6.1 tbl 6 (incomplete)

Question 1

What is bereavement?

Answer 1

loss of a close relationshi

Question 2

What is grief?

Answer 2

emotional response caused by a loss including pain, distress, and physical and emotional suffering.

Question 3

What is mourning?

Answer 3

psychological process through which the bereaved person undoes his or her bonds to the deceased.

Question 4

How does one diagnose complicated grief?

Answer 4

Complicated/prolonged grief is defined as the persistence, for at least six months, of a constellation of disruptive emotional reactions including yearning and four of the following eight symptoms:
- Difficulty moving on
- Numbness/detachment
Bitterness
- Feelings that life is empty without the deceased
- Trouble accepting the death
- A sense that the future holds no meaning without the deceased
- Being on edge or agitated
- Difficulty trusting others since the loss
- Other indicators of complicated grief include social withdrawal and difficulty reengaging with life

Question 5

what is norepinephrine related to?

Answer 5

alertness and energy as well as anxiety, attention and interest in life

Question 6

what is lack of serotonin related to?

Answer 6

anxiety, obsessions and compulsions

Question 7

what is dopamine related to?

Answer 7

attention, motivation, pleasure and reward, as well as interest in life

Question 8

What is depression defined as?

Answer 8

• Mood state, which may be normal or part of a psychopathological syndrome
• Syndrome, which is a constellation of symptoms and signs (eg, major depression or minor depression)
• Mental disorder that identifies a distinct clinical condition (eg, unipolar major depression)

Question 9

What is the DSM- 5 diagnostic criteria for a manic episode?

Answer 9

A. A distinct period of abnormally and persistently elevated, expansive, or irritable mood and abnormally and persistently increased activity or energy, lasting at least one week and present most of the day, nearly every day (or any duration if hospitalization is necessary).

B. During the period of mood disturbance and increased energy or activity, three (or more) of the following symptoms (four if the mood is only irritable) are present to a significant degree and represent a noticeable change from usual behavior:

1) Inflated self-esteem or grandiosity.
2) Decreased need for sleep (eg, feels rested after only three hours of sleep).
3) More talkative than usual or pressure to keep talking.
4) Flight of ideas or subjective experience that thoughts are racing.
5) Distractibility (ie, attention too easily drawn to unimportant or irrelevant external stimuli), as reported or observed.
6) Increase in goal-directed activity (either socially, at work or school, or sexually) or psychomotor agitation (ie, purposeless non-goal-directed activity).
7) Excessive involvement in activities that have a high potential for painful consequences (eg, engaging in unrestrained buying sprees, sexual indiscretions, or foolish business investments).

C. The mood disturbance is sufficiently severe to cause marked impairment in social or occupational functioning or to necessitate hospitalization to prevent harm to self or others, or there are psychotic features.

D. The episode is not attributable to the physiological effects of a substance (eg, a drug of abuse, a medication, other treatment) or to another medical condition.

Question 10

What is the DSM- 5 diagnostic criteria for a hypomanic episode?

Answer 10

A. A distinct period of abnormally and persistently elevated, expansive, or irritable mood and abnormally and persistently increased activity or energy, lasting at least four consecutive days and present most of the day, nearly every day.

B. During the period of mood disturbance and increased energy and activity, three (or more) of the following symptoms (four if the mood is only irritable) have persisted, represent a noticeable change from usual behavior, and have been present to a significant degree:

1) Inflated self-esteem or grandiosity.
2) Decreased need for sleep (eg, feels rested after only three hours of sleep).
3) More talkative than usual or pressure to keep talking.
4) Flight of ideas or subjective experience that thoughts are racing.
5) Distractibility (ie, attention too easily drawn to unimportant or irrelevant external stimuli), as reported or observed.
6) Increase in goal-directed activity (either socially, at work or school, or sexually) or psychomotor agitation.
7) Excessive involvement in activities that have a high potential for painful consequences (eg, engaging in unrestrained buying sprees, sexual indiscretions, or foolish business investments).

C. The episode is associated with an unequivocal change in functioning that is uncharacteristic of the individual when not symptomatic.

D. The disturbance in mood and the change in functioning are observable by others.

E. The episode is not severe enough to cause marked impairment in social or occupational functioning or to necessitate hospitalization. If there are psychotic features, the episode is, by definition, manic.

F. The episode is not attributable to the physiological effects of a substance (eg, a drug of abuse, a medication, or other treatment).

Question 11

What kind of depression is physical examination/ lab evaluation indicated?

Answer 11

• new onset depression (especially if the psychosocial context or precipitant is not clear),
• severe depression (particularly patients with melancholic or psychotic features), or
• treatment resistant depression, as well as
• patients who have or at risk for chronic medical condition

Question 12

what do commonly performed screening laboratory tests include?

Answer 12

complete blood count, serum chemistry panels, urinalysis, thyroid stimulating hormone, vitamin B folate, human chorionic gonadotropin (pregnancy), toxicology, human immunodeficiency virus, and rapid plasma reagin (RPR)

Question 13

What is the DSM-5 diagnostic criteria for a major depressive episode?

Answer 13

A. Five (or more) of the following symptoms have been present during the same two-week period and represent a change from previous functioning; at least one of the symptoms is either (1) depressed mood or (2) loss of interest or pleasure.

1) Depressed mood most of the day, nearly every day, as indicated by either subjective report (eg, feels sad, empty, hopeless) or observations made by others (eg, appears tearful). (NOTE: In children and adolescents, can be irritable mood.)
2) Markedly diminished interest or pleasure in all, or almost all, activities most of the day, nearly every day (as indicated by either subjective account or observation)
3) Significant weight loss when not dieting or weight gain (eg, a change of more than 5% of body weight in a month), or decrease or increase in appetite nearly every day. (NOTE: In children, consider failure to make expected weight gain.)
4) Insomnia or hypersomnia nearly every day
5) Psychomotor agitation or retardation nearly every day (observable by others, not merely subjective feelings of restlessness or being slowed down)
6) Fatigue or loss of energy nearly every day
7) Feelings of worthlessness or excessive or inappropriate guilt (which may be delusional) nearly every day (not merely self-reproach or guilt about being sick)
8) Diminished ability to think or concentrate, or indecisiveness, nearly every day (either by their subjective account or as observed by others)
9) Recurrent thoughts of death (not just fear of dying), recurrent suicidal ideation without a specific plan, or a suicide attempt or a specific plan for committing suicide

B. The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.

C. The episode is not attributable to the direct physiological effects of a substance or to another medical condition.

D. The occurence of the major depressive episode is not better explained by schizoaffective disorder, schizophrenia, schizophreniform disorder, delusional disorder, or other specified and unspecified schizophrenia spectrum and other psychotic disorders.

E. There has never been a manic or hypomanic episode.

Question 14

What is the diagnostic criteria for ‘anxious distress; under ‘major depressive episode + anxious distress’ ?

Answer 14

Anxious distress is characterized by the presence of two or more of the following symptoms during most days of the depressive episode

• Tension
• Restlessness
• Impaired concentration due to worry
• Fear that something awful may happen
• Fear of losing self control

Question 15

What is the diagnostic criteria for ‘atypical features’ under ‘major depressive episode + atypical features’ ?

Answer 15

Atypical features are characterized by at least three of the following symptoms during the depressive episode; at least one of the symptoms is mood reactivity to pleasurable stimuli

• Reactive to pleasurable stimuli (ie, feels better in response to positive events)
• Increased appetite or weight gain
• Hypersomnia (eg, sleeping at least 10 hours per day, or at least two hours more than usual when not depressed).
• Heavy or leaden feelings in limbs
• Longstanding pattern of interpersonal rejection sensitivity (ie, feeling deep anxiety, humiliation, or anger at the slightest rebuff from others), which is not limited to mood episodes, and which causes social or occupational conflicts.

Question 16

What is the diagnostic criteria for ‘catatonia features’ under ‘major depressive episode + catatonia features’ ?

Answer 16

Catatonic features are characterized by prominent psychomotor disturbances (either increased or decreased activity), which occur during most of the depressive episode

Question 17

What is the diagnostic criteria for ‘melancholic features’ under ‘major depressive episode + melancholic features’ ?

Answer 17

Melancholic features are characterized by at least four of the following symptoms during a depressive episode; at least one of the symptoms is either loss of pleasure or lack of reactivity to pleasurable stimuli:

• Loss of pleasure in most activities
• Unreactive to usually pleasurable stimuli (ie, does not feel better in response to positive events)
• Depressed mood marked by profound despondency, despair, or gloominess
• Early morning awakening (eg, two hours before usual hour of awakening)
• Psychomotor retardation or agitation
• Anorexia or weight loss
• Excessive guilt

Question 18

What is the diagnostic criteria for ‘mixed features’ under ‘major depressive episode + mixed features’ ?

Answer 18

Depressive episodes with mixed features are characterized by full criteria for the depressive episode and at least three of the following symptoms during most days of the episode :

• Elevated or expansive mood.
• Inflated self esteem or grandiosity.
• More talkative than usual or pressured speech (an increased amount of speech that is accelerated and difficult to interrupt; the patient may continue talking even if no one is listening).
• Flight of ideas (abrupt changes from one topic to another that are based upon understandable associations) or racing thoughts.
• Increased energy or goal directed - activity.
• Decreased need for sleep – Sleeping less than usual and still feeling rested and energetic. Decreased need for sleep differs from insomnia, which is marked by difficulty falling or staying asleep, and poor sleep quality.
• Excessive involvement in pleasurable activities that have a high potential for painful consequences (eg, buying sprees or sexual indiscretions)

Question 19

What is the DSM-5 diagnostic criteria for persistent depressive disorder (dysthymia)?

Answer 19

A. Depressed mood for most of the day, for more days than not, as indicated either by subjective account or observation by others, for at least two years.
NOTE: In children and adolescents, mood can be irritable and duration must be at least one year.
B. Presence, while depressed, of two (or more) of the following:
1) Poor appetite or overeating.
2) Insomnia or hypersomnia.
3) Low energy or fatigue.
4) Low self-esteem.
5) Poor concentration or difficulty making decisions.
6) Feelings of hopelessness.
C. During the two-year period (one year for children or adolescents) of the disturbance, the individual has never been without the symptoms in Criteria A and B for more than two months at a time.
D. Criteria for a major depressive disorder may be continuously present for two years.
E. There has never been a manic episode or a hypomanic episode, and criteria have never been met for cyclothymic disorder.
F. The disturbance is not better explained by a persistent schizoaffective disorder, schizophrenia, delusional disorder, or other specified or unspecified schizophrenia spectrum and other psychotic disorder.
G. The symptoms are not attributable to the physiological effects of a substance (eg, a drug of abuse, a medication) or another medical condition (eg, hypothyroidism).
H. The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.

Question 20

What is the DSM-5 diagnostic criteria for schizophrenia?

Answer 20

A. Two (or more) of the following, each present for a significant portion of time during a one-month period (or less if successfully treated). At least one of these must be (1), (2), or (3):

1) Delusions.
2) Hallucinations.
3) Disorganized speech (eg, frequent derailment or incoherence).
4) Grossly disorganized or catatonic behavior.
5) Negative symptoms (ie, diminished emotional expression or avolition).

B. For a significant portion of the time since the onset of the disturbance, level of functioning in one or more major areas, such as work, interpersonal relations, or self-care, is markedly below the level achieved prior to the onset (or when the onset is in childhood or adolescence, there is failure to achieve expected level of interpersonal, academic, or occupational functioning).

C. Continuous signs of the disturbance persist for at least 6 months. This six-month period must include at least 1 month of symptoms (or less if successfully treated) that meet Criterion A (ie, active-phase symptoms) and may include periods of prodromal or residual symptoms. During these prodromal or residual periods, the signs of the disturbance may be manifested by only negative symptoms or by two or more symptoms listed in Criterion A present in an attenuated form (eg, odd beliefs, unusual perceptual experiences).

D. Schizoaffective disorder and depressive or bipolar disorder with psychotic features have been ruled out because either 1) no major depressive or manic episodes have occurred concurrently with the active-phase symptoms, or 2) if mood episodes have occurred during active-phase symptoms, they have been present for a minority of the total duration of the active and residual periods of the illness.

E. The disturbance is not attributable to the direct physiological effects of a substance (eg, a drug of abuse, a medication) or another medical condition.

F. If there is a history of autism spectrum disorder or a communication disorder of childhood onset, the additional diagnosis of schizophrenia is made only if prominent delusions or hallucinations, in addition to the other required symptoms of schizophrenia, are also present for at least one month (or less if successfully treated).

Question 21

What does the James- Lange theory of emotion state?

Answer 21

emotions occur as physiological reactions to events and the interpretation of the physical response causes an emotional experience

Question 22

What is the Cannon- Bard theory of emotions?

Answer 22

The Cannon-Bard theory of emotion directly challenges the James-Lange theory by proposing that physiological reactions follow emotions (rather than the other way round).

Question 23

What is mood?

Answer 23

Mood is the pervasive and sustained feeling tone which is experienced internally and influences a person’s behaviour and perception of the world.

Question 24

What are abnormal mood states (mood disorders) defined as?

Answer 24

Abnormal mood states (mood disorders) are defined as when the mood of depression, elation, or irritability meets the following criteria:

1. Out of proportion in intensity and duration to what is understandable or acceptable
2. Dominates or overwhelms the individual → affects normal functioning (secondary effects on other mental functions like thinking, memory, behaviour)

Question 25

The efficacy of antidepressant medications is generally comparable between and within classes of medications (including SSRIs, SNRIs, bupropion, TCAs, MAOIs):
• Choice of medication is largely based on patient preference, previous drug response, safety, tolerability, side effect profile, pharmacological properties, cost
• Optimal treatment for most patients: _________________
• Use of MAOIs: generally restricted to those who do not respond to other treatments
o If medication is being changed to/from a MAOI, a washout period is essential to prevent the potentially lethal serotonin syndrome
o Serotonin syndrome is caused by use of ≥ 2 serotoninergic drugs → high fever, agitation, increased reflexes, tremor, sweating, dilated pupils, diarrhoea
• General principle: start with small dose then raise dose incrementally as tolerated until therapeutic dose is reached/patient reaches remission
o Improvement may be observed very early, but full benefit may not be achieved until later (must remind patients to prevent non-adherence)

Answer 25

SSRI/SNRI/mirtazapine/bupropion

Question 26

What is the following behaviour called?

Exaggerating/minimising the importance of events (e.g. believing own achievements are unimportant, mistakes are excessively important)

Answer 26

Magnification & minimisation

Question 27

What is the following behaviour called?

Seeing only the worst possible outcomes of a situation

Answer 27

Catastrophising

Question 28

What is the following behaviour called?

Making broad interpretations from a single or a few events (e.g. I felt awkward during my job interview. I am always so awkward)

Answer 28

Overgeneralisation

Question 29

What is the following behaviour called?

Belief that acts will influence unrelated situations (e.g. I am a good person, bad things shouldn’t happen to me)

Answer 29

Magical thinking

Question 30

What is the following behaviour called?

Interpreting the meaning of a situation with little/no evidence

Answer 30

Jumping to conclusions

Question 31

What is the following behaviour called?

Interpreting the thoughts and beliefs of others without adequate evidence (e.g. I know she wouldn’t go on a date with me because she thinks I’m ugly)

Answer 31

Mind reading

Question 32

What is the following behaviour called?

Expecting that a situation will turn out a certain way (e.g. I know at the end of all this I will get nothing back)

Answer 32

Fortune telling

Question 33

What is the following behaviour called?

Assumption that emotions reflect the way things really are (e.g. I feel like a bad friend, therefore I must be a bad friend)

Answer 33

Emotional reasoning

Question 34

What is the following behaviour called?

Recognising only the negative aspects of a situation while ignoring the positive (e.g. receiving many compliments on an evaluation but only focusing on the single negative feedback)

Answer 34

Disqualifying the positive (mental filtering)

Question 35

What is the following behaviour called?

Belief that things should/must be a certain way (e.g. I should always be friendly, People must give way to others)

Answer 35

“Should/Must” statements

Question 36

What is the following behaviour called?

Thinking in absolutes (e.g. If it’s not done properly it’s not worth doing)

Answer 36

All-or-nothing thinking

Question 37

What are the stages of grief?

Answer 37

1) Shock & denial (minutes- weeks): Initial phase of disbelief and numbness → searching behaviours (pining, yearning, protest)
2) acute anguish (weeks- months): Period of intense discomfort (waves of somatic distress, withdrawal, preoccupation, anger, guilt)
3) lost patterns of conduct: Restlessness and agitation, aimlessness and amotivational, identification with the bereaved
4) Resolution (months to years): Period of reintegration into the usual rhythms of life (have grieved → return to work, resume old roles, acquire new roles, re-experience pleasure, seek companionship and love of others)