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EPPP, study > Diagnosis & Psychopathology 3 > Flashcards

Diagnosis & Psychopathology 3 Flashcards

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0
Q

What are some risk and course factors associated with Major Depressive Disorder?

A
  • 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
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1
Q

What is the suicide rate associated with Bipolar I Disorder?

A

10-15%

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2
Q

List some gender differences in prevalence and risk of Major Depressive Disorder.

A
  • 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
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3
Q

What are prevalence rates and other factors associated with post-partum depressive symptoms?

A
  • 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
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4
Q

What is “double depression?”

A
  • 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
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5
Q

What is the etiology of Seasonal Affective Disorder?

A
  • 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
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6
Q

What is the role of genetics in the etiology of mood disorders?

A
  • 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
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7
Q

What is the role of stress in the etiology of mood disorders?

A
  • 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
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8
Q

What is the catecholamine hypothesis of mood disorders?

A
  • 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
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9
Q

What is the permissive theory of mood disorders?

A
  • 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
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10
Q

What are some sleep cycle irregularities associated with depression?

A
  • unusually rapid REM onset
  • reduced slow-wave sleep
  • early morning wakening
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11
Q

Name a behavioral intervention for sleep cycle disturbances associated with depression.

A

Sx can sometimes be reduced with partial sleep deprivation or going to sleep 5-6 hours early

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12
Q

What factors in attributional style are associated with the learned helplessness approach to understanding depression?

A
  • attributing negative events as
    • global (vs specific)
    • stable (vs transient)
    • internal (vs external)
  • emphasis on hopelessness
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13
Q

What is the self-control model of depression?

A
  • 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.

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14
Q

Describe general indications for prescribing tricyclic and SSRI antidepressants.

A

typically used to treat classic depression Sx

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15
Q

Describe indications for prescribing MAOIs.

A

usually used for treating atypical depression, e.g., that with anxiety, hypochondria, and obsessive-compulsive Sx

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16
Q

Discuss efficacy and other relevant factors in pharmacological treatment of mood disorders.

A
  • 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
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17
Q

What two therapies are mentioned as being effective for depression?

A
  • CBT

- IPT (interpersonal therapy)

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18
Q

Describe the three stages of Beck’s CBT for depression.

A
  • ID automatic thoughts producing depression
  • understand how thoughts distort reality
  • come to see how thoughts are unfounded
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19
Q

Describe Wolpe’s behavioral model of “neurotic depression.”

A
  • 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
20
Q

Describe behavioral approaches to depression treatment.

A
  • increasing pleasurable activities
  • improving social skills (not clearly related to depression relief)
  • best when combined with cognitive therapies
21
Q

Describe etiology and treatment of depression according to Interpersonal Therapy.

A
  • 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
22
Q

Discuss effectiveness of CBT vs medication in treatment of depression.

A
  • both about equally effective overall
  • CBT more effective for milder depression
  • meds more effective for moderate to severe
23
Q

What are the indications for Electroconvulsive Therapy?

A
  • severe endogenous depression w/delusions and suicidal ideation
  • depression has not improved w/meds
24
Q

What are some of the side effects of Electroconvulsive Therapy?

A
  • 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
25
Q

How does combining psychotherapy and medication affect relapse of depression?

A
  • no consistent additive superiority of therapy plus med maintenance
  • relapse rates lower with psychotherapy alone vs meds alone
26
Q

What risk factors are associated with depression relapse?

A
  • persisting residual symptoms
  • increased expressed emotion in family

NOTE: Think expressed emotion = criticism

27
Q

Discuss prevalence rates and other relevant factors in anxiety disorders.

A
  • 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
28
Q

Describe three types of panic attack.

A
  • unexpected/uncued (out of the blue)
  • situationally bound/cued (almost invariable w/cue)
  • situationally predisposed (more likely, but not invariable w/cue)
29
Q

Discuss prevalence rates for Panic Disorder.

A
  • 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
30
Q

Discuss prevalence and comorbidities of Panic Disorder with Agoraphobia

A
  • 1/3 to 1/2 of people with PD have Agoraphobia (community samples)
  • comorbidities:
    • GAD highest
    • Social Phobia, Specific Phobia fairly high
    • PTSD lowest
31
Q

Discuss the etiology of Panic Disorder.

A
  • evidence of high sodium lactate levels
  • evidence of genetic predisposition
    • more prevalent among first degree relatives
32
Q

List three CBT approaches for Tx of Panic Disorder.

A
  • 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

33
Q

Discuss prevalence and other factors associated with Social Phobia.

A
  • 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
34
Q

Name two types of pharmacological interventions for Social Phobia.

A
  • anti-depressants

- beta-blockers

35
Q

Discuss prevalence, onset, and course of Specific Phobia.

A
  • 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
36
Q

Discuss etiology of phobias according to different theories.

A
  • 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
37
Q

Discuss treatment approaches for Specific Phobia.

A
  • 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
38
Q

Discuss treatment approaches for Agoraphobia without Panic.

A
  • in-vivo exposure with response prevention
    • best when combined with medication
  • group therapy with significant others present
39
Q

Discuss demographic factors, comorbidity, and differences in onset associated with Obsessive-Compulsive Disorder.

A
  • 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
40
Q

Discuss theories of etiology of Obsessive-Compulsive Disorder according to different theories.

A
  • 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.
41
Q

Discuss treatment approaches to Obsessive-Compulsive Disorder.

A
  • 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
42
Q

Discuss treatments for Posttraumatic Stress Disorder other than EMDR.

A
  • 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
43
Q

Discuss Eye Movement Desensitization and Reprocessing therapy for Posttraumatic Stress Disorder.

A
  • 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
44
Q

Discuss disorders that are commonly comorbid with Generalized Anxiety Disorder.

A
  • substance-related disorders
  • mood disorders
  • other anxiety disorders, esp.:
    • Social Phobia
    • Specific Phobia
    • Separation Anxiety Disorder
    • OCD
    • PTSD
45
Q

Name two factors moderating CBT for Generalized Anxiety Disorder.

A
  • client’s expectations of improvement

* client’s tendency to interpret ambiguous stimuli as threatening

46
Q

Name two treatments for Generalized Anxiety Disorder.

A
  • progressive muscle relaxation

- cognitive restructuring (decatastrophizing)

47
Q

List some psychopharmacological treatments for anxiety disorders.

A
  • antidepressants (based on physiological similarity between panic and depression)
    • tricyclics (imipramine)
    • MAOIs
    • benzodiazepines (alprazolan)

NOT EFFECTIVE: beta-blockers

48
Q

Discuss primary and secondary gains in the context of Conversion Disorder.

A
  • primary gain: symptom reduces anxiety and keeps internal conflict out of conscious awareness
  • secondary gain: symptom helps individual avoid aversive activity or obtain support

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