Diagnosis & Psychopathology 3 Flashcards
Priority 1
What are some risk and course factors associated with Major Depressive Disorder?
- 50%-60% of those who have one major depressive episode will have more
- ~15% of individuals with MDD die by suicide
- relapse is predicted by
- absence of social support
- family hostility, criticism, and overinvolvement
What is the suicide rate associated with Bipolar I Disorder?
10-15%
List some gender differences in prevalence and risk of Major Depressive Disorder.
- MDD about twice as common in adolescents and women than men by age group
- MDD may be underdiagnosed in men
- women may express well-being more extremely (in both directions)
- risk factors in women include passivity, dependency, poverty, having young children
- having multiple roles is a protective factor for women
- marriage is a protective factor, but more for men than women
What are prevalence rates and other factors associated with post-partum depressive symptoms?
- 50%-80% of women experience tearfulness and mood swings in the first few days after giving birth
- within four weeks of giving birth, 10%-20% of women experience Sx meeting criteria for a mood disorder
- Sx typically last 2-8 weeks, can persist for one year
What is “double depression?”
- Dx of both Major Depressive Disorder and Dysthymic Disorder
- associated with lower recovery rates and higher relapse rates than episodic Major Depressive Disoder, greater psychological disturbance, and increased suicide attempts
What is the etiology of Seasonal Affective Disorder?
- believed to be abnormal regulation of pineal melatonin secretion
- can be responsive to light therapy
- phenotype with hypersomnia and carbohydrate craving more responsive
- phenotypes with insomnia and weight loss, chronic depression, incomplete summer remission less responsive but may benefit
What is the role of genetics in the etiology of mood disorders?
- 60%-65% of individuals with a bipolar disorder have a relative with bipolar or unipolar depression
- having either parent with depression increases risk of having depression
What is the role of stress in the etiology of mood disorders?
- appears to be more impactful on early course of uni- and bipolar depression, e.g., critical to first or second episode
- depressed people report 3x as many stressful life events as non-depressed
- day-to-day stressors are also associated with depression, esp. mild forms
What is the catecholamine hypothesis of mood disorders?
- imbalance of catecholamines (incl. e.g., norepinephrine) affect mood
- depletion produces depression
- excess produces mania
- supported by fact that tricyclics and MAOIs increase availability of norepinephrine and lithium decreases norepinephrine and dopamine
What is the permissive theory of mood disorders?
- low serotonin produces mood disorder, then norepinephrine levels determine type:
- depression is due to low norepinephrine and low serotonin
- mania due to high norepinephrine and low serotonin
- supported by SSRI action
What are some sleep cycle irregularities associated with depression?
- unusually rapid REM onset
- reduced slow-wave sleep
- early morning wakening
Name a behavioral intervention for sleep cycle disturbances associated with depression.
Sx can sometimes be reduced with partial sleep deprivation or going to sleep 5-6 hours early
What factors in attributional style are associated with the learned helplessness approach to understanding depression?
- attributing negative events as
- global (vs specific)
- stable (vs transient)
- internal (vs external)
- emphasis on hopelessness
What is the self-control model of depression?
- selective attention focusing on
- negative events
- immediate outcomes
- stringent self-evaluation standards
- dysfunctional attributions
- positive outcomes external
- negative outcome internal
- dysfunctional self-conditioning
- insufficient self-reinforcement
- excessive self-punishment
Rehm’s Self-Control Therapy is based on these findings.
Describe general indications for prescribing tricyclic and SSRI antidepressants.
typically used to treat classic depression Sx
Describe indications for prescribing MAOIs.
usually used for treating atypical depression, e.g., that with anxiety, hypochondria, and obsessive-compulsive Sx
Discuss efficacy and other relevant factors in pharmacological treatment of mood disorders.
- 60% of depressed patients improve (40% do not)
- almost half treated relapse within a year of Rx termination
- up to 50% of patients unilaterally reduce or discontinue medication, in part due to side effects
What two therapies are mentioned as being effective for depression?
- CBT
- IPT (interpersonal therapy)
Describe the three stages of Beck’s CBT for depression.
- ID automatic thoughts producing depression
- understand how thoughts distort reality
- come to see how thoughts are unfounded
Describe Wolpe’s behavioral model of “neurotic depression.”
- similar to learned helplessness: prolonged exposure to inescapable aversive stimuli leads to increased emotional arousal and eventually depressed mood
- i.e., depressed mood due to low rate of response contingent reinforcement
Describe behavioral approaches to depression treatment.
- increasing pleasurable activities
- improving social skills (not clearly related to depression relief)
- best when combined with cognitive therapies
Describe etiology and treatment of depression according to Interpersonal Therapy.
- depression arises from interpersonal difficulties arising early in life, esp. attachment
- considers depression to be an illness
- Tx focuses on
- interpersonal deficits and conflicts
- difficult role changes
- prolonged grief reactions
Discuss effectiveness of CBT vs medication in treatment of depression.
- both about equally effective overall
- CBT more effective for milder depression
- meds more effective for moderate to severe
What are the indications for Electroconvulsive Therapy?
- severe endogenous depression w/delusions and suicidal ideation
- depression has not improved w/meds
What are some of the side effects of Electroconvulsive Therapy?
- nonverbal (nonsense syllables, geometric figures) memory and learning impaired
- verbal memory and learning impaired
- bilateral ECT only; if ECT is right hemisphere-unilateral, impairment appears not to occur or be undetectable within 6 months
How does combining psychotherapy and medication affect relapse of depression?
- no consistent additive superiority of therapy plus med maintenance
- relapse rates lower with psychotherapy alone vs meds alone
What risk factors are associated with depression relapse?
- persisting residual symptoms
- increased expressed emotion in family
NOTE: Think expressed emotion = criticism
Discuss prevalence rates and other relevant factors in anxiety disorders.
- anxiety disorders are the most common psychiatric disorder among older adults
- GAD is most prevalent among anxiety disorders
- depression commonly comorbid with anxiety among adults, esp. older adults
- anxiety in older adults may be underdiagnosed and is probably undertreated
- may be more likely to attribute Sx to physical health issues and so seek medical rather than psychological help
Describe three types of panic attack.
- unexpected/uncued (out of the blue)
- situationally bound/cued (almost invariable w/cue)
- situationally predisposed (more likely, but not invariable w/cue)
Discuss prevalence rates for Panic Disorder.
- overall prevalence of 1%-2% (w/ or w/o Agoraphobia)
- very rare in children
- argued that children not capable of linking panic Sx to catastrophizing about death
Discuss prevalence and comorbidities of Panic Disorder with Agoraphobia
- 1/3 to 1/2 of people with PD have Agoraphobia (community samples)
- comorbidities:
- GAD highest
- Social Phobia, Specific Phobia fairly high
- PTSD lowest
Discuss the etiology of Panic Disorder.
- evidence of high sodium lactate levels
- evidence of genetic predisposition
- more prevalent among first degree relatives
List three CBT approaches for Tx of Panic Disorder.
- exposure to internal cues associated with attacks
- exposure to somatic Sx through controlled inducement
- alterations of distorted interpretations of somatic sensations
Note: CBT generally considered to be most effective
Discuss prevalence and other factors associated with Social Phobia.
- prevalence 5%
- third most common adult mental disorder worldwide
- some studies show equal gender occurrence; others 3:2 women:men
- onset typically during adolescence, but can occur after a significant life event
- typical course is chronic and lifelong
Name two types of pharmacological interventions for Social Phobia.
- anti-depressants
- beta-blockers
Discuss prevalence, onset, and course of Specific Phobia.
- onset usually early childhood
- may be younger in women than men
- vasovagal response/fainting common (75%) in Blood/Injection/Injury subtype (short increase in bp/heart rate followed by drop)
- other subtypes show increase in blood pressure
Discuss etiology of phobias according to different theories.
- psychoanalysis: paralyzing conflict due to unacceptable impulses toward person/object
- behaviorism: classically conditioned response
- biology: some stimuli are biologically prepared, e.g., those that pose or have posed a threat to survival
Discuss treatment approaches for Specific Phobia.
- imaginal exposure
- in-vivo exposure
- hypnosis (to induce relaxation, gain access to relevant memories; SP patients tend to be highly hypnotizable)
- tricyclics (imipramine) and SSRIs
- for Blood/Injection/Injury: applied tension with exposure
Discuss treatment approaches for Agoraphobia without Panic.
- in-vivo exposure with response prevention
- best when combined with medication
- group therapy with significant others present
Discuss demographic factors, comorbidity, and differences in onset associated with Obsessive-Compulsive Disorder.
- OCD sufferers have a disproportionately large fraction of high SES and high IQ individuals
- typical comorbidity with Major Depressive Disorder
- in late onset (adolescence or later), obsessions and compulsions begin at about the same time
- in early childhood onset (pre-adolescence), compulsions tend to start 1-2 years earlier than obsessions
- early onset is associated with:
- male gender
- tic disorders
- familial loading for OCD
- higher frequencies of repeating compulsions and of hoarding obsessions and compulsions
Discuss theories of etiology of Obsessive-Compulsive Disorder according to different theories.
- psychodynamic: overdevelopment of ego and superego, over-reliance on reaction formation and displacement
- behavioral: initial anxiety response to previously neutral stimulus (classical conditioning), followed by compulsive rituals to avoid stimulus (negative reinforcement)
- biopsychology: OCD associated with basal ganglia & frontal lobe abnormalities.
Discuss treatment approaches to Obsessive-Compulsive Disorder.
- exposure with response prevention, with a preference for in-vivo over imaginal exposure
- habituation with thought stopping for obsessions
- supportive therapy for concomitant depressed mood, sexual dysfunction, and family relationship issues
- SSRIs, but Sx tend to reappear after discontinuation if pharmacotherapy alone
Discuss treatments for Posttraumatic Stress Disorder other than EMDR.
- CBT emphasizes prolonged exposure and stress inoculation, as well as coping skills
- pharmacotherapy can reduce depression, panic, and psychotic Sx when they are too intense but is not a cure in itself
- brief psychodynamic psychotherapy works to integrate experience of trauma
- hypnosis and relaxation training can decrease motor tension and autonomic arousal
- crisis intervention can help prevent development of delayed or chronic Sx and reduce distress
Discuss Eye Movement Desensitization and Reprocessing therapy for Posttraumatic Stress Disorder.
- patients select an anxiogenic memory
- patients then follows a cue with their eyes (lateral movement of therapist’s finger, a light, etc.)
- patient responds to Q: “What comes up?”
- process repeats until memory no longer anxiogenic
- EMDR as effective as other exposure-based Tx
- lateral eye movement as such may not be necessary
Discuss disorders that are commonly comorbid with Generalized Anxiety Disorder.
- substance-related disorders
- mood disorders
- other anxiety disorders, esp.:
- Social Phobia
- Specific Phobia
- Separation Anxiety Disorder
- OCD
- PTSD
Name two factors moderating CBT for Generalized Anxiety Disorder.
- client’s expectations of improvement
* client’s tendency to interpret ambiguous stimuli as threatening
Name two treatments for Generalized Anxiety Disorder.
- progressive muscle relaxation
- cognitive restructuring (decatastrophizing)
List some psychopharmacological treatments for anxiety disorders.
- antidepressants (based on physiological similarity between panic and depression)
- tricyclics (imipramine)
- MAOIs
- benzodiazepines (alprazolan)
NOT EFFECTIVE: beta-blockers
Discuss primary and secondary gains in the context of Conversion Disorder.
- primary gain: symptom reduces anxiety and keeps internal conflict out of conscious awareness
- secondary gain: symptom helps individual avoid aversive activity or obtain support
