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College Material > Abnormal Psychology #3 > Flashcards

Abnormal Psychology #3 Flashcards

1
Q

Persistent Tic

A

25% of kids have transient tic, and it goes away. Only 1% experiences persistent tic.
On the OCD spectrum

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2
Q

Obsession and Compulsion

A

Obsession: intrusion, uncontrollable, unwanted
Compulsion: actions that neutralize obsession
Compulsions neutralizes the obsessions
Work temporarily, temporary escape

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3
Q

OCD Symptoms

A

A. Obsession and or compulsion (98% have both)
B. Time consuming (>1hr/day), cause significant distress, avoidance of situations and activities that prompt obsessions
C.D. Not due to substance, medical condition, or other mental disorder

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4
Q

OCD Symptom Domains

A
  1. Symmetry/order
  2. Contamination/dirt/germ
  3. Hoarding
  4. Harm
  5. Aggressive/sexual/religious
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5
Q

OCD: POC

A 
Prevalence
• 2% lifetime prevalence
• Roughly equal female to male ratio
Onset
 • Bimodal age of onset:
• Age 10‐12; late adolescence to early adulthood
Course
• Usually chronic if untreated
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6
Q

OCD self-awareness

A

They mostly know it’s an unfounded fear, but have it nonetheless
4% has this consciousness absent

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7
Q

Biological Causes of OCD

A

Genetics: moderate heritability
Brain: increased metabolic activity in basal ganglia, orbital frontal cortex
Neurotransmitters: serotonin, and likely glutamate, GABA and dopamine

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8
Q

Psychological Causes of OCD

A

Learning
Abnormal responses to normal thoughts: appraisal of thoughts (over-reacting), thought suppression
Memory deficit (lack of confidence of memory)

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9
Q

Mowrer’s Two Factor Theory

A

Something gets labeled as bad, anxious when confronting

Ritualizes to reduce anxiety to prevent bad outcome, negatively reinforce

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10
Q

Abnormal response to normal bad thoughts

A

84% of a sample of undergraduates reported having regular, intrusive, unacceptable thoughts and impulses
Rachman & Silva, 1978; Baer, 2001
Every human being is visited from time to time by the Imp of the Perverse who makes you think the most inappropriate thought at the most inappropriate times.
Lee, Baer, Ph.D., 2001, p. 6

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11
Q

OCD Belief about thoughts

A

Bad thoughts reflect character
Thoughts SHOULD be controlled
Thought-action fusion

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12
Q

Thought suppression

A

Daniel Wegner: white bears

Suppression makes you think even more

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13
Q

Memory deficit

A

van den Hout & Kindt, 2003
OCD have no problem with their memory, but there is a problem with their confidence
Experiment: checking virtual stoves.
Results: repeated checking causes memory deficit

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14
Q

Environmental factors in OCD

A

Stress: times of heightened responsibility or loss of control, though 40% have no identifiable precipitant
Infection: PANDAS

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15
Q

OCD Treatment

A

CBT: exposure and response prevention
Medication: clomipramine, SSRI
Severe patients: DBS
Experimental: TMS Glutamatergic medication

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16
Q

Tourette

A

Born with Ticks, kicking, twitching, snapping
Doing uncontrollable things
Can’t help it, not contagious

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17
Q

Eating disorder spectrum

A

Anorexia nervosa, Bulimia nervosa, binge eating disorder

Can and often overlap and change

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18
Q

Anorexia Nervosa

A

Extreme caloric restriction
Relentless pursuit of thinness
Desperate fear, try to avoid by all means

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19
Q

Anorexia diagnosis

A

A. Restriction of energy, extreme low body weight in the context. BMI<17.5
B. Intense fear of gaining weight, behavior that interferes with weight gain
C. Disturbance in the way in which one’s body is experienced, body influence impact on self-evaluation

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20
Q

Anorexia subtypes

A

Restricting: last 3 months, had not engaged in binge eating or purging
Binge/purging: past 3 months, recurrent binge (out of control) or purging (self-induced vomiting)

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21
Q

Anorexia Nervosa: POC

A

Prevalence
• Lifetime prevalence of 0.9 % for women; 0.3% for men
• Much more common among women than men
• More common in some populations (e.g., dancers, gymnasts, models, wrestlers, gay men)
Onset
• Usually begins between 16 and 20 years old
• Often starts as a diet
Course
• Highly variable
• High rates of death from medical complications and suicide
• Recovery is also entirely possible

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22
Q

Anorexia: follow up

A 
21 year follow-up study
52% fully recovered
22% partially recovered
10% not recovered
16% deceased, primarily from starvation or suicide
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23
Q

Bulimia Nervosa

A

Out of control binging and compensatory behaviors but not underweight

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24
Q

Binge

A

out of control eating, much more than one would normally eat, can eat close to 5000 calories in less than 2 hours

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25
Q

Bulimia Nervosa Diagnosis

A

A. Episodes of binge, with eating and sense of lack of control
B. Recurrent inappropriate compensatory behaviors to prevent weight gain: vomiting, medication, fasting, misuse of laxatives, etc.
C. Once a week for at least 3 months
D. Self-evaluation influenced by body shape

26
Q

Bulimia Nervosa: POC

A 
Prevalence
• 1.5% lifetime prevalence for women
• 0.5% lifetime prevalence for men
Onset
• Most likely to begin in early 20s (21‐24)
• Often starts as a diet
Course
• 11‐12 year follow‐up: 
• 70 % recovered
27
Q

Binge Eating Disorder

A

A. episodes of binge eating
B. 3 or more: more rapid than normal, feeling uncomfortably full, eating when not hungry, embarrassed for how much one eats, disgusted with self
C. Distress regarding binge eating
D. Once a week for at least 3 months

28
Q

Binge Eating Disorder: POC

A 
Prevalence
• Most common eating disorder
• 3.5% lifetime prevalence for women 
• 2% lifetime prevalence for men
Onset
• Typically later: 30s to 50s
• Often starts as a diet
Course
• 6 year follow‐up: 60 % recovered
29
Q

Etiology of eating disorders

A

Internalization of thin ideal

30
Q

Eating disorder: biological risk factors

A

Genes, 28-84% heritability
Temporal cortex (body image)
Serotonin
Much of research is based on Anorexia and complicated by starvation

31
Q

Eating disorder: psychological risk factors

A

Personality: perfectionism, impulsivity
Cognitive factors: rigidity, attentional biases, perceptual abnormalities
Emotional dysregulation: eating as a tool to regulate emotion
Comorbid depression and anxiety

32
Q

Eating disorder: sociocultural risk factors

A

Cultural message of thinness
Demanding, overinvolved family environment
Dieting

33
Q

Eating disorder treatment

A

Anorexia: antidepressants, antipsychotics, family therapy, CBT
Bulimia: antidepressants, CBT
Binge eating: antidepressants, IPT, CBT

34
Q

Drug addiction relapse rate

A

Drug: 40-60%
Type I Diabetes: 30-50%
Hypertension: 50-70%
Asthma: 50-70%

35
Q

Stages of Addiction

A
  1. Binge/intoxication (Nucleus accumbens)
  2. Withdrawal/negative affect (Amygdala)
  3. Preoccupation/anticipation (Cerebral cortex)
    (Volkow N, NEJM 2016)
36
Q

Dependence v. addiction

A

Dependence: tolerance/withdrawal
Addiction: compulsive

37
Q

Classical Conditioning

A

Environmental stimuli -> Reward->̀ dopamine release -> associated learning
Mechanism of addiction

38
Q

Addiction and reward system

A

More drug consumption triggers smaller and smaller release of dopamine in nucleus accumbens
Reward system less sensitive to stimulation
Drug and non-drug related rewards
Less motivated by everyday stimuli (relationships, hobbies)

39
Q

Withdrawal/negative effects

A

Addiction activates anti-reward system
Adaptation in amygdala:
Increase reactivity to stress, increased negative emotions, intense motivation to escape after-effects of use

40
Q

Preoccupation/anticipation

A

Addiction disrupts decision making
Down regulation of dopamine in prefrontal cortex impact executive functioning
Decision making, self-regulation, prioritization
Weakens ability to resist strong urges

41
Q

Predisposition to addiction

A

Family (genetic and environmental)
Highly heritable genetically (Nature Reviews Genetics, 2005)
Early exposure to drug/high risk environment
Psychiatric disorders
Trauma/ACE

42
Q

ACE

A 
Adverse Childhood Experiences (ACEs)
Early Adversities has lasting impacts on injury, mental health, maternal health, infectious disease, chronic disease, risky behavior, opportunities
Emotional Abuse
Physical Abuse
Sexual Abuse
Witnessed Abuse
Neglect
Divorce
Parent
	Addiction
	Mental illness
	Incarceration
Death
43
Q

ACE and addiction

A

Stress/trauma->Increased cortisol->less developed prefrontal cortex (impaired self-control), changes in nucleus accumbens, sensitivity to DA (more rewarding, more intense craving)

44
Q

Abstinence and Addiction

A

After prolonged abstinence, brain activation scan shows similar pattern to healthy controls

45
Q

Percentage of users turning addicts

A 
Tobacco: 32%
Heroin: 29%
Cocaine: 17%
Alcohol: 15%
Marijuana: 9%
46
Q

Nicotine and Addiction

A

Nicotine primes the brain for addiction
Causes epigenetic changes in cholinergic and dopaminergic systems, sensitizing brain to other drugs
Nicotine reinforces addictive brain circuits, making it easier for drugs to “teach” the brain to keep using (Yuan, J Phisiology, 2015; Kandel, NEJM, 2014; Science Translational Research, 2011)

47
Q

Vaping

A

Vaping in 12th graders increased 90% between 2017 and 2018
21% of 12th graders report vaping in past 30 days
Vaping associated lung injuries
More likely to transition into using tobacco products
THC vaping product thickening it, causes inflammatory responses
(2018 Monitoring the Future Survey)

48
Q

Cannabis

A

Abstaining from cannabis improves memory and learning in 18-25 year old regular users
Strong association between regular cannabis use and development of psychosis
(Schuster, J Clin Psych, 2018)
Cannabis impairs driving
12% increase in the relative risk of a fatal traffic crash after 4:20 PM on April 20
(Staples, JAMA IM, 2018)

49
Q

Alcohol

A

Optimal amount of alcohol per week that maximizes benefits and limits harm is ZERO
Leading risk factor of disability/death in adults 15-49
(Burton, Lancet, 2018)
Alcohol increases cancer risk: Bottle of wine/week =
= 1-1.5% lifetime increase in cancer
= 5-10 cigarettes/week
(Hydes, BMC Pub Health, 2018)

50
Q

Annual deaths in US, 2017 from substances

A

Tobacco: 480,000
Alcohol: 88,000
Opioids: 47,600

51
Q

Opioid Crisis

A

Patients are overmedicated
Doctors feel pressured to prescribe opioid to treat pain
Cited 1980 New England Journal of Medicine, but the study is very tenuous
Rx Opioids
Heroin
Fentanyl, much more potent than Heroin
Society’s perception changed from criminal issue to public health issue
Life expectancy for American white males age 45-54 is declining for first time in modern history
Suicide
Drug overdoses
Alcohol
(Case and Deaton, Brookings Inst, 2017)

52
Q

Overdose in Maine

A

418 deaths in 2017
6th highest rate in nation
Consistently higher than motor vehicle deaths

53
Q

MAT

A

Medication-Assisted Treatment (MAT)
Important part of the solution
MAT reduces heroin deaths (Schwartz, Am J Public Health, 2013)
Maintenance is key, all control dropped out after 60 days, 20% died (Kakko, Lancet, 2003)

54
Q

Suboxone

A 
Buprenorphine + naloxone
	A common treatment
	Control cravings
Reduces heroin death
Does not decrease addiction, but keeps people in treatment
55
Q

Buprenorphine

A
  1. Partial activation: a ceiling effect
  2. High affinity: binds tightly, heroin bounces off, cannot replace buprenorephine
  3. Slow Dissociation: stays on receptor a long time
56
Q

Naloxone (Narcan)

A

Naloxone blocks or reverses the effects of opioid medication, including extreme drowsiness, slowed breathing, or loss of consciousness.
Deterrent to IV use, only active IV

57
Q

two specific instances in which we have evidence to suggest that a diathesis interacted with a stressor

A
  1. Caspi et al., 2003
    Study about diathesis-stress
    • Longitudinal study of 1037 children in New Zealand
    • Relationship between stress and depression
    • But not everyone who is stressed gets depressed
    • Genotyping: 5HTT gene (s/s; s/l, l/l)
  2. Lewinsohn 2001,
    High levels of dysfunctional belief predicted later depression but only among those who also had stressful life events
58
Q

Choose one symptom that is present in three or more disorders that we have studied this semester. Identify the symptom and name the disorders in which it appears. Then, speculate as to why

A
  • Diminished interest in activities: PTSD, schizophrenia, major depression
    • Reason: rather than distinct and separate categories, these disorders may be the same system of an individual respond to different kinds of stress (negative valence system).
59
Q

Choose one specific risk factor, two disorders that this involves

A

• Lack of social support: major depression, PTSD
• Depression: Individuals without meaningful social support are at greater risk of developing depression when they encounter stress (Brown & Harris, 1978)
• PTSD: Negative or unsupportive environment can predispose someone at greater risk of developing PTSD as a result of a traumatic event.
In both of these disorders, social support is an important factor that helps individual deal with stress. A lack of social support can result in an inadequate and unhealthy response to stressful events and subsequent development of disorders.

60
Q

pathologize what might otherwise not be considered “disordered.

A

• Psychotic disorder and its hallucinatory symptoms, in a country where religion plays a bigger role in people’s lives, might be considered a divine message or the likes of it.

61
Q

What are your most important priorities?

A

○ Research into CBT and mindfulness. More and more research are affirming the efficacy of CBT and mindfulness in the treating of many mental disorders.
○ More and more research are affirming the efficacy of CBT and mindfulness in the treating of many mental disorders. While a therapist is often integral to the treatment and recovery of the patient, in many cases people may not feel like they meet the threshold of a mental disorder even though they experience distress, or people may not have access to quality treatment of their mental disorder, and this is where greater education about CBT and mindfulness comes in. It may not be a perfect solution, since it requires an individual to actively put in the work, but it can be a remedy that improves the situation.
○ De-privatize healthcare. The private healthcare system, operating through Health Maintenance Organizations, often fail to provide adequate care, albeit provided at a discounted price. In many cases, such care is insufficient. Public healthcare, given sufficient funds, is the solution needed for providing adequate care to more people.

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