional episodes of dissociation, the episodes where individuals lose touch with reality are characterized more by delusions and hallucinations, not a loss of memory or awareness. Individuals with schizoid personality disorder—which is a personality disorder, not a dissociative disorder—have little interest in close relationships with others and are generally "cold" or detached in affect. Post-traumatic stress disorder is an anxiety disorder characterized by sudden episodes of worry, unease, apprehension, and fear due to some emotional trigger that causes flashbacks to the traumatic event and hyperarousal during the event.

“Factitious disorders” are psychiatric or behavioral conditions in which an individual knowingly fabricates or exaggerates illness in order to receive medical treatment, sympathy, or care. Factitious disorders are distinguished from “hypochondriasis,” “conversion disorders,” and “somatic symptom disorders” in that the individual is consciously creating their symptoms, while in the other disorders listed they are not.

Borderline personality disorder is a diagnosis in people who are impulsive, unstable in mood, and manipulative. They can be charming and friendly one minute and angry, irritable, and sarcastic the next. People who need to escape from extreme trauma, most often from sexual or physical abuse in childhood, may develop distinct different personalities. This is termed dissociative identity disorder. People who lie, cheat, steal, and have no sense of responsibility and no anxiety of guilt about their behavior are described as having an antisocial personality disorder. People with schizophrenia experience hallucinations and delusions. Generalized anxiety disorder consists of persistent, excessive worrying and uncontrolled anxiety that has lasted for at least six months.

"Borderline personality disorder" is characterized by difficulty regulating behavior or thoughts, extreme fluctuations in mood, unstable relationships due to idealization or demonization, fear of abandonment or other attachment disorders, and impulsive or reckless behavior.

The other choices are incorrect. "Obsessive-compulsive disorder" is typified by repetitive, unwelcome thoughts that compel the individual to perform ritualistic acts. "Paranoid personality disorder" is a condition of pervasive, long-standing paranoia and general mistrust of others. "Schizotypal personality disorder" is an antisocial disorder: individuals experience social anxiety, the urge to isolate themselves from others, and odd behavior or beliefs.

The DSM IV criteria for diagnosis of borderline personality disorder includes at least five of the following symptoms:

• Extreme reactions to abandonment, real or perceived
• A pattern of tumultuous relationships with family, friends, and romantic interests, often vacillating from extreme idealization to extreme dislike or devaluation.
• Distorted and unstable self-image, which can result in sudden changes in feelings, opinions, values, plans, or goals
• Impulsive and destructive behaviors, such as spending sprees, unsafe sex, substance abuse, reckless driving, and binge eating
• Recurring suicidal behaviors or self-harming behavior
• Intense and highly changeable moods
• Chronic feelings of emptiness and/or boredom
• Inappropriate, intense anger or problems controlling anger
• Having stress-related paranoid thoughts or severe dissociative symptoms, such as feeling cut off from oneself, observing oneself from outside the body, or losing touch with reality.

Schizophrenia is a mental disorder where people perceive things without a stimulation—hallucinations. These people also suffer paranoid delusions, and their behaviors can be totally inappropriate. The development of distinctly separate personalities is called dissociative identity disorder (DID). People with schizophrenia do not have a split personality. People with bipolar disorder alternate between episodes of depression and mania. Trichotillomania is characterized by the repeated urge to pull out body hair. When there is no identifiable physical cause to explain physical disorders that are real to the patient, somatoform disorder may be diagnosed.

People with schizophrenia have hallucinations, delusions, and difficulty concentrating. Symptoms of schizophrenia typically begin to appear in the late teens and twenties. Social phobias involve fear of being embarrassed in social situations. The most common is fear of public speaking. People with generalized anxiety disorder are frightened of something but are unable to speak about a specific fear. They develop physical fear reactions. Alterations of episodes of depression with episodes of mania is called bipolar disorder. The inability to resist and impulse to perform an action that is harmful to the individual or to others is an impulse control disorder. Examples are kleptomania and pyromania.

The amygdala, along with the insular cortex and the limbic system, demonstrates hyperactivity when a person experiences high levels of fear and/or anxiety, and would show hyperactivity in a patient with an anxiety disorder.

On the other hand, the other choices are incorrect. For example, Wernicke's area is associated with comprehension of spoken language, while the occipital lobe is associated with visual perception. Last, the parietal lobe helps integrate various forms of sensory input with each other to create an understanding of the world.

Methylphenidate shows an early response when added to behavior therapy is the correct answer. Attention-deficit/hyperactivity disorder is a neurodevelopmental disorder characterized by persistent patterns of inattention, hyperactivity, and impulsivity. The history must reveal that symptoms of inattention or hyperactivity and impulsivity are present in more than one setting, as symptoms may be absent when the patient is interacting in the clinician's office. Evidence-based behavior therapy should be prescribed as the first line of therapy for preschool-aged children, and stimulant medications may be prescribed for the preschooler with severe ADHD or inadequate response to behavior therapy.

ADHD symptoms may be associated with artificial food additives in diet, so behavior therapy may be avoided by adhering to additive-free diet is the correct answer. Behavior therapy should be prescribed for all preschool-aged children as treatment for ADHD. Stimulant medications may be prescribed for moderate to severe ADHD and when behavior therapy fails to provide improvement in ADHD symptoms.

Parkinson's is a degenerative neuromuscular disease, often associated with muscular tremors and shaking. In later stages, the neurological symptoms become more evident. While the exact cause of Parkinson's Disease is unknown (it is still considered idiopathic), there are correlations that suggest the cause is linked to the death of dopaminergic neurons in the substantia nigra region of the midbrain. Beta-amyloid protein plaques are also associated with Parkinson's Disease, as well as Alzheimer's Disease.

The correct asnwer is the nervous system; this is what causes the tremors commonly associated with Parkinson's disease.

Cholinergic drugs used for the treatment of Alzheimer's disease are used to improve memory rather than to cure the disease. These drugs can slow the decline in cognitive function. Patients in the early stages of the disease can benefit from reality orientation, which involves the repetition of verbal and nonverbal information to remind the person of names, dates, and other pertinent information. Alzheimer's disease is a progressive degenerative cognitive disorder. Although motor capabilities are assessed, the disease primarily involves loss of cognition, not motor function. If a patient is experiencing sleep disturbances, sleeping during daytime hours is discouraged.

"Tau proteins," proteins that aid in the cellular transport system of neurons, often become tangled in the brains of Alzheimer's disease, resulting in loss of cellular nutrient and waste transport and eventual cell death.

The other choices are incorrect. "Prion proteins" are found in various prion diseases such as bovine spongiform encephalopathy. "Lewy bodies" are symptomatic of Parkinson's disease, while "C-reactive proteins" are elevated in any condition associated with inflammation.

Depression is treated with selective serotonin reuptake inhibitors (SSRIs). Serotonin is a neurotransmitter responsible for mood. By allowing more serotonin to be active in the synapses, mood is elevated. Bipolar disorder is treated with the mood stabilizer lithium. Psychosomatic disorder is treated using biofeedback and relaxation techniques to reduce tension and spasm. Schizophrenia is treated with antipsychotic medications, also called major tranquilizers. Risperidone is one of these. The treatment for dissociative identity disorder is psychotherapy.

Seasonal affective disorder has been associated with an increase in "serotonin transporter," or SERT. This protein is responsible for removing serotonin from the synaptic cleft and replacing it in the presynaptic neuron; therefore, it ends serotonin's signaling in the brain. Individuals with seasonal affective disorder (SAD) have been shown to have higher levels of SERT in the winter months or any condition of decreased light exposure.

The American Psychiatric Association developed the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) to uniformly classify and describe mental disorders. The DSM-IV provides a detailed description of the symptoms seen in psychiatric disorders. "Insanity" is a legal term for severe mental illness present at the time a crime was committed. It is not a mental diagnosis. The International Classification of Disease is used to assign codes to medical diagnoses that are used for reimbursement purposes. The Physician Desk Reference (PDR) provides detailed information on medication administration. The DSM-IV does not provide information about treatment.

Symptoms that may not be accompanied by excessively repetitive behaviors is the best choice because it directly addresses that impairments in social skills may be seen in the presence or absence of restricted, repetitive behaviors. Autism spectrum disorder is characterized by social communication impairments and restricted, repetitive patterns of behavior, often in the first 2 years of life. None of the other choices discuss the association that impairments in social skills may have with restricted interests and repetitive behaviors.