Section One: Short questions: (30 marks)

Key Concepts (12 marks):

Compulsion:
Repetitive behaviors (e.g., checking) or mental acts (counting) that the
individual feels driven to perform in response to an obsession or according
to rules that must be applied rigidly. The behaviors or mental act are
aimed at preventing or reducing anxiety or to distress. In some cases,
preventing dreaded events or situations. However, these behaviors or
mental acts are not connected in a realistic manner to what they are
designed to neutralize or prevent or are clearly excessive.
Emotion:
A reaction that occurs when an organism encounters a meaningful
stimulus, for example, the emotion of anger can be aroused by an insult.
Feeling:
An experience of emotion that influences our behaviors, for instance, the
anger we feel from an insult can influence us to act violently towards the
person who made the insult.
Affect:
The outward expression of an emotional state. Such as having an angry
expression on your face due to an insult.

Speech disturbance associated with schizophrenia: (6

marks)
Disorganized speech in schizophrenia can take various forms according to
APA:
Loosening of associations: Also referring to as slippage or derailment,
entails that person moving between unrelated ideas in conversation.
Speech may be incoherent, and responses may be bizarre and
idiosyncratic. The presence of losing associations is regarded as one of the
most valuable diagnostic distinctions in the diagnosis of schizophrenia.
Tangentiality: Statements or answers that are unrelated to the topic at
hand and stated unclearly in relation to the topic.
Incoherence: Utterances that are incomprehensible, so-called “word-
salad”
Neologisms: The speech of some people with a diagnosis of
Schizophrenia may contain new words that combination of words in
common usage.

Symptoms of anxiety-related conditions: (6 marks)

Anxiety-related can manifest through various symptoms:
Physical: Rapid heartbeat, sweating, fatigue, shortness of breath,
trembling or shaking, gastrointestinal issues. (E.g., diarrhea, stomach
pain.)
Cognitive: Racing thoughts irrational fears, difficulty concentrating an
excessive worry.
Emotional: Restlessness, irritability, trouble sleeping, feeling of
apprehension and dread.
Behavioral: Compulsive behaviors, agitation or fidgeting, avoidance of
anxiety-related situations.

Clinical indicators of depression and bereavement: (6

marks)
Depression:
 Extremely ‘self-focused,’ feels like an outcast or alienated from
friends and loved ones.
 Sense of hopelessness and believes that the depression will never
end.
 Experiences of low self-esteem and self-loathing.
 Experiences few positive feelings or memories.
 Guilt surrounds feeling of being worthless or useless to others.
 Persuasive anhedonia.
 Often inconsolable
 Chronic thoughts of not deserving, or not wanting to live.
Bereavement\ Grief:
 May have tendencies to isolate themselves but generally maintains
emotional connections to others.
 Hopes and beliefs that the grief will get better someday. (Being
Delulu)
 Maintains overall feelings of self-worth.
 Experiences positive feelings and memories along with painful ones.
 Guilt, if present, is focused on letting on ‘on letting down’ the
deceased person in some way.
 Loss of pleasure is related to longing for the deceased loved one.
  Suicidal feelings are more related to the longing of the reunion of
the deceased.
 May be able to be consoled by family, friends, music, art, literature
etc.

Section Two: Long questions: (20 marks)

Distinguish between anxiety disorders and anxiety-
related conditions.(10 marks)
Important Distinctions
 Shared Traits: Anxiety disorders and anxiety-related conditions
share common features, including excessive worry, physiological
arousal (e.g., increased heart rate, sweating), and avoidance
behavior.
 Unique Traits: Each disorder has unique diagnostic criteria. For
instance, GAD involves chronic worry, while panic disorder is
characterized by sudden panic attacks. PTSD and acute stress
disorder are both related to trauma, but PTSD is diagnosed when
symptoms persist for longer than one month.

Anxiety Disorders:
Anxiety disorders are mental health conditions characterized by excessive
fear, worry, or anxiety that interferes with daily life. Anxiety disorders
involve an inappropriate response to a real or perceived threat and
include various types, each with distinct characteristics.
Separation anxiety disorder:
Characterized by excessive fear or anxiety about being separated from
home or attachment figures (such as parents or caregivers). The anxiety
often focuses on the possibility of harm to oneself or the attachment
figure when apart.
Symptoms:
o Persistent worry about harm coming to attachment figures.
o Reluctance or refusal to go out due to fear of separation.
o Nightmares about separation.
o Physical complaints (e.g., headaches, stomach aches) when
separation occurs or is anticipated.
DSM-5 Diagnostic Criteria:
o Developmentally inappropriate and excessive fear or anxiety
concerning separation from attachment figures, lasting at
least 4 weeks in children and 6 months in adults.
o The presence of at least three of the following symptoms:
 Recurrent distress when anticipating separation.
 Excessive worry about losing attachment figures.
 Reluctance to go out or sleep away from home.
 Nightmares involving separation.
Example: A 9-year-old child becomes extremely anxious whenever they
are dropped off at school, fearing that something terrible will happen to
their parents while they are apart. The child frequently complains of
stomach aches and refuses to attend school because of this fear.

Specific Phobia:
Involves an extreme, irrational fear of specific objects or situations, such
as spiders, heights, or flying. The fear is excessive and leads to avoidance
behavior, significantly impairing daily functioning. There are five
categories\ Types:
 Natural environment
 Blood injection or an injury type
 Animal type
 Situational type
 Other types
Symptoms:
 Immediate fear response when exposed to the phobic object or
situation.
 Avoidance of the feared object or situation.
 The fear is out of proportion to the actual danger posed by the
object or situation.
DSM-5 Diagnostic Criteria:
 Marked fear or anxiety about a specific object or situation, lasting 6
months or more.
  The phobic object or situation almost always provokes immediate
fear or anxiety.
 The individual actively avoids the object or situation.
 The fear is disproportionate to the actual threat posed by the
specific object or situation.
Example: A person has an intense fear of flying and avoids getting on
planes at all costs. Even the thought of booking a flight causes them to
panic, and if they must fly, they experience extreme anxiety days before
the trip.

Panic Disorders:
Involves recurrent, unexpected panic attacks, which are sudden periods of
intense fear or discomfort accompanied by physical symptoms such as
heart palpitations, sweating, and trembling. These attacks peak within
minutes.
Symptoms:
 Palpitations, pounding heart, or accelerated heart rate.
 Sweating, trembling, or shaking.
 Shortness of breath or sensations of choking.
 Fear of losing control, going crazy, or dying.
DSM-5 Diagnostic Criteria:
 Recurrent unexpected panic attacks, with at least one month of:
o Persistent concern or worry about additional panic attacks or
their consequences (e.g., losing control, having a heart
attack).
o Significant maladaptive changes in behavior related to the
attacks (e.g., avoiding unfamiliar places).
 Panic attacks are not attributable to a substance or another mental
disorder.
Example: A person is shopping in a mall when suddenly they feel an
overwhelming sense of terror. Their heart starts racing, they begin
sweating, and they feel like they are choking. The panic attack peaks
within minutes, and now they avoid malls, fearing another attack.
Social anxiety disorder:
Involves a marked fear of social situations where one might be judged,
humiliated, or scrutinized by others. This can include public speaking,
meeting new people, or eating in public. Common fears associated with
social anxiety disorders are the following:
 Public speaking
 Performing on stage
 Social gatherings
 Meeting new people
 Dealing with conflicts
 Eating or Dinning in public
Symptoms:
 Intense fear of acting in a way that will be embarrassing or
humiliating.
 Avoidance of social interactions or enduring them with intense
anxiety.
 Physical symptoms like blushing, sweating, trembling, or nausea
when in social situations.
DSM-5 Diagnostic Criteria:
 Marked fear or anxiety about one or more social situations in which
the individual is exposed to possible scrutiny by others.
 The individual fears that they will act in a way that will be negatively
evaluated.
 The social situations are avoided or endured with intense fear or
anxiety.
 The fear lasts for 6 months or more and causes significant
impairment in functioning.
Example: A man feels extremely anxious at the thought of attending a
work meeting where he might have to speak in front of others. He is afraid
of embarrassing himself by saying something foolish or blushing. As a
result, he avoids attending meetings and social gatherings.

Agoraphobia:
Characterized by the fear of being in situations where escape might be
difficult or help unavailable, such as being in a crowd, using public
transport, or being in open or enclosed spaces. The individual often avoids
these situations, which can limit their life significantly.
 Symptoms:
 Fear of being in at least two or more of the following situations:
o Using public transportation.
o Being in open spaces (e.g., parking lots, marketplaces).
o Being in enclosed spaces (e.g., theatres, shops).
o Standing in line or being in a crowd.
o Being outside of the home alone.
 The fear is out of proportion to the actual threat posed by the
situation.
 DSM-5 Diagnostic Criteria:
 The fear or anxiety is about two or more of the situations
mentioned above.
 These situations are either avoided or endured with significant
distress.
 The fear or anxiety lasts for 6 months or more.
 Causes significant impairment in daily functioning or social
interactions.
Example: A woman avoids going to crowded places, like shopping malls
or concerts, because she is terrified of being unable to escape if she feels
panicked. She also avoids public transportation and prefers to stay at
home as much as possible.

Generalized Anxiety Disorder:

Characterized by excessive, uncontrollable worry about a variety of
everyday issues. Individuals with GAD often experience apprehensive
expectation about numerous activities or events, accompanied by physical
symptoms such as restlessness, fatigue, and irritability.
Symptoms:
 Restlessness or feeling on edge.
 Being easily fatigued.
 Difficulty concentrating or mind going blank.
 Irritability.
  Muscle tension.
 Sleep disturbances (difficulty falling asleep, staying asleep, or
restless sleep).

DSM-5 Diagnostic Criteria:

 Excessive anxiety and worry occurring more days than not for at
least 6 months, about various activities or events.
 The individual finds it difficult to control the worry.
 The anxiety is associated with three or more of the following
symptoms:
o Restlessness or feeling on edge.
o Being easily fatigued.
o Difficulty concentrating.
o Irritability.
o Muscle tension.
o Sleep disturbances.
 The anxiety causes significant distress or impairment in social,
occupational, or other areas of functioning.
Example: A woman constantly worries about various aspects of her life,
such as her job, finances, and the health of her family. Despite
reassurance from her doctor and family, she can't shake the persistent
worry and often experiences muscle tension and trouble sleeping due to
her constant anxiety.

Anxiety-related Conditions:
Anxiety-related conditions are disorders where anxiety plays a major role
but are distinguished by different features or causes from traditional
anxiety disorders.

Panic Attacks:
 Symptoms: Sudden, intense fear or discomfort that peaks within
minutes. Symptoms include heart palpitations, sweating, trembling,
shortness of breath, and a sense of impending doom.
 Unique Features: Panic attacks can occur in the context of any
anxiety disorder or independently. They may be triggered by specific
situations or occur unexpectedly.
  Difference from Panic Disorder: In Panic Disorder, panic
attacks are recurrent and not triggered by external circumstances.
However, panic attacks can also occur in other anxiety-related
conditions without meeting the criteria for panic disorder.

Acute Stress Disorder:

 Symptoms: Similar to PTSD but occur immediately after a
traumatic event and last between 3 days to 1 month. Symptoms
include dissociation, flashbacks, hypervigilance, and avoidance of
reminders of the trauma.
 Difference from PTSD: Acute Stress Disorder has a shorter
duration and occurs within a month of the trauma. PTSD is
diagnosed if symptoms persist beyond one month.

Adjustment Disorder with Anxiety:

 Symptoms: Anxiety that develops in response to an identifiable
stressor, such as a major life change (e.g., job loss, divorce).
Symptoms include nervousness, worry, and jitteriness that impair
daily functioning.
 Unique Features: Unlike GAD or panic disorder, the anxiety in
adjustment disorder is related to a specific life event, and symptoms
typically subside once the stressor is resolved.

Substance/Medication-Induced Anxiety Disorder:

 Symptoms: Prominent anxiety or panic symptoms that are directly
attributable to the effects of a substance (e.g., drug abuse,
medication) or withdrawal.
 Unique Features: Symptoms occur only during or shortly after
substance use or withdrawal.
Diagnostic Criteria (DSM-5):
Evidence from the history, physical examination, or laboratory findings
indicates that the disturbance is caused by a substance or medication.

Anxiety Due to Another Medical Condition:

 Symptoms: Anxiety or panic symptoms that are directly linked to a
medical condition, such as hyperthyroidism or cardiovascular
disease.
 Unique Features: The anxiety is not due to a psychological cause
but is a result of the medical condition. Once the underlying
condition is treated, anxiety symptoms often diminish.

Symptoms Categories in Schizophrenia: (10 marks)

Positive Symptoms:
Active manifestation of abnormal behavior. Distortions or exasperations of
normal behavior.
 Hallucinations: a false perception not responding to the
corresponding stimuli present in the environment. A person hears
voices telling them to do things, even though no one else is around.
 Delusions: The basic feature of madness (Gross misrepresentations
of reality)
o Delusion of thought broadcasting. A person believes that
everyone around them can hear their thoughts.
o Delusion of control. A person is convinced that their movements
are being controlled by a government satellite.
o Delusion of reference. A person thinks that the news anchor on
TV is sending them secret messages.
o Delusions of grandeur. A person believes they are a famous
celebrity or deity with special powers.
o Delusions of persecution. A person believes they are being
followed and plotted against by a group of spies.
o Thought withdrawal. A person insists that aliens are removing
their thoughts from their mind.
 Disorganized thinking: Disorganized thinking refers to a disturbance
in an individual's ability to organize, connect, and express their
thoughts logically. This symptom is often reflected in the person’s
speech, which may be incoherent, fragmented, or illogical. A person
talks about their favourite food, suddenly switches to a random
topic about politics, and then starts discussing outer space without
any logical connection.
 Disorganized behavior: Disorganized behavior refers to abnormal,
unpredictable, or inappropriate actions that are out of context with
the situation. These behaviors may range from childlike silliness to
extreme agitation and can impair an individual's ability to carry out
daily activities (e.g., self-care, maintaining a job, or interacting
socially). A person wears several layers of winter clothing on a hot
summer day and randomly dances in public for no apparent reason.
 Experiences of positivity and control: Typically refers to delusions
where individuals believe they have extraordinary abilities or are
under external control. These types of delusions are considered part
of positive symptoms in schizophrenia:
 o Positivity: This could refer to delusions of grandeur, where
individuals believe they have exceptional powers or talents,
such as believing they are a famous figure or have divine
influence. A person believes they have superhuman strength
and can control the weather.
o Control: Delusions of control involve the belief that one’s
thoughts, actions, or feelings are being controlled by external
forces. The individual may feel as though an outside entity is
manipulating them, such as aliens, the government, or
supernatural powers. A person thinks their hand movements
are being controlled by extraterrestrial beings.

Negative symptoms:
Absence of normal behavior.
 Alogia: Relative absence of speech. When asked about their day, a
person responds only with brief, one-word answers like "fine" or
"okay."
 Restricted effect: narrowing the range of outward expressions of
emotions. A person talks about a personal tragedy without showing
any facial expression or emotion.
 Avolition (or apathy): Lack of initiation and persistence either not
wanting to take any action or lacking the energy. A person stays in
bed all day, unable to muster the energy or motivation to get up,
even to eat.
 Anhedonia : Lack of pleasure, or indifference. A person no longer
enjoys hobbies they once loved, such as playing sports or spending
time with friends.
 Asociality: Lack of interest in social relationships. A person avoids
social events and has no interest in interacting with friends or
family.
 Affective flattening: Little expressed emotion. A person speaks in a
monotone voice and shows little facial expression, even during
emotional conversations.
 Catatonia: a condition in which the individual shows marked
psychomotor disturbance\ retardation. A person stands frozen in one
position for hours, unresponsive to any external stimuli.

Disorganized Symptoms:
Erratic speech, emotions, and behavior.
  Cognitive slippage (attention deficits): illogical and incoherent
speech and deterioration. During a conversation, a person starts
speaking incoherently, mixing up unrelated ideas and losing track of
the topic.
 Tangentiality: “going off on a tangent.” When asked how their day
was, a person starts talking about a completely unrelated topic, like
the weather in another country.
 Loose associations: conversation in unrelated directions. A person
begins discussing their favourite movie, then suddenly talks about
how dogs are the best pets, with no clear connection between the
two.
 Disorganized speech: language that is incomprehensible and
incoherent and lacks logical flow. A person’s speech becomes
difficult to follow, jumping from one random topic to another without
making sense.
 Neologism: invented (new) words. A person uses the word
"flibberflop" to describe how they feel, even though it isn’t a real
word.
 Inappropriate affect: the extent to which a person’s emotional
expressiveness fails to correspond to the social cues present or to
content of what is being discussed. A person starts laughing
hysterically while describing a sad or tragic event, like a funeral.

Theoretical Models in understanding the Aetiology of

Mood Disorders (e.g., Biopsychosocial Model): (10
marks)
1. The Biopsychosocial Model:
The Biopsychosocial Model posits that mood disorders arise from an
interplay between three major components: biological, psychological, and
social factors. This integrated approach suggests that no single factor is
sufficient to cause a mood disorder, but rather a combination of these
influences increases vulnerability.
a. Biological Factors:
 Genetic Predisposition:
o Studies have shown that mood disorders, particularly
depression and bipolar disorder, tend to run in families,
suggesting a genetic component. Twin and family studies
indicate higher concordance rates for mood disorders among
individuals who have relatives with the same disorder,
especially among identical twins.
 Neurotransmitter Imbalances:
 o A dysfunction in neurotransmitters like serotonin,
norepinephrine, and dopamine is strongly linked to mood
disorders. For example, low levels of serotonin are
associated with depression, while fluctuations in dopamine
levels are implicated in the mood swings seen in bipolar
disorder.
 Hormonal Imbalances:
o Abnormalities in the hypothalamic-pituitary-adrenal (HPA)
axis, which controls the body's stress response, have been
observed in individuals with depression. Chronic stress can
result in an overactive HPA axis, leading to elevated cortisol
levels, which is often found in people with mood disorders.
 Brain Structure and Function:
o MRI studies show that individuals with mood disorders may
have abnormalities in certain brain regions, such as the
amygdala, which processes emotions, and the prefrontal
cortex, which regulates mood and decision-making. In
bipolar disorder, shifts in brain activity during manic and
depressive episodes have been observed.
b. Psychological Factors:
 Cognitive Patterns:
o Psychological theories, such as Beck’s Cognitive Theory,
suggest that mood disorders are influenced by negative
thinking patterns, including distorted views about oneself,
the world, and the future. These cognitive distortions can lead
to persistent feelings of worthlessness or hopelessness,
contributing to depression.
o Learned Helplessness: Seligman's theory of learned
helplessness posits that people develop depression when they
believe they have no control over their situation, leading to a
sense of powerlessness.
 Personality Traits:
o Certain personality traits, such as pessimism,
perfectionism, or high levels of neuroticism, can make
individuals more prone to developing mood disorders. These
traits increase susceptibility to stress and heighten the
likelihood of experiencing negative emotions.
 Childhood Trauma:
 o Early adverse experiences, such as abuse, neglect, or loss of a
parent, can predispose individuals to mood disorders later in
life. These experiences can alter how one processes emotions,
leaving lasting psychological effects.
c. Social Factors:
 Life Stressors:
o Significant life events, such as the death of a loved one,
divorce, or job loss, can trigger or exacerbate mood disorders.
Chronic stress, including financial difficulties or ongoing
interpersonal conflicts, is a major risk factor for depression.
 Social Support:
o The availability and quality of social support play a crucial role
in both the onset and recovery from mood disorders. A lack of
social support is strongly correlated with higher rates of
depression, while strong, supportive relationships can serve as
a protective factor.
 Cultural and Societal Influences:
o Societal expectations, cultural norms, and stigma surrounding
mental health can affect how individuals perceive and cope
with their mood disorder. In some cultures, expressing
emotional distress is frowned upon, leading individuals to
suppress their feelings, which may worsen their condition.
 Socioeconomic Status:
o Individuals from lower socioeconomic backgrounds are at a
higher risk for developing mood disorders due to increased
exposure to stressors like financial instability, limited access
to mental health care, and poor living conditions.

2. Diathesis-Stress Model:
An extension of the biopsychosocial model is the Diathesis-Stress
Model, which posits that individuals have a genetic vulnerability
(diathesis) to mood disorders, but the actual development of the
disorder depends on the presence of environmental stressors. For
example, a person with a genetic predisposition to depression might only
experience a depressive episode after encountering a major stressor, like
the loss of a loved one or a traumatic life event.