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Psych 350 > Exam 2 > Flashcards

Exam 2 Flashcards

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1
Q

Episodic depression

A

Last 2-9 months if untreated (episodes will remit within one year)

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2
Q

In what % of episodes do not remit for 2= years

A

10-20%

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3
Q

What percentage of people who experience a major depressive episode will experince 1+ recurrences

A

40-50%

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4
Q

People who experince recurrent depression are not entirely

A

Symptom- free between episodes

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5
Q

What increases with # of last episodes, presence of comorbidities

A

Probability of recurrence

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6
Q

Depression is common

A

Lifetime prevalence of unipolar major depression ~17%

  • fail to detect depression in 50% of patients
  • twice as common in women
  • three times as common among people in poverty
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7
Q

What can play an important role symptom expression and description

A

Cultural factors

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8
Q

Disparity

A

Observed in most countries around the world

  • starts in adolescence and continues until age 65
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9
Q

Depression age of onset

A

Early 20s

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10
Q

Functional consequences of depression

A

1) leading cause of disability worldwide

2) even subsyndromal depression symptoms associated with significant impairment

3) long-term effects of MDD in adolescence often felt at least through young adulthood

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11
Q

Bipolar disorder

A

Severity and duration of mania is hallmark (bipolar 1 vs bipolar 2)

  • can be diagnosed with bipolar disorder without ever having an episode of depression

-mixed episodes are common (high risk for suicide)

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12
Q

Prevalence rates of bipolar

A

1% in US

  • .6% worldwide

0”4-0.2% for bipolar 2

-4% for cyclothymia

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13
Q

Bipolar disorder

A

Average age onset of 20’s

-no gender differences in rates of bipolar disorders

  • high rate of misdiagnosis
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14
Q

Consequences of bipolar disorder

A

Considered a severe and persistent mental illness

  • episodic and recurrent
  • 6th leading cause of disability worldwide

-high rates of suicide

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15
Q

Genetic factors (MDD)

A

35% in twin studies

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16
Q

Genetic factors (bipolar)

A

60-85% in twin studies

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17
Q

Genetic models

A

Predict risk and age of onset to a degree, but not frequency, severity, or duration of episodes

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18
Q

Monoamine hypotheis

A

Early focus on serotonin and norepinephrine especially on low absolute levels of serotonin

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19
Q

Depression and Neurotransmission

A

Focus on complex interactions between neurotransmitters and with other hormonal and neurophysiological patterns and biological rhythms

  • relative balance of serotonin to other neurotransmitters
  • role of dopamine, particularly in anhedonic symptoms
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20
Q

Depression and brain function

A

Earl neurological finding: injury to the left anterior prefrontal cortex often followed by depression

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21
Q

Depression and the neuroendocrine system

A

Hypothyroidism

  • inflammation
  • over activity of stress reposne system
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22
Q

What percentage of blood plasma cortisol evaluation occurred in outpatients with depression

A

20-40%

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23
Q

What percentage of blood plasma cortisol elevation occurred in hospitalized patients with severe depression

A

60-80%

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24
Q

What percentage of people with dexamethasone either fail to entirely suppress cortisol or failed to sustain its suppression

A

45%

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25
Q

Depression and Life stress

A

Early adversity associated with long term vulnerability

  • chronic stress
  • interpersonal relationships and interpersonal stress
  • high levels of familial expressed emotion predict relapse
  • depression strongly associated with martial conflict
  • lack of social support increase risk
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26
Q

Perinatal depression

A

1/7 women experience perinatal depression

  • men also at risk

-hormone change can play a role

Major challenge: distinguishing postpartum depression from “baby blues”

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27
Q

Depression and psychological factors

A

Personality variables
* strong evidence for negative affectivity
* tendency to experience frequent and intense negative affect
* also predicts onset of anxiety, which is highly comorbid

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28
Q

Depression and psychological factors

A

Behavioral theories
- lewinsohn: absence of response- contingent positive reinforcement and/ or high rate of negative experinces, low levels of activity/ behavioral engagement-> vicious cycle

  • seligman: learned helplessness

Cognitive theories: negative thought patterns, beliefs cause depression

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29
Q

Beck’s theory of depression

A
  • negative views of beliefs about self, world, future (depressogenic schemas)
  • life experinces thought to play critical role in formation, activation of these belief

*automatic cognitive biases: tendency to process information in negative ways
Ex: tending to minimize positive events

  • descriptive theory
  • causal theory
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30
Q

Abramson’s Helplessness/ Hopelessness theories of depression

A

*pressimistic attributional style: negative life events attributed to internal, stable, and global causes

Ex: this bad thing happened because I’m fundamentally a bad person

*hope is an important ingredient in treatment/ recovery

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31
Q

Psychosocial factors in bipolar disorder

A

Similar to unipolar depression: negative live events, negative affectivity, negative conditions, expressed emotion, and lack of social support

*predictors of mania
- reward sensitivity: high responsivity to rewards, strong attachment to and pursuit of goals, life events that involve attaining goals

  • disruption of sleep, circadian rhythms, social rhythms
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32
Q

Issues with etiological models

A
  • cause vs effect
  • effect sizes
  • specificity
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33
Q

Medications for depression

A

75% prescribed antidepressants

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34
Q

Citalopram (celexa) depression

A

33% achieved full symptom relief

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35
Q

Treatments for depression

A
  1. Interpersonal psychotherapy
  2. Cognitive therapy
  3. Mindfulness- based cognitive therapy
  4. Behavioral activation
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36
Q

Cognitive therapy for MDD

A
  1. Efficacious as medication for severe depression
  2. More efficacious than medication in the long-term for reducing relapse risk
  3. Medication can potentially be quicker
  4. Increase odds of recovery over either alone by 10-20%
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37
Q

Bipolar disorder lithium

A

Naturally occurring salt

  • up to 80% experince least some relief
  • aversive and potentially medically serious side effects
  • high rate of discontinuation
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38
Q

Bipolar disorder medications

A

Mood stabilizers

  • recommended if people are not able or not willing to use lithium
  • may be combined with lithium
  • six medications on average
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39
Q

Psychological treatment of bipolar disorder

A

Psychotherapy for BD: cognitive therapy, family-focused treatment, interpersonal and social rhythms therapy

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40
Q

Strong evidence that psychological treatments can

A
  1. Promote consistent medication use
  2. Reduce relapse and hospitalizations
  3. Reduce acute symptoms of depression and mania
  4. Improve quality of life, social, and occupational functioning
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41
Q

Mediators

A

We don’t understand enough about how and why our treatments work

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42
Q

Moderators

A

We don’t know nearly enough about who will benefit most from which treatments

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43
Q

Self-harm

A

Umbrella term for self-injuries behavior

*fuzzy boundaries (some would include disordered eating behaviors)

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44
Q

Suicidal ideation

A

Thoughts of wishes to die, ranging from comparatively passive ideation to images of ending one’s life to concrete planning

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45
Q

Suicide attempt

A

Deliberate, self-inflicted harm at least partly intended to en one’s life (regardless of likely or actual medical lethality)

  • people are often ambivalent about taking their own lives)
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46
Q

Suicide

A

Death resulting from a suicide attempt

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47
Q

No suicidal self-injury

A

Deliberate, direct destruction of body tissue without any intent to die

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48
Q

Where do self-injurious thoughts and behaviors appear as symptoms

A

In the DSM

  • diagnostic categories for the behaviors themselves don’t exist
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49
Q

Multiple proposed diagnostic entities

A

1) suicidal behavior disorder

2) non-suicidal self-injury disorder

3) suicidal crisis syndrome

4) suicidal affective disturbance

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50
Q

Epidemiology of suicidality

A

12th Leading cause of death in the US

  • 2nd leading cause of death for ages 20-34
  • someone in the US dies from suicide every 11 minutes
  • > 50% of Americans have been affected by suicide in some way
  • suicide rate in the US has risen in the 21st century
  • suicide rates are almost certainly underestimated
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51
Q

Worldwide epidemiology of suicidality

A

9% report suicidal ideation at least once in their lives; 2.5% have made at least one suicide attempt

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52
Q

Demographics of suicide

A

Men tend to use more lethal means

-50% of all suicides are by firearms

> 50% of firearm deaths are suicides

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53
Q

Other demographics at higher risk for suicide

A

1) age 45+ (rates increasing more rapidly for adolescents)

2) LGBTQ+

3) veterans

4) people living in rural areas

5) people who are divorced or widowed

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54
Q

Risk factors for suicide

A

Clear evidence of associations w genetic and biological factors, but associations are very weak and likely multiple meditated

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55
Q

Environmental and sociocultural factors ( suicide)

A

1) stressful life events

2) economic recessions

3) cuktural norms

4) availability of firearms

5) past history of suicide attempt, non suicidal self-injury

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56
Q

Psychological factors (suicide)

A

1) psychological disorders not only depression

2) psychache

3) hopelessness strong predictor of ideation, but not of attempts

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57
Q

What is a strong predictor of suicide attempts

A

Suicidal ideation

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58
Q

Ideation to Action

A

Suicide attempts aren’t always preceded by deliberate ideation and most people who ideate about suicide will not go on to attempt

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59
Q

The interpersonal theory of suicide (Joiner)

A

Thwarted belonging: I am alone

Perceived burden: I am a burden

Capability for suicide

Perdue d and capability: lethal ( suicide attempts)

Thwarted and perceived: Desire for suicide

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60
Q

Aftermath of suicide

A

Loss of a loved one through suicide is often associated with symptoms of depression, social withdrawal, anger, and perceived stigma from others

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61
Q

Suicides by close others and highly publicized suicides is associated with

A

Heightened risk of suicide

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62
Q

Challenges in studying suicide

A

1) low base of completed suicide

2) reluctance to disclose

3) suicides and suicide attempts often undercounted in official records

4) studying people who are no longer alive

5) at the end of thr day our ability to predict who will attempt suicide or when they will attempt is poor

  • people with many risk factors may never attempt; others with few risk
  • suicidologists disagree about how important prediction is a goal
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63
Q

Treating suicidality

A
  • importance of routine suicide assessment
  • direct (cognitive therapy) vs indirect (targeting depression treatments)
  • may include psychological, pharmacological, and non-pharmacological biological approaches

*before vs after attempts
- addressing medical concerns after attempts
- those who receive therapy after an attempt have a lower risk of future attempts

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64
Q

Suicidality and Hospitalization

A
  • suicidality most common reason for psychiatric hospitalization
  • may be voluntary or involuntary
  • most hospitalizations are quite short
  • can potentially offer an important respite, opportunity for stabilization
  • can also be very stressful, disruptive, undermine autonomy
  • ongoing risk during and following hospitalization
  • period immediately after discharge is very high risk
  • follow up and ongoing access to care is essential- but many people don’t received systematic follow-up
65
Q

Stepped Care Model

A

1) in patient hospitalization

2) partial hospitalization or intensive outpatient program

3) outpatient care

4) brief intervention and follow up

5) crisis support and follow up

66
Q

When were formal suicide prevention program was founded and where

A

1955 in Los Angeles

67
Q

Public health: preventing suicide

A

Suicide hotlines and other crisis services

*targeted education directed to healthcare providers, first responders and teachers may be more effective

68
Q

Prevention strategy with the strongest evidence

A

Is universal means restriction (reducing access to firearms, suicide deterrent nets on bridges)

  • when deterrents are installed at hotspot bridges there’s often some corresponding increase in suicides at other nearby bridges, but the net effect is still a decrease in total suicides
69
Q

Important knowledge

A

People who are prevented from attempting suicide or whose attempts do not result in death won’t necessarily attempt again in the future

70
Q

Epidemiology of NSSI

A

Not an altogether uncommon behavior
* lifetime prevalence of up to 18% internationally
* only a small proportion will engage in repeated NSSI

Most prevalent in adolescents and young adulthood
* substantially lower prevalence in adulthood but still 4-5%

  • women slightly higher risk than men
  • LGBTQ+ people at higher risk
71
Q

Risk factors

A

*Psychologists disorders

  • negative affectivity and related traits
  • life stress
  • difficulties with emotion regulation and tolerating distress
72
Q

Toward a functional model of NSSI

A

Barriers
- many reasons for people not to self-harm such as
* stigma, social norms
* self-preservation motives
* fear of pain

Functions
-reguakte distressing emotions
* pain-offset model

  • gravity self-punishment motives
  • communicate distress to others
73
Q

Consequences of NSSI

A

Result in unintended serious harm or even death

Associated with : suicide risk, life stress, depression

Highly stigmatized
- report negative attitudes, feeling ashamed
- may contribute to a vicious cycle

74
Q

Treatment of NSSI

A

Dialectical Behavior Therapy

  • originally develoed by Marsha Linehan as a treatment for people who were chronically suicidal and self-harming
  • stringer evidence for efficacy in adolescence than in adulthood
75
Q

Fear and Anxiety

A
  • alert and orient us to acute, potential, or sustained threats
  • motivate and organize our response to threat
  • “loosely coupled” behavioral (fight, flight, freeze), physiological (increased heart rate, sweating), cognitive responses
  • communication of danger to conspecifics
  • helped us to survive
76
Q

Specific phobia

A

Fear of objects or situations that is out of proportion to any real danger

77
Q

Social anxiety disorder

A

Fear of unfamiliar people or social scrutiny

78
Q

Panic disorder

A

Anxiety about recurrent panic attacks

79
Q

Agoraphobia

A

Anxiety about being in places where escaping or getting help would be difficult if anxiety symptoms occurred

80
Q

Generalized anxiety disorder

A

Uncontrollable worry

81
Q

Agoraphobia (part 2)

A
  • marked fear of being in public spaces, particularly crowded spaces
  • often comorbid with and may frequently arise as a consequence of panic attacks
  • fear of fear hypothesis: Expectations of catastrophic consequences of having a panic attack in a crowded public place
82
Q

Panic attack and panic disorder shared features

A
  • clinically significant distress or impairment
  • excessive mess
  • people with anxiety disorders often regard their own anxiety as disproportionate
  • avoidance
  • can be overt or more subtle
  • inhibits problem solving, learning
  • if im avoiding this, it must be too scary to face
  • no universal, objective demarcating line
    *how much anxiety is appropriate amount of anxiety?
  • how to distinguish between problematic avoidance vs important safety precautions or leaving an unhealthy situation
83
Q

Epidemiology

A

12 month prevalence: 18%

Lifetime prevalence: 29%

Social anxiety disorder > generalized anxiety disorder (more common than others)

More common in women than men

84
Q

Comorbid it’s

A

80% of those with an anxiety disorder meet criteria for another anxiety disorder

75% of those with an anxiety disorder meet criteria for another type of psychological disorder

  • disorders commonly comorbid with anxiety include depression, substance use, and personality disorders
85
Q

Conditioned learning of fears (Mowrer)

A

Classical conditioning
1) UCS (dog bite)
2) Linked by contiguous pairings
3) CS (dog)
4) CR: Conditioned fear of dogs

Operant conditioning
1) strong fear response acts as a stimulus or drive
2) overt avoidance response

86
Q

Extensions of Mowrer’s Model

A
  • coincident panic attack (associative learning)
  • prior learning
  • social and vicarious learning
  • social learning can also inoculate against fear
  • individual differences ( some people may be more susceptible to acquiring fears than others/ and or to be more resistant to fear extinction)
87
Q

Genetics

A

Twin studies consistent with heritability, with estimates ranging from 20-50% for the various anxiety disorders

  • non shared environmental factors seem to play a role in anxiety disorders
  • genetic effects highly complex, polygenic
88
Q

Neurobiological

A

Fear circuit

  • amygdala, hippocampus, and medial prefrontal cortex
89
Q

Neurotransmission

A
  • multiple NT implicated: GABA, serotonin, norepinephrine
  • corticotropin releasing factor- neuropeptide that regulates the HPA axis
90
Q

Personality

A

Negative affectivity

  • recall that this is also a major risk factor for depression, among other mental health conditions
91
Q

Temperament: behavioral inhibition in early childhood

A
  • shy, subdued, wary of novel stimuli
  • particularly related to social anxiety
92
Q

Cognition

A
  • perceived unpredictability of, lack of control over one’s environment
  • beliefs about the future ( bad things will happen-> motivation to avert worst-case catastrophe)
  • childhood trauma and adversity, some forms of parenting can foster these beliefs and information processing strategies
  • adverse life events may be unpredictable, uncontrollable
93
Q

Cognitive biases

A

Information processing (bias towards interpreting neutral information as threatening), overestimation of likelihood of danger, and recall of fear-relevant stimuli

94
Q

Social anxiety disorder

A

Evolutionary context: very important for humans to maintain social ties

Learning: many people with social anxiety disorder recall traumatic social experiences, bullying

  • avoidance of social situations can interfere with development of social skills
  • engagement in safety behaviors ( not making eye contact)
95
Q

Social anxiety disorder

A

Cognitive factors
- unrealistic beliefs about consequences
- negative self -evaluation
- heightened self-awareness
- attention to and interpretation of possible social threat cues
- upward social comparison

96
Q

Panic: neurobiology

A
  • early theorizing focused heavily on locus coeruleus= major source of norepinephrine
  • panic circuit
  • hippocampus presumably plays an important role in the conditioning of the emotional response
97
Q

Panic: anxiety sensitivity

A

Anxiety sensitivity: tendency to focus on bodily sensations, have difficulty interpreting bodily sensations, and interpret of bodily sensations as potentially harmful

98
Q

Generalized anxiety

A

Problem orientation: tendency to view challenges as threats

  • attempts to control worries can backfire

Functional models
1) simultaneous believe that worrying is useful and harmful + uncontrollable

2) worrying suppresses physiological arousal

3) worry distracts from/ avoids more unpleasant emotions and thoughtS

4) contrast avoidance model: worry produces sustained, modest negative affect and so protects from dramatic shifts in emotion

99
Q

Behavioral component (treatment): Exposure

A

Involves facing the situation or object that triggers fear/ anxiety

  • can take various forms like imaginable or in vivo
  • habitual model: do it till you’re bored
  • inhibitory model: learning to feel safe
  • should include as many features of the trigger as possible
  • reduce or eliminate use of safety behaviors like reassurance-seeking
100
Q

Cognitive components

A
  • increase belief in ability to cope with the anxiety trigger: ability and willingness to tolerate/ accept uncertainty, anxious sensations
  • challenge unhelpful beliefs
  • post-exposure debriefing to facilitate new learning
  • increase mindfulness
101
Q

Relaxation and other skills

A
  • diaphragmatic breathing
102
Q

Medications

A

Benzodiazepines

  • can produce fast-acting relief
  • effects are shirt lived
  • induce physical, psychological dependence
  • produce various unpleasant side effects
  • dangerous in combination with other drugs
103
Q

Anxiety disorders are

A

1) highly comorbid with each other

2) share many common etiologcial factors

3) can be treated with a unified protocol

104
Q

Obsessions

A

Persistent and recurrent intrusive thoughts, images, or impulses experiences as disturbing, inappropriate, or uncontrollable

  • people who have such obsessions often try to actively resist, suppress, or neutralize them
105
Q

Compulsions

A

Repetitive behaviors or rituals that a person feels driven to perform, often according to very specific or rigid rules

-people can simultaneously feel compelled to perform compulsions and regard those compulsions as excessive

106
Q

Excoriation

A

Compulsive skin-picking

107
Q

Trichotillomania

A

Compulsive hair-pulling

108
Q

Compulsive and related disorders

A

1) obsessive compulsive disorder

2) body dysmorphic disorder

3) compulsive hoarding

109
Q

OCD

A

Previously classified as an anxiety disorder

110
Q

BDD

A

Previously classified as a somatoform disorder

111
Q

Body dysmorphic disorder

A

Most people have some aspect of their body that they dislike

  • spend 3-8 hours/day thinking about their body-related concerns
112
Q

Epidemiology of OCD

A

Lifetime prevalence: 2-3%

  • equally common in women and men
  • common onset is childhood
  • may have both obsessions and compulsions
  • co-occurs with anxiety disorders, etc
113
Q

Epidemiology of BDD

A

1-2% common

  • equal in women and men
  • age of onset is adolescence
  • associated with stress and diminished quality of life
114
Q

BDD and plastic surgery

A

1/5 will undergo plastic surgery and visit dermatologist

115
Q

Epidemiology of hoarding

A

Compulsive hoarding as a symptom occurs in 3-6% of adults

  • people conceal
  • early signs begin in childhood
  • high rates of unemployment and social alienation
  • can be dangerous: fire risk
116
Q

Biological factors in OCD

A

Moderate heritability

-basic idea: impulses most people keep under control with little effort

  • difficulty inhibiting prepotent actions
  • experince fear in response to obsessions
  • heightened neurological response to making errors

Neurotransmission: serotonin, glutamate, GABA, dopamine all potentially implicated- but exact roles remain unclear

117
Q

Behavioral processes in OCD

A

Conditioned learning (mowrer’s model of fear learning)

  • coincidences -> superstitions
  • habits are hard to change
118
Q

Cognitive processes in ocd

A

Attentional and perceptual biases: disproportionate attention toward obsession-related stimuli; difficulty blocking out negative information

  • thought action fusion (Rachmaninov): thoughts are morally equivalent to actions -> guilt, self-blame, self-recrimination, shame, as well as efforts to neutralize the thoughts and to seek reassurance
  • endorse beliefs that thoughts can and should be controlled
  • high standards of conduct and morality; responsibility-> heightened efforts to avert harms
  • lack of confidence in effectiveness of preventative (harm-avoiding) actions
119
Q

Yedasentience

A

Internally generated feeling that you’ve done enough

  • associated with goal completion
  • facilitates termination of action and thinking related to that goal
120
Q

Etiology of BDD

A

Environments that focus on apperance

  • strong belief in the importance of apperance, valuing apperance
  • biased attention to physical attractiveness features, words, perceived flaws
  • attentions to details
121
Q

Etiology of hoarding

A

High rates of drama

  • cognitive factors
  • difficulty with organization
  • common beliefs about self

Self: unlovable and unworthy

Others: can’t be trusted

Possession: irreplaceable, important

122
Q

Exposure and response prevention

A

Exposure to situations that elicit obsessions

Prevention of engagement in compulsive behavior

50-70% show improvement

  • limited access to therapy
123
Q

Biological treatments

A

Medication: SSRI and SNRI

  • higher doses and more time than for depression
  • relapse common if medication are discontinued
  • little known about hoarding disorder
  • 50-60% of those with OCD experince improvement from SSRI

Deep brain stimulation for OCD

  • indicated for those who don’t experience relief from pharmacological interventions
  • 50% of those treated with DBS attain significant relief within a couple months
124
Q

Mental health disparities

A

Risk is even higher for people with multiple minioritzed identities-> intersectionality

125
Q

Social/ structural determinants of health

A

1) education

2) healthcare

3) physical environment/ neighborhood

4) economic security

5) social environment

126
Q

Distal stress factors

A

1) gender-related discrimination

2) gender-related rejection

3) gender-related victimization

4) non-affirmation of gender identity

127
Q

Proximal stress factors

A

1) internalized transphobia

2) negtajve expectations

3) concealment

128
Q

Resilience factors

A

1) community connectedness

2) pride

129
Q

Extensions

A

Diamond and alley: it’s not just stress- it’s also insufficient social safety

Social safety: reliable social connection, inclusion, protection

Social safety imperiled by queerphobia

Lack of social safety-> chronic threat-vigilance

Virginia brooks: minority stress and socioeconomic factirs (restricted access to economic opportunities)

130
Q

Stress generation and adaptation

A

The set of psychological and physiological processes that allow us to respond to actual, potential, or perceived threats, challenges, and demands

131
Q

Types of stress

A

Acute vs chronic

  • major life events vs daily hassles
  • chronic persistent vs chronic intermittent
132
Q

Timing of stressors

A

Childhood seems to be a particularly important sensitive period

  • greater biological, psychological plasticity
  • less control, autonomy
  • less time in which to have developed coping skills

Loss of a spouse at age 30 vs age 90

Casual compounding (loss of job-> loss of stable housing)

133
Q

Measure stress

A

Self- report (questionnaires and interviews)

  • exposure to stressors
  • perceived stress

Stress physiology

  • activity of the autonomic nervous system
  • hormonal assays (cortisol)
134
Q

Stress response system

A

1) pupils dilate

2) muscle tense

3) increased sweating

4) lungs dilate

5) heart rate accelerated

6) suppression of non-essential bodily functions (digestion)

135
Q

Psychological (chronic stress)

A

1) negative affect

2) positive affect

3) executive function

4) beliefs about self, others, and world

136
Q

Behavioral (chronic stress)

A

1) sleep

2) substance use

3) social withdrawal

4) diet

5) physical activity

137
Q

Biological (chronic stress)

A

1) brain structure, function

2) systematic inflammation

3) immune suppression

4) metabolic function

138
Q

Subjective stress vs stress exposure

A

Ratings are a strong predictor of poor betaken than stress exposure, even if the exposure is weighted by stress or severity

  • subjective stress ratings index a combination of stress exposure and health-relevant individual and contextual differences in vulnerability to stress
139
Q

Pathways linking stress to disease

A

1) direct biological: inflammation

2) indirect behavioral: poor nutrition

3) indirect psychological: motivation

  • health problems are significant stressors*
140
Q

Factors associated with resilience

A

Access to resources

  • psychological: self-esteem
  • interpersonal: social supoort
  • financial, systemic: health insurance
141
Q

DSM criteria A for PTSD

A

1) exposure to actual or threatened violent death, serious injury, or sexual violence

2) direct Experience, witnessing (in-person), learning about trauma experience by a close other, experiencing repeated or extreme exposure to details of trauma (first responders)

142
Q

Traumatic stress spectrum

A

Having some post-traumatic stress symptoms ( nightmares and hyper vigilance) is very common in the immediate wake of a traumatic experience

  • not same as PTSD
143
Q

PTSD in the DSM

A

Introduced in 1980: inclusion was initially opposed by some in part because PTSD has an explicit, external cause (the trauma)

  • not limited to soldiers and veterans
144
Q

DSM-5 Criteria

A

A: exposure to trauma

B: one of more intrusion symptoms (flashbacks or nightmares)

C: persistent avoidance (behavioral, cognitive, emotional)

D: changes in cognition and mood

E: marked alteration in arousal and reactivity

F: duration is less than a month

145
Q

Epidemiology of Trauma and PTSD

A

1) report at least one criterion A trauma in their lifetime

2) symptom develop within 6 months of the trauma

3) symptoms can be highly chronic

  • not everyone develops PTSD: lifetime prevalence is 7-9
146
Q

Epidemiology of PTSD

A

1) comorbid with other conditions

2) higher prevalence in women than men

3) sociocultural factors can shape risk (poverty and exposure to violence)

4) associated with significant functional impairment across multiple life domains

147
Q

Acute stress disorder

A

1) symptoms similar to PTSD

2) covers 1 month gap between trauma exposure and ability to quality for PTSD diagnosis

3) only diagnosed immediately following the trauma

148
Q

Complex PTSD

A

Judith Herman: argues that prolonged exposure to serial traumatization wit limited opportunities to escape can give rise to a syndrome related to, but distinct from OTSD

  • focus on difficulties with emotion regulation, negative self-concept, interpersonal difficulties
149
Q

Trauma experience can produce

A

1) atypical memory trace (past is present)

2) allostatic load

3) alter beliefs about self, other people, the world

4) interfere with various aspects of living

150
Q

Stuck point in 5 dimensions

A

Safety: I can’t protect myself

Trust: Otehr people shouldn’t trust me

Power/Control: I must control everything that happens to me

Esteem: I deserve to have bad things happen to me

Intimacy: I am unlovable because of the trauma

151
Q

More direct exposure to trauma

A

Causes higher risk of trauma

152
Q

Adverse Childhood Experiences

A

Increase lifetime risk for a host of psychological and physical health problems
* dose-response relationship

153
Q

Overlapping risk factors with anxiety

A

1) genetic risk

2) neural circuitry

3) cognitive factors (selective attention)

4) personality factors (negative affectivity)

5) two-factor model of conditioning

6) avodinave

154
Q

Reduced hippocampal volume

A

Both a risk factor for PTSD and a consequence of traumatic stress exposure

155
Q

Trauma- focused psychotherapy

A

1) first-line treatment

2) various forms
* prolonged exposure and cognitive processing therapy

3) Key element: Exposure

4) effective, but many people don’t get access to evidence-based treatment

156
Q

Misconceptions about TF psychotherapy

A

Can be held by both service users and service providers

Ex: TF psychotherpay not suitable for complex/ multiple trauma

Ex: most people with trauma are too fragile for TF psychotherapy

Ex: exposure therapy is harmful because it can increase distress

157
Q

Prevention

A

1) reducing incidence of trauma exposure

2) enhancing psychological preparedness for those at high-risk

3) disrupting memory consolidation

158
Q

Trauma- informed care

A

Reflects growing recognition of the role of trauma

Key idea: shift the focus from what’s wrong with you to what happened to you

159
Q

Moral injury

A

1) not classified as mental disorder

2) begins with an event witnessed, perpetrated or learnt about that goes against be beliefs

3) result of direct or indirect threat to core mental beliefs

4) strongly associated with emotions that developed such as guilt and shame

Psych 350 (2 decks)

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