2.3C Mental Health Challenges: Part II (Clinical Psychology) – Exam Summary | EUR

Table of Contents
POST-TRAUMATIC STRESS DISORDER (PTSD) ...................................................................................................... 2

OBSESSIVE-COMPULSIVE DISORDER (OCD) ......................................................................................................... 3

SCHIZOPHRENIA .................................................................................................................................................... 5

PERSONALITY DISORDERS (PDS)........................................................................................................................... 8

NEUROCOGNITIVE DISORDERS (NCDS) ...............................................................................................................10

COMORBIDITY ......................................................................................................................................................12

GENDER DYSPHORIA .............................................................................................................................................13

PARAPHILIC DISORDERS .......................................................................................................................................14

SOMATIC DISORDERS ...........................................................................................................................................15

PREVALENCE (HIGHEST TO LOWEST) ..................................................................................................................17

, Post-Traumatic Stress Disorder (PTSD)
• Adult DSM-5 criteria
A. Exposure to a traumatic event (4 possible ways)
o Life-threatening illness is NOT a traumatic event
B. Intrusion symptoms (5 criteria) + incl. dissociation
C. Avoidance (2 criteria)
D. Mood changes and negative cognitive patterns (at least 2 out of 7)
E. Changes in activity (at least 2 out of 6)
• Symptom presence: 1+ months
o With delayed expression: appear after 6+ months after trauma
• Children under 6 criteria
C. Avoidance and negative changes in cognition or mood (at least 1)
• Prevalence: 8.7%
o 33% in survivors of rape, military combat, captivity, and genocide
o More in females
• Onset: any time after 1 y.o
o 3 months after trauma
o Half of adults recover within 3 months
o Intentional traumas (rape) lead to symptoms worsening over time, with non-intentional
(accident) it gets better
• Factors:
o More dissociation during trauma => more dissociation after
o More perceived social support => less PTSD symptoms (most important factor)
• Comorbidity: 80% more likely to have another disorder (mood, anxiety, SUD)
• Manifestation
o Children: age regression, clinginess
o Teens: thoughts of revenge, guilt for not preventing harm`
o Adults: less anger outbursts, crying spells, more distressing memories, suicidal thoughts
• Assessment: Screening in primary care clinic => Diagnosis => Symptom severity and treatment
monitoring
• Therapy
o Prolonged exposure (PE): imaginal and in vivo
o Cognitive processing therapy (CPT): managing negative thought patterns + written trauma
accounts
▪ People with no dissociation benefit more without written trauma accounts
o Eye movement desensitisation and reprocessing (EMDR): processing trauma
o Stress inoculation training (SIT): increases sense of agency and builds resilience against future
stress
▪ Kitchen sink effect: overload from multiple techniques
• Meds
o Approved SSRIs: sertraline and paroxetine
o Other: trazodone and prazosin (for nightmares) to fix sleep disturbances

, • Social-interpersonal framework model of PTSD: Trauma => 3 factors => individual recovery,
relationship quality, community integration
o Social affects (guilt, shame, anger and aggression)
▪ PTSD => anger (mediator) => aggression in relationships
o Close relationships
▪ Trauma disclosure is the most important
o Culture and society
▪ Social acknowledgement as a victim (esp. for man-made trauma)
▪ Modern values => better PTSD outcomes, however in society after trauma people
resort to traditional values
• Resilience: social connections are the key factor
o Disorder-specific couple therapy for PTSD is the best



Obsessive-Compulsive Disorder (OCD)
• Criteria
A. Obsessions and/or compulsions to reduce anxiety
B. More than 1 hour per day or cause significant distress
• Specifiers
o 3 levels of insight: (def not true, probably true, def true)
o Tic-related: 30% have a tic disorder, mostly males with early onset
• Prevalence: 1.1%-1.8%
o Higher in females, males more likely to have tics
• Onset: 19.5 y.o on average, 25% start by 14, onset is rare after 35
o Males have earlier onset, with 25% developing it before 10 y.o
o Chronic fluctuating course, 40% of childhood-onset cases go into remission
• Biological factors
o Dysregulation in cortico-striato-thalamo-cortical (CSTC) circuits
▪ Orbitofrontal cortex: decision-making and detecting errors
▪ Anterior cingulate cortex: emotional regulation
▪ Striatum: movement and habits
o Circuits: sensorimotor, dorsal cognitive, frontoparietal network, ventral cognitive, ventral
motivational
o Genetic predisposition (~40-50% heritability)
o Neurotransmitter abnormalities (serotonin, dopamine, glutamate)
• Comorbidity: 90% have another disorder; 75% have an anxiety disorder, OCD develops afterwards;
60% have a mood disorder, OCPD, tic disorders, impulse control disorders, and SUD are also
comorbid
• Dimensions: contamination, harm-related, unacceptability, symmetry, hoarding
o Changes over life occur within the same dimension
• Genes: polygenic, copy number variations (CNVs) - large deletions or duplications of DNA segments
– in a region linked to neurodevelopmental disorders. (16p13.11)