Exam 2 Flashcards
Flight-or-Fight Response
Begins in Hypothalamus
The Autonomic nervous system and endocrine system are activated
Hypothalamus excites the sympathetic nervous system, causes heart rate to increase etc.
Parasympathetic nervous system calms our body down
The hypothalamic-pituitary-adrenal (HPA) axis is also active, which release the adrenocorticotropic hormone (ACTH) which signals the adrenal cortex to release corticosteroids such as cortisol
Acute Stress Disorder & Trauma Definition
Trauma - an event in which a person is exposed to actual or threatened death, serious injury, or sexual violation, and would be considered traumatic by most, if not all, individuals
Acute Stress Disorders: symptoms begin within four weeks of the traumatic event and last less for a month
Posttraumatic Stress Disorder (PTSD)
Symptoms can begin at any time following the event
Around 25% of people affected don’t develop the full syndrome until 6 months or more
At least 50% of all cases of acute stress disorder evolve into PTSD
Symptoms of ASD and PTSD
Their symptoms are nearly identical
Increased arousal, negative emotions, and guilt (hyperalertness, difficulty sleeping, depression, anxiety, mood fluctuation, survivor’s guilt)
Reexperiencing the traumatic event either through flashbacks, nightmares, or reoccurring thoughts
Avoidance—Individuals may avoid talking about the traumatic event, thinking about it, or situations that remind them of it
Reduced responsiveness and dissociation (only in around 30% of cases)
Other ASD and PTSD Stuff
Facts:
Affects 3.5-6% of North Americans a year and 7-12% in a lifetime
Around half seek treatment, but well after the symptoms develop
Around 20% attempt suicide
Increased risk for other psychological or physical disorders
Women twice as likely to develop
People with low income twice as likely to develop
Hispanic, African, and Native Americans are at an increased risk
Triggers:
Combat
Disasters, Accidents, and Illnesses
Victimization
Terrorism and Mass Shootings
Torture
Causes of ADP and PTSD
Biological Factors: people with PTSD tend to already have an overly reactive stress response, and this increases after developing PTSD. There is also dysfunction in the brain’s stress circuit (overactive amygdala, underactive prefrontal cortex). People are also more likely to inherit PTSD if their family had PTSD.
Childhood Experiences: Childhood experiences like poverty, psychological disorders in family, assault, abuse, catastrophe, and parental separation increase the risk of PTSD
Cognitive Factors and Coping Styles: People with memory difficulties, high intolerance of anxiety, and poor coping styles are more likely to develop PTSD when exposed to trauma while people with resiliency and good coping styles are less likely to develop PTSD.
Social Support Systems: People with a good social support system are less likely to develop PTSD than those who don’t have one.
Severity and Nature of Trauma: The more exposure and severity, the greater likelihood of developing a stress disorder. Especially mutilation, sever injury, witnessing the injury or death.
Developmental Psychopathology Model: All these factors play a role in the development of stress disorders.
Treatment of ASD and PTSD
Only 1/3 improve within 12 months, and another 1/3 continue to struggle even after many years.
Treatments Goals: End lingering stress reactions, gain perspective on the traumatic experience, and return to constructive living.
Combat Treatment: Antidepressant drugs, they have shown to help around half of the patients. Group therapy also helps
Cognitive Behavioral: Cognitive processing therapy aims to change the attitudes and beliefs (mindfulness meditation). Exposure therapy also help (prolonged exposure therapy and EMDR).
Couple and Family Therapy: Clients work with families to address the trauma and work on learning better problem-solving and communication skills
Psychological Debriefing: Talk about feelings and reactions within days of the incident. This has mixed opinions; talking about it right afterwards can be beneficial for some, but harmful to others. Psychological First Aid is similar but individuals don’t have to talk about what happened.
Dissociative Disorders
The key to our identity is memory, so dissociative disorders involve the loss of some part of memory.
Types:
Dissociative Amnesia, Dissociative Fugue, Dissociative Identity Disorder, and Depersonalization-Derealization Disorder
Dissociative Amnesia (Dissociative Fugue)
People are unable to recall information about their lives
The loss is much more extensive than normal forgetting
Can be localized (most common, effects events within a limited period of time), selective (some but not all events within a limited period of time), generalized (effects memory from an event and extends back), or continuous (forgetting into the future, quite rare)
The disorder is only on personal material, while encyclopedic memory is still there
At least 2% of all adults experience dissociative amnesia each year
Dissociative Fugue occurs when someone has dissociative amnesia so they leave their current life and start a new one in a new location (typically lasts a few hours or days, but ends suddenly). Most people regain memory.
Dissociative Identity Disorder
Also known as Multiple-Personality Disorder
Development of two or more distinct personalities called subpersonalities
The host subpersonality is the one that appears the most, but transitions can occur suddenly and dramatically
This is very rare, some researches believe it is iatrogenic, or cause by treatment.
Most are diagnosed late adolescence or early adulthood, women 3 times more likely to develop, symptoms generally begin after childhood episodes of abuse
The subpersonalities can be mutually amnesiac, mutually cognizant, or most commonly one-way amnesiac.
The average number of subpersonalities is 8 for men, 15 for women
The subpersonalities can differ in identifying features (gender or age), abilities and preferences (different languages or job skills), or physiological responses
Causes of DID and DA
Psychodynamic: These disorders are caused by repression. Dissociative amnesia and dissociative fugue are single episodes of massive repression. DID is thought to result form a lifetime of excessive repression. This has little research, but most support come from case studies where children were abused
State-Dependent Learning: A cognitive-behavioral view; people learn something in a particular state of mind, and are more likely to remember in the same condition. They believe that each thought, memory, and skill is tied to a particular state of arousal, and people with dissociative disorders only remember these things in an identical state of arousal.
Self-Hypnosis: Hypnosis can be used to help people forget facts, event,and their personal identity. There are similarities between dissociative amnesia and hypnotic amnesia.
Treatment of DA and DID
People with DA often recover on their own.
People with DID usually need treatment to regain lost memories and develop an integrated personality.
Treatments of DA are more effective than DID
Psychodynamic therapy guide patients unconscious to bring forgotten experiences into consciousness
Hypnotic therapy helps people remember forgotten events
Injections of barbiturates (truth serum) helps people remember events
In DID treatment, the therapists treatment is complex, but the goal is to help the patient recognize the disorder, recover their memories, and integrate the subpersonalities
Depersonalization-Derealization Disorder
The DSM-5 categorizes this a dissociative disorder, but it is not caused by lack of memory.
Depersonalization: one’s mental functioning or body feels unreal or detached
Derealization: the sense that one’s surroundings are unreal or detached.
These experiences don’t constitute a disorder, there has to multiple, reoccurring episodes.
This occurs in around 2% of the population, this occurs most commmonly in adolescents and young adults (not so much older than 40)
The disorder comes on suddenly and tends to be long-lasting, and few theories have been offered to explain this disorder.
Unipolar Depression Facts
In the US, approximately 8 percent suffer from severe unipolar depression and 5 percent suffer mild forms in any given year.
Approximately 20 percent of all adults will experience a major depressive episode.
Twice as common in persons younger than age 65.
Twice as common for women (26 percent).
Approximately 85 percent recover within 6 months, some without treatment, but more than half will experience another episode.
Between 6 and 15 percent of severely depressed individuals die by suicide.
Symptoms of Depression
Five main areas of functioning may be affected:
Emotional—feeling “miserable” or “empty”; anhedonia
Motivational—lacking drive, initiative, spontaneity, thoughts of suicide or actual suicidal behavior.
Behavioral—less active or productive, slowed speech, psychomotor retardation
Cognitive—negative self-view; pessimistic, helplessness and hopelessness
Physical symptoms—headache, dizziness, general pain, fatigue, difficulties sleeping, disturbances in appetite
Diagnosing Unipolar Depression
(Major Depressive Episode)
A period of two or more weeks marked by five or more symptoms:
depressed mood and/or loss of interest
loss of pleasure
changes in sleep, appetite, or weight
psychomotor retardation or agitation
feelings of fatigue
decreased in concentration or decisiveness
feelings of hopelessness, worthlessness, or guilt
thoughts about death or suicide.
psychosis, including mood-related hallucinations and delusions.
Type of Depressive Disorders
Major: Seasonal, catatonic (severe motor agitation or retardation), peripartum (pregnancy), or melancholic (loss of pleasure)
Persistent: lasts for two years or more, can also be classified with major depressive episodes (more severe) or with dysthymic syndrome (less severe).
Premenstrual Dysphoric: clinically significant symptoms the week before menstruation
Disruptive Mood Regulation: Persistent depressive symptoms and recurrent outbursts of anger, typically emerges in mid-childhood or adolescence
Biological Causes of Unipolar Depression
Genetic factors: 30% of relatives affected but only 10% of the general population is affected
Biochemical Factors: Low activity of norepinephrine and serotonin and their interaction w/ other NT’s such as glutamate, abnormal levels of cortisol, overactive hypothalamic-pituitary adrenal axis
Brain circuits: prefrontal cortex, hippocampus, amygdala, and subgenual cingulate (sc is most important) cause it.
Immune System: stress decreases lymphocytes and increase cytokines
Biological Treatment of Unipolar Depression
Antidepressants
Monoamine Oxidase Inhibitors: slow down production of MAO which breaks down norepinephrine, serotonin, and dopamine, about half of patients are helped, can cause serious spikes in blood pressure when eating tyramine
Tricyclics: three ring molecular structure, 50-60% of patients experience benefit, if continued for five months chance of relapse decreases, reduces depression by blocking reuptake
Second Generation Antidepressants: can be selective serotonin reuptake inhibitors (SSRIs) or serotonin-norepinephrine reuptake inhibitors, fewer side effects but can reduce sex drive and cause weight gain.
Ketamine-Based Drugs: causes relief in around 70% of patients, often combined with other drugs, increases activity of glutamate
Antidepressant treatment fails to help at least 30% of clients
Brain Stimulation
Electroconvulsive therapy: fast acting and effective (50-80% improve), has major side effects like memory loss and possible neurological damage
Vagus Nerve: they stimulate the vagus nerve with electricity and this helps some patients with treatment-resistant depression
TMS: used to change activity in the prefrontal cortex and may impact the entire depression related-brain circuit, helps if administered daily for 4-6 weeks
Psychodynamic Model of Unipolar Depression
Cause: Freud links depression with grief and unmet needs in early life. Object relation theorists propose that depression results when people’s relationships have them feeling unsafe and insecure
Strength: research supports the idea that significant loss and unmet needs early in life can lead to depression
Limitations: many who experience early losses and inadequate parenting don’t develop depression, and some individuals with depression did receive adequate parenting without a loss
Treatment:
Seek to bring the underlying issues into consciousness and work through them.
Short-term approaches have performed better than traditional approaches.
Cognitive-Behavioral Model of Unipolar Depression
Behavioral: believe that depression stems from rewards and punishment and depressed individuals receive fewer rewards
Cognitive: Beck believes there are four components: maladaptive attitudes, negativing thinking (of self, world, and future), errors in thinking (arbitrary inferences), and automatic thoughts (steady stream of negative thinking). These have received a lot of support.
Learned helplessness has also received support from research
Treatment:
Behavioral activation: increase and reinforce participation in positive or pleasurable activities and improve social skills, seems to be of only limited help alone.
Beck’s Cognitive therapy: Focus on increasing and elevating moods, challenging automatic thoughts, identifying negative thinking and biases, and changing primary attitudes. 50-60% show improvement and follow up treatment reduces likelihood of relapse
New-wave therapy: Acceptance and Commitment therapy
Sociocultural Model of Unipolar Depression
The family-sociocultural perspective and multicultural perspective both play roles.
Treatment can include family social treatments like interpersonal therapy paired with couple’s therapy, and this has been just as successful as CBT
Gender and culture plays a large role and multiple theories have been suggested.
Treatment can also include culture-sensitive therapies.
Bipolar Disorders Facts & Symptoms
Facts: People with a bipolar disorder experience depression and mania. Somewhere between 10 and 15 percent commit suicide.
Symptoms: can be emotional, motivational, behavioral, cognitive, or physical symptoms.
Diagnosing Bipolar Disorders
People are considered to be in a full manic episode when, for at least one week, they display an abnormally high or irritable mood, increased activity or energy, and at least three of the following symptoms:
a. Grandiosity or overblown self-esteem
b. Reduced sleep need
c. Rapidly shifting ideas or the sense that thoughts are moving very fast
d. Attention pulled in many directions
e. Heightened activity or agitated movements
f. Excessive pursuit of risky and potentially problematic activities
Significant distress or impairment which can include psychosis
When symptoms are less severe and of a shorter duration (less than a week), the person is said to be experiencing a hypomanic episode.
Bipolar 1 has a full manic and major depressive episodes while Bipolar 2 has a hypomanic disorder and major depressive episodes
If a person experiences numerous episodes of hypomania and mild depressive symptoms, a diagnosis of cyclothymic disorder is appropriate. Comes with increased risk for becoming Type I or II.
Causes of Bipolar Disorder
Studies have found abnormalities in norepinephrine, serotonin, glutamate, and dopamine but the findings are inconsistent
Ion activity may cause neurons to fire too easily (mania) or resist firing (depression)
Brain structure and circuitry like the hippocampus, basal ganglia, and cerebellum tend to be smaller in people with bipolar disorders, decreases in gray matter and abnormalities in the prefrontal cortex, the amygdala, and raphe nuclei have been noted.
Genetic factors also play a role because monozygotic twins experience a concordance rate of 40-70%.
Treatments of Bipolar Depression
Mood stabilizing drugs:
Lithium is extraordinarily effective but can also lead to lithium intoxication (poisoning), with can include vomiting, diarrhea, seizures, kidney failure, cardiac problems, and death.
Some individuals respond better to antiseizure medications, or a combination of mood stabilizers and atypical antipsychotics.
More than 60 percent improve with treatment and most experience fewer episodes while on the medications.
Findings suggest that the mood stabilizers or prophylactic help prevent symptoms from developing.
Can help reduce depressive episodes to a lesser degree.
Reduce risk of future depressive episodes and suicide attempts.
The effect is not clearly understood.
Adjunctive Psychotherapy:
Psychotherapy and mood stabilizing drugs together tend to be the best form of treatment and significantly increase medication compliance.
Growing research suggests that adjunctive therapy helps to reduce hospitalization, improve social functioning, and increase a client’s ability to obtain and hold a job.
Suicide Facts
1 million suicides a year, 48k in the US, 25 million globally and 1.8 million US unsuccessful attempts, people believe the stats are lower than what they actually are because “accidents” are often suicides and stigmatism.
4 Kinds of Suicide
Death Seeker: clearly intend to end life
Death Initiators: end lives because death is already underway
Death Ignorers: death does not mean the end of existence
Death Darers: behavior may or may not lead to death (Russian roulette)
Note: Subintentional death is when an individual plays an indirect or unconscious role in their own deaths
Self Harm Statistics
About 13% of adolescence self harm, looking to include this in DSM-5, ex. 5 or more self harm in one year w/o intent to kill
Factors that affect Suicide
Country, religion, gender (women double to attempt, men 3 times more likely to die), transgender, no friends, divorce or lack of significant other, race
Causes of Suicide
Stressful Events and Situations: more stressful events leads to higher chance of suicide like combat stress, loss of loved one, loss of job, natural disaster, social isolation, serious medical illness, abusive environments, and occupational stress.
Mood and Thought Changes
Alcohol and Other Drug Use
Mental Disorders: severe depression, bipolar disorder, chronic alcoholism, and schizophrenia are at great risk
Contagion of Suicide
Combination of Factors
Psychological Views on Suicide
Psychodynamic: depression and anger on oneself
Sociocultural View: Durkheim, probability of suicide determined by social ties, there are egoistic (no control, isolation), altruistic (intentional sacrifice), and anomic (no stability or meaning of life) suicides.
Interpersonal: Suicide is caused by perceived burdensomeness and thwarted belongingness if the person has the psychological capability to kill themselves
Biological: Twins more likely to commit suicide if one does, low serotonin levels and poor brain circuitry attempt more and more lethal means
Suicide and Age
Children: rare, 9 out of 100 attempt self harm, linked to loss of loved one, abuse, depression, etc., 11-33% of children have reported suicidal thoughts
Adolescents: suicide more common after 13, 2,400 teens commit each year, 17% have suicidal thoughts and 7% attempt, second leading cause of death for this age (18% of deaths), at increased risk for contagion effects, more teens attempt than succeed (200: 1 ratio)
Elderly: account for 20% of suicides, represents 16% of population, illness, loss of control, friends, or social status play a role, they give fewer warnings and have higher success rates, lower chance amongst native and african americans
Treatment of Suicide
After Attempt: things like medical care, psychotherapy, drug therapy, and family/group therapy are used, the goal is to keep patient alive and get them into the right state of mind, around half of all suicides made a previous attempt CBT has been proven to be effective like Dialectical Behavior Therapy
Prevention: goal is to establish relationship and trust, formulate a treatment plan, and assess the situation, prevention programs are difficult to measure and results are mixed, education is best form of prevention.
Biological and Psychological models fail to explain suicide.
Factitious Disorder
Symptoms are fake (malingering), could be for external gain or for attention
Munchausen syndrome is when the individual creates the appearance of an illness like giving themselves unprescribed medicine
More common in women and children, common in people who had extensive medical attention, have bad social skills and family life
There are not precise causes but it could be depression bad parenting or extreme social need, infected feel they have no control over problem there is also Munchausen syndrome by proxy
Conversion Disorder
aka functional neurological symptom disorder
Individuals experience symptoms like blindness, paralysis, or loss of feeling without neurological basis
Difficult to distinguish from real, do not want to consciously produce the symptoms
Begins between late childhood and young adulthood, twice in women, occurs suddenly often in times of stress, occurs it at most 5 out of 500 people, seems to be overly susceptible like hypnosis
Somatic Symptom Disorder
Excessive worry about bodily symptoms, less severe but longer lasting than conversion
Somatization pattern (Briquet’s syndrome) is when people experience many long-lasting effects that don’t have logical basis, often dramatic and exaggerated terms used to describe symptoms, lasts many years and don’t heal without treatment, 4% of US experience somatization pattern in a year, runs in families, between adolescence and young adulthood
Predominant pain pattern is fairly common, develops after a preexisting injury involving pain, begins at any age and more often women
Causes of Conversion and Somatic Symptom Disorders
Used to be referred to as hysterical disorders because uncontrolled emotion were thought to control bodily symptoms, none of the models have received much support
Psychodynamic: Freud believed they were caused by emotional conflict and physical pain during the phallic stage, today it is believed to be developed by primary gain (developed to avoid thinking about conflicts) or secondary gain (enables people to receive attention or avoid unpleasant activities)
Cognitive-Behavioral: somatic vigilance is common in individuals which is over awareness of bodily reactions, this causes more anxiety, hysterical disorders also bring rewards which reinforces the symptoms, and it also acts as a way of communicating something difficult.
Multicultural: western clinicians think somatic symptoms are a bad way of handling emotions while it is different in other countries
Treatment of Hysterical Disorders
Psychotherapy is usually the last resort
Many therapists focus on insight (conscious of symptoms and feelings), exposure (expose them to events/memories that causes the symptoms), and drug therapy.
Other things include education, reinforcement, or cognitive restructuring (changing thinking about the symptoms)
Illness Anxiety Disorders
Also known as hypochondriasis, is chronic anxiety about developing a medical condition without any symptoms
Repeated checking and misinterpretation of bodily reactions are signs of serious illness despite bodily functions being normal
Equal in men and women, develops in early adulthood, fewer than 1% of people, symptoms rise and fall over the years
Cognitive-Behavioral: illness fears are created through conditioning and modeling, treatment is similar to OCD (Antidepressant medication, exposure and response prevention, and cognitive interventions aimed at beliefs about the illness
Psychophysiological Disorders
Ulcers: lesions in stomach causing pain, bleeding, and vomiting, 25 mill in US affected, 6,500 deaths a year, caused by bacterial infection and anxiety or anger
Asthma: narrowing of the body’s airways, 25 mill in US affected, occurs in children, caused by anxiety and allergies or immune issues
Insomnia: difficulty falling asleep, 1/3 of people occasionally 1/10 long term, caused by anxiety or depression and overactive arousal system
Chronic Headaches: frequent and intense aches of head or neck, muscle contraction/tension affects 45 mill Americans a year, Migraine are caused by blood vessels contract and expanding which affects 30 mill Americans yearly, caused by helplessness fear, anger, anxiety, or depression, and vascular problems abnormal serotonin, and muscle weakness
Hypertension: chronic high bp, affects 77 mill US, caused by stress, danger, feelings of anger and depression, and obesity, smoking, poor kidney function, or high levels of collagen in blood vessels
Coronary Heart Disease: blocking of coronary artery, 28 mill people suffer yearly in US, leading cause of death in US (647,000 death annually), typically middle aged people especially men, caused by both factors
Causes of Psychophysiological Disorders
Biological factors
Psychological factors like certain needs, emotions, attitudes, or coping styles (overeating)
Sociocultural factors (adverse social conditions) like poverty, minority, or discrimination worsen while family support, religion, and social ties help
Psychoneuroimmunology
Focus on immune system, specifically stress slows down activity of lymphocytes and other physical processes
Biochemical activity: stress leads to SNS activity releasing hormones like norepinephrine, corticosteroids, or cytokines
Behavioral Changes: poor sleep patterns, poor eating, no exercise, drinking, smoking etc.
Personality Style: optimism and constructive coping styles help, hopelessness increases likelihood of heart disease and critical illness
Social Support: lonely people have worse immune functioning, good support leads to faster recovery
Psychological Treatments for Physical Disorders
called behavioral medicine because it combines psychological and physical interventions to treat/prevent illness
Relaxation training: helps with stress related illness
Biofeedback: uses machine to learn how to control bodily activities
Meditation: goal is to turn focus inward, mindfulness meditation (no judging) helps chronic pain
Hypnosis: sleeplike, suggestible state, self-hypnosis, can help with various diseases
Cognitive-Behavioral Interventions: teach new attitudes or cognitive responses, ex self-instruction training or stress inoculation training
Support Groups and Emotion Expression: expressing emotions has been shown to be successful in various diseases
Combination Approaches: These should be combined with other psychological and medical treatments to help the most
