Exam 2 Flashcards
1
Q
What are the Mood Disorders
A
Depression, Bipolar I and II
2
Q
What are the two types of Depressive Disorders and their differences
A
Persistent depressive disorder (PDD) is a chronic long term but less acute form of depression with episodes ebbing and flowing over a long time say like 2 years
-Major Depressive Disorder (MDD): is discrete episodes lasting 2 weeks or more with substantial changes in affect, cognition and neurovegetative functions
3
Q
Premenstrual dysphoric disorder
A
specific form of depression during a woman’s period
4
Q
disruptive mood disorder
A
added to combat the overdiagnosis in children and is characterized by persistent irritability and behaviroal dyscontrol and develop unipolar, not bipolar depressive or anxiety disorders as they move into older years.
5
Q
Mood Diagnostics for depressive disorders
A
mood disturbances and feelings of disinterest (anhedonia)
6
Q
Behavior diagnostics for depressive disorders
A
decreased physical activity and productivity in daily life such as work, home and play life
7
Q
Cognitive diagnostics for behavioral (mood) disorders
A
they hold a negative view of themselves and the world. A negative feedback loop reinforces their depressive states where they blame themselves when things go wrong and do not take credit for their accomplishments. Their mood also makes it hard for them to perform cognitive tasks and they may engage in self harm or suicide
8
Q
Physical diagnostics for mood disorders
A
Hypersomnia and insomnia, changes in weight from undereating or overeating, psycho motor problems
9
Q
Whats the difference between MDD and PDD
A
2 weeks of severe symptoms for MDD and two years of not so severe symptoms for PDD
10
Q
Premenstral disorder symptoms
A
present during menses and disappear after menses such as anger/irritability, depressed mood, anxiety or tension. Also must have one of the following in accompaniment such as anhedonia, difficulty concentrating, lethargy, changes inn appetite, hypersomnia or insomnia, feelings of being overwhelmed or out of control and breast tenderness or swelling
11
Q
Bipolar I and II distinction
A
If the person has experienced a manic episode with depression, its Bipolar I. if a person has only experienced a hypomanic episode with occasional depression , its Bipolar II.
12
Q
Manic episode:
A
: A period of time when a person experiences an abnormal, persistent or expansive irritable mood nearly all day and every day for 1 weeks. A person can also experienced accessive happiness that may result into the person engaging in haphazardly sexual or interpersonal interactions. They also experience rapid shifts called Mood Liability going from happy to sad very quickly
13
Q
Hypomanic episode
A
Same as Mania but not as severe for one week
14
Q
Cyclothymic disorder:
A
Individuals experience symptoms similar cases as mania or hypomania but they are not nearly as severe and have mild depressive symptoms lasting no more than 2 months at a time and it can escalate to Bipolar I or II
15
Q
Epidemiology of MDD
A
7% US
16
Q
Epidemiology of Dysthymic disorder
A
0.5% US
17
Q
Epidemiology of Bipolar I and Bipolar II
A
1.5% and is not gender specific and 0.8% in the US and 0.3 internationally more likely women respectively
18
Q
Depression suicide rates
A
17 times the normal population
19
Q
Bipolar suicide rates
A
20-30 times the normal population
20
Q
MDD comorbidity
A
high comorbidity rate with ¾ of them suffering a comorbidity such as substance abuse, GAD, PTSD, OCD, anorexia, bulimia and BPD
21
Q
PDD comorbidity
A
higher risk for comorbidity anxiety, substance abuse and personality disorders
22
Q
Bipolar I comorbidity
A
have a history of three or more disorders including anxiety, alcohol/substance abuse, ADHD, BPD, ASD and Schizophrenia
23
Q
Bipolar II comorbidity
A
often associated with other disorders such anxiety, phobia and excessive cannabis use
24
Q
Cyclothymic disorder comorbidity
A
comorbid with substance abuse and sleep disorders
25
Twin studies with depression
if one has depression, there is a 46% chance the other twin will have it showing a strong genetic link
26
twin studies with Bipolar
if one twin has Bipolar, the other is 72% likely to have it however its only 5-15% likely with other close relatives. But considering Bipolar is at a 1% risk for the general population, that is still high
27
Neurotransmitters and hormones with Depression
Low amounts of Serotonin and norepinephrine are linked to depressive disorders also Cortisol and Melatonin are hormones involved with depression
28
Neurotransmitters and Bipolar
research is still being done however it is possible that manic episodes are caused by low serotonin and high norepinephrine, but it isn’t conclusive
29
Brain structures and depression
drastic changes in blood flow throughout the prefrontal cortex have been linked with depressive symptoms. Similarly, a smaller hippocampus, and consequently, fewer neurons, has also been linked to depressive symptoms. Finally, heightened activity and blood flow in the amygdala, the brain area responsible for our fight or flight response, is also consistently found in individuals with depressive symptoms
30
Brain structures and Bipolar
basal ganglia and cerebellum, which appear to be much smaller in individuals with bipolar disorder compared to the general public. Additionally, there appears to be a decrease in brain activity in regions associated with regulating emotions, as well as an increase in brain activity among structures related to emotional responsiveness
31
Learned Helplessness
Based on Martin Seligman’s asshole dog shocking experiment (Im going to find the fucker and kick him in the nuts!!!!!!!!!!!!) the term learned helplessness applies. That if an animal is placed in a situation that is painful and is displeasing but they have no way to escape they will continue the sense of helplessness even when no longer applicable
32
Attribution styles
modes of thinking, they can be positive or negative with internal, stable and global features. With depression it is a negative attribution style and that things are always their fault (internal) bad things always happen to them (stable) and it happen all day (global)
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Maladaptive attitudes
negative attitudes about oneself and false beliefs such as I am stupid or worthless.
34
Cognitive triad
or how an individual interprets themselves, experiences and futures is often negative in people with depression
35
Cognitive Distortions or errors in thinking
misappraisal is often involved in depression with involves catastrophizing, jumping to conclusions and overgeneralization. Such as I will always fail
36
Automatic thoughts
negative thoughts occur constantly and without good appraisal
37
Life stress theory
Women experience higher chronic stress which leads to higher rates of depression.
38
gender roles theory
Women are not as inspired to seek personal autonomy thinking they are more dependent on the whims of another
39
Artifact or hormone theory
thought that feminine mentalities (artifact theory) or hormonal influxes (hormone theory) for women make depression more likely but research hasn’t held well to these theories.
40
Rumination theory
Women are more likely to ruminate on a problem than men
41
SSRI's
effective treatments with some minimal side effects but it still produces tolerance and doesn’t fix the inherent problem
42
Tricyclic antidepressants
block the reuptake of Serotonin and norepinephrine and are pretty effective in treating depression however the side effects are worse such as constipation, sexual dysfunction and memory impairment and heart issues
43
Four steps of CBT
Phase 1: increasingly pleasurable activities
Phase 2: Challenging Automatic thoughts
Phase 3: Identifying negative thoughts
Phase 4: Changing thoughts
44
Who believed constructive behaviors occurred more infrequently until they stopped because the individual was not rewarded for those behaviors
Peter Lewisohn
45
treating Bipolar
Meds are the best route however patients often forgo them for those euphoric highs so psychotherapy help with adherence and thus a combo may be the best option for both types of Bipolar disorder. Mood stabilizers are the main treatment
46
Most common stressors
combat or physical/sexual assault
47
PTSD Category 1
Recurrent experiences: The client suffers reoccurring experiences of distressing memories or dreams that can are triggered by environmental stimuli similar to the event and the symptoms can last seconds to days
48
PTSD Category 2
Avoidance of Stimuli: They are avoiding environmental cues or stimuli that are related to the traumatic event to avoid the distressing thoughts or feelings
49
PTSD Category 3:
Negative Alterations in cognition or mood: A generalized negative state of being along with an impaired memory of either something amnesia-like or false beliefs about themselves or the event
50
PTSD Category 4
Alterations in Arousal or activity: PTSD patients often react violently or aggressively in a physical or verbal manner due to triggers related to the event and increased states of environmental sensitivity. They also are most likely suffering from sleep issues and are likely to be irritable from that.
51
Acute Stress Disorder:
PTSD like symptoms but must have nine symptoms across five categories and the symptoms are present 3 days after the trauma to one month
52
Adjustment Disorder
Problems adjusting up to 3 months after a stressor such as loss of a job or death of a loved one. There is not a list of symptoms that must be met like in PTSD however they are being impaired due to hurting from the event and show signs of depression, anxiety and mixed disturbance in someway
53
Prolonged Grief disorder:
A longing or yearning for a loved one that has passed in the last 12 months. The person must experience 3 symptoms including numbness, disbelief in the death, hopelessness and meaninglessness, loneliness and social withdrawal and emotional pain also negative views of themselves and the world. It is not yet in the DSM 5
54
PTSD Prevalence rate
prevalence rate is about 6.8 for US adults and 5.0-8.1% for US children
PTSD is most common among those who survive highly traumatic ordeals such as soldiers, rape victims, survivors of genocide and police/firefighters. In fact 30% of veterans are estimated to have PTSD
55
Prevalence of Acute Stress disorder
Its estimated an average of 7-30% of those surviving a traumatic event will develop acute stress disorder and women are more likely than men to suffer from it. but Numbers are hard to identify for Acute Stress disorder because they must seek treatment in 30 days and they often do not.
56
Prevalence of Adjustment disorder
Adjustment disorder is relatively common as life stressors are common. 5-20% of outpatient individuals from mental health treatment facilities suffer from this
50% of people who develop acute stress disorder go on the have PTSD
57
Prevalence of Prolonged Grief Disorder
Prolonged Grief disorder is pretty new so there are no solid numbers yet, however a pooled prevalence of 9.8% has been shown
58
PTSD comorbidity
depression, bipolar, anxiety and substance abuse symptoms along with major neurocognitive disorders
59
Acute Stress Disorder Comorbidity
becomes PTSD after 30 days so its comorbidities have not been studied. 80% of accident survivors met the criteria for acute stress disorder.
60
Prolonged Grief disorder comorbidity
MDD, PTSD, substance abuse and separation anxiety
61
Biological factors of PTSD
HPA axis, PTSD patients show increased Amygdala activation
62
Mental disorders that make PTSD more likely
Depression and anxiety
63
Psychological Debriefing
is a way for therapists to feel out what happened to a client after a traumatic event. It’s a crisis intervention to help the client process the trauma and prevent the onset of PTSD. The rules are
1. Identifying the facts (what happened?)
2. Evaluating the individual’s thoughts and emotional reaction to the events leading up to the event, during the event, and then immediately following
3. Normalizing the individual’s reaction to the event
4. Discussing how to cope with these thoughts and feelings, as well as creating a designated social support system (Kinchin, 2007).
-Psychological debriefing is largely considered an ineffective tool as there is a alck of data supporting it and some data that says it may be worse because they could ruminate on the fact they may have PTSD instead of coping normally
64
Ways of Exposure therapy
Imaginal, In-vivo, flooding
65
TF-CBT
* P: Psycho-education about the traumatic event. This includes discussion about the event itself, as well as typical emotional and/or behavioral responses to the event.
* R: Relaxation Training. Teaching the patient how to engage in various types of relaxation techniques such as deep breathing and progressive muscle relaxation.
* A: Affect. Discussing ways for the patient to effectively express their emotions/fearsrelated to the traumatic event.
* C: Correcting negative or maladaptive thoughts.
* T: Trauma Narrative. This involves having the patient relive the traumatic event (verbally or written), including as many specific details as possible.
* I: In vivo exposure (see above).
* C: Co-joint family session. This provides the patient with strong social support and a sense of security. It also allows family members to learn about the treatment so that they are able to assist the patient if necessary.
* E: Enhancing Security. Patients are encouraged to practice the coping strategies they learn in TF-CBT to prepare for when they experience these triggers out in the real world, as well as any future challenges that may come their way
66
EMDR
Eye movement desensitization and reprocessing)is used by using lateral eye movement in a saccade like fashion as part of exposure therapy. The steps are as follows.
1. Patient History and Treatment Planning – Identify trauma symptoms and potential barriers to treatment.
2. Preparation – Psychoeducation of trauma and treatment.
3. Assessment – Careful and detailed evaluation of the traumatic event. Patient identifies images, cognitions, and emotions related to the traumatic event, as well as trauma-related physiological symptoms.
4. Desensitization and Reprocessing – Holding the trauma image, cognition, and emotion in mind, while simultaneously assessing their physiological symptoms, the patient must track the clinician’s finger movement for approximately 20 seconds. At this time, the patient must “blank it out” and let go of the memory.
5. Installation of Positive Cognitions – Once the negative image, cognition, and emotions are reduced, the patient must hold onto a positive image or thought while again tracking the clinician’s finger movement for approximately 20 seconds.
6. Body Scan – Patient must identify any lingering bodily sensations while again tracking the clinician’s fingers for a third time to discard any remaining trauma symptoms.
7. Closure – Patient is provided with positive coping strategies and relaxation techniques to assist with any recurrent cognitions or emotions related to the traumatic experience.
8. Reevaluation – Clinician assesses if treatment goals were met. If not, schedules another treatment session and identifies remaining symptoms.
67
Meds with stress disorders
While Meds are not the first line of treatment with Stress disorders. It can be a second line if therapy doesn’t work. There is some data that SSRI’s and MAOI’s do help but the data is limited.
68
Dissociative Disorders
group of disorders characterized by symptoms of disruption and/or discontinuity in consciousness, memory, identity, emotion, body representation, perception, motor control and behavior which are likely to appear after a single significant stressor or years of ongoing stress
69
Symptoms of Dissociative Disorders
similar symptoms that can be also PTSD and acute stress disorder related such as amnesia, numbing, flashbacks and depersonalization and derealization. But PTSD and other stress disorders have identifiable stressors whereas Dissociative Disorders do not.
70
DID diagnosis
key diagnoses factors is the client is taken by two or more personalities in one body or a an experience of possession. How overt or covert these personalities are depend on several factors such as culture, motivation, stress, emotions and personal conflicts/dynamics
Another diagnostic is lapse in memory or attention from switching from personalities including well learned skills or recent events
The personalities must cause impairment in some way for a diagnosis and be involuntary
71
DID average amount of personalities
Women average 15 and men 8 for those with DID
72
Dissociative Amnesia
Diagnosed by inability to recall important autobiographical information following a significant stressor
73
Localized Amnesia
the most common which is the inability to recall events during a specific period that can vary in time.
74
Selective Amnesia
the client can recall some but not all information in the length of time in the amnesia.
75
Systemized Amnesia
the individual fails to recall a specific category of information within the period of amnesia
76
Generalized Dissociative Amnesia
a complete loss of semantic and procedural memory from sometimes acute traumas and individuals are often seen wondering around disoriented and are often hospitalized
Remember the John Doe assignment. Sometimes the total loss is just autobiographical and semantic memory remains
77
Depersonalization/Derealization disorder
-Depersonalization can be experienced a detachment from ones own body, a sort of out-of-body experience. Sometimes the report feeling like a robot or enlarged or shrunk in their own skin. They also feel detached from their feelings despite knowing they can have them
-Derealization can be seen as a detachment or feelings of unreality about the world. Such as feeling surrounds that should be familiar are not. Disconnection from intimate family/peer members. Feeling burry, fuzzy or in a daze.
78
Epidemiology of Dissociative Disorders
rare, but more common than once thought. 1.5% of the US population has DID with it mostly being women. Dissociative amnesia effects 1.8%.
79
Epidemiology of Depersonalization or Derealization
half of US adults suffer a depersonalization/dissociative episode at least once in their lives but few go beyond these episodes.
80
Comorbidities of Dissociative Disorders
PTSD and depression
81
DID and dissociative amnesia comorbidities
- dependent, obsessive-compulsive, avoidant, and borderline personality traits/disorders are comorbid and for dissociative identity disorder and dissociative amnesia there is evidence of comorbid substance-related and feeding and eating disorders
82
Biological cause of Dissociative Disorders
Dissociation disorders show some studies of a 50-60% genetic rate. However this disorder does have some strong environmental roots.
83
Cognitive Cause of Dissociative Disorders
: Psychological stressors and other factors may produce deficits in the prefrontal cortex in charge of memory retrieval but there is some contention to these findings. However there is differences in the hippocampus with dissociative disorders. Since memory retrieval is considered an issues, frontal lobe issues are believed to be part of the problem
84
Sociocultural Cause of Dissociative Disorder
There is some evidence that mass media might have an impact particularly in its portrayal. After a publication of a woman named Sybil’s case who had 16 personalities, there was an uptick in cases of DID
remember quiz said this was strictly social
85
Psychodynamic Cause of Dissociative Disorder
Caused by suppressed thoughts and feelings and using the personalities as a defense. Abuse can provoke the use of these personalities as a defense however there isn’t a ton of evidence for this claim
86
Steps of integrating personalities
Step 1: Build a strong relationship with the prime personality. Then the therapist can gradually get the subpersonalities to engage with each other.
Step 2: Encourage fusion between the personalities
Step 3: Encourage a final fusion of all the personalities into the prime one.
It should be noted not all clients can or want to achieve the final fusion. For them, functionality is the prime directive
87
Treatment of Dissociative Amnesia
Most dissociative amnesias recover on their own. But although not clinically well evidenced, hypnosis can help to reclaim memoires and sometimes even truth serums can help bring the memories back.
88
Treatment for Depersonalization/Derealization
With depersonalization/derealization disorder, sometimes just a diagnosis helps them cope and snap them out of it. In more severe cases treating secondary comorbidities such and anxiety and depression symptoms can help heal and challenge the main trauma. SSRI’s along with psychological treatment is usually the most effective if this point is reached.
