Exam 2 Flashcards
this domain of assessment utilizes pictures of the brain
neuroimaging
two types of examinations of the brain:
structure and function
this examination of the brain assesses whether there is damage; size of various parts
structure
this examination of the brain assesses what parts are functioning during specific tasks; looks at blood flow
function
two imaging techniques used to assess brain structure:
computerized axial tomography (CAT or CT scan) and magnetic resonance imaging (MRI)
this scan utilizes x-rays of brain; pictures in slices
computerized axial tomography (CAT or CT scan)
does MRI have better resolution than CAT scan? or vice versa?
MRI has better resolution than CAT
this imaging technique operates via a strong magnetic field around the head
-more expensive, more time-consuming, and difficult for certain patients to tolerate
magnetic resonance imaging (MRI)
three imaging techniques used to assess brain function:
- positron emission tomography (PET)
- single photon emission computed tomography (SPECT)
- functional MRI (fMRI)
- provide detailed information regarding brain function
- procedures are expensive; lack adequate norms
- procedures have limited clinical utility
advantages and limitations of imaging techniques that assess brain FUNCTION
methods used to assess brain structure, function, and activity of the nervous system
psychophysiological assessment
- electroencephalogram (EEG)
- heart rate and respiration
- electrodermal response and levels
- electromyography (EMG)
- penile plethysmograph
psychophysiological assessment domains
electroencephalogram (EEG) measures
brain wave activity
heart rate and respiration measures
cardiorespiratory activity
electrodermal response and levels measure
sweat gland activity
electromyography (EMG) measures
muscle tension
penile plethysmograph measures
sexual arousal
when is a penile plethysmograph used?
in instances where someone may not be willing to report sexual arousal
clinical assessment vs. psychiatric diagnosis:
assessment is an ___ approach
idiographic approach
this approach emphasizes what is unique to this person (personality traits, family, background, culture, or other circumstances)
idiographic approach
clinical assessment vs. psychiatric diagnosis:
diagnosis is a ___ approach
nomothetic approach
this approach applies what we know about a person to what we know about people more broadly
-seeing if specific problems fit with a general class of problems
nomothetic approach
is clinical assessment or psychiatric diagnosis more important in treatment planning and intervention?
both are important
diagnostic classification:
-classification is ___ to all sciences
-develop categories based on ___ attributes
central ; shared
terminology of classification systems:
___ is classification in a scientific context
taxonomy
terminology of classification systems:
___ is taxonomy in psychological/medical contexts
nosology
terminology of classification systems:
___ is nosological labels (ex. panic disorder)
nomenclature
two widely used classification systems used to diagnose and classify psychological disorders:
international classification of diseases and health related problems (ICD-11) and diagnostic and statistical manual of mental disorders (DSM)
the international classification of diseases and health related problems (ICD-11) is published by the ___
world health organization
the diagnostic and statistical manual of mental disorders (DSM) is published by the ___
american psychiatric association
what is the most current version of the DSM?
DSM-5 (2013)
the nature and forms of classification systems:
3 approaches:
- classical (or pure) categorical approach
- dimensional approach
- prototypical approach
the nature and forms of classification systems:
classical (or pure) approach pertains to:
categories
- yes/no decisions
- each disorder viewed as fundamentally different from others
- clear underlying cause
- individual required to meet all requirements for classification
- viewed as inappropriate to complexity of psychological disorders
characteristics of the classical (or pure) approach
individual required to meet all requirements for classification
monothetic
is the classical (or pure) categorical approach monothetic or polythetic?
monothetic
the dimensional approach is characterized by classification along ___
dimensions
- symptoms or disorders existing on a continuum (ex. 0 to 100)
- patient might be mildly depressed (60) and moderately anxious (70)
- create a profile to represent person’s functioning
- no aggreement on number of dimensions or which dimensions required
4 characteristics of the dimensional approach
the prototypical approach is both:
classical and dimensional
- categorical (yes/no decisions) but individual does not have to for every symptom
- rather, patient must meet some minimal number of prototypical criteria (ex. 5 of 9 depression symptoms)
characteristics of the prototypical approach
is the prototypical approach monothetic or polythetic?
polythetic
(creates within-category heterogeneity and presumes homogeneity within the “yes” and “no” group)
3 purposes of the DSM system:
- aid communication
- evaluate prognosis and need for treatment
- treatment planning
evolution of the DSM:
these two versions, between these two times, relied on unproven theories and were unreliable
-very freudian - very psychoanalytically driven
-did not have the complex symptom list that they do now
DSM-I (1952) and DSM-II (1968)
evolution of the DSM:
DSM ___ through DSM ___
-atheoretical, emphasizing clinical description, not underlying etiology
-detailed criterion sets for disorders
-emphasis on reliability (inter-rater; test-retest)
-questions about validity (many decisions were not empirical - why have to have 4 panic attacks in a 4 week period; why have to be depressed for 2 weeks; why 5 of 9 depression symptoms?)
DSM-III (1980) through IV (2000)
evolution of the DSM:
this version of the DSM emphasizes the understanding that many (most) symptoms are not specific to a single disorder, but cut across many disorders (ex. anxiety, depression, suicidal ideation)
-introduction of new dimensional measures that exist across disorders
DSM-5 (2013)
-what problems cause distress or impair functioning?
-why do people behave in unusual ways?
-how can we help people behave in more adaptive ways?
questions driving a science of psychopathology
basic components of research:
research starts with a ___
hypothesis
true or false: all hypotheses are testable
false
true or false: a scientific hypothesis must be testable
true
can hypotheses be rejected or accepted?
yes
research design is a method to test ___
hypotheses
the variable that causes or influences behavior
independent variable
the behavior is influenced by the independent variable
dependent variable
ex. “exercise reduces depression”
what are the independent and dependent variables?
independent variable: exercise
dependent variable: ratings of depression
did the independent variable produce the outcomes?
-did you do the study in a competent way so you can have faith in its conclusions?
internal validity
are the findings generalizable (ex. to other settings, other locations, other types of samples, other problems)?
external validity
must first have ___ validity before external validity
internal validity
how can you increase internal validity?
by minimizing confounds
factors that might make the results uninterpretable
confounds
individuals not exposed to independent variable but are like the experimental group in every other way
control group
individuals are assigned to either experimental group or control group randomly; avoid some systematic bias
random assignment procedures
study related phenomenon in controlled conditions of laboratory setting (ex. alcohol)
analog models
relation between internal and external validity
can be at odds
-want to control any confounds that could impact results
-BUT, also want results to generalize to the “real world”
researchers work hard to balance these competing needs by:
creating multiple studies
these methods help protect against biases in evaluating data
statistical methods
are these results due to chance?
statistical significance
3 components of statistical significance:
- size of effect (correlation; difference in means)
- level of significance
- sample size
are the results clinically meaningful?
clinical significance
does statistical significance imply clinical meaningfulness?
no
extensive observation and detailed description of a client
-foundation for early developments in psychopathology
nature of the case study
- lack scientific rigor and suitable controls
- internal validity is typically weak
- often entails numerous confounds (finding unique to individual ; more inference from “researcher”)
limitations of case study
statistical relation between two or more variables
-no independent variable is manipulated
the nature of correlation
a problem of directionality (ex. breakups and depression) exists between ___ and ___
correlation and causation
true or false: correlation does not mean causation (ex. smoking and drinking)
true
nature or correlation and strength of association:
-rank from ___ to ___
___ vs. ___ correlation
rank from -1 to 1
negative vs. positive correlation
why use correlation studies?
in instances where you can’t randomly assign individual to groups and can’t manipulate the independent variable
this form of research studies incidence, prevalence, and course of disorders - looking for clues about the disorder
epidemiological research
number of new cases during a specified time
incidence
number of people with a disorder at any given time
prevalence
more or less common in certain populations
distribution
epidemiological research examines what factors are associated with ___
-ex. gender, socioeconomic status, certain behaviors
frequency
the goal of epidemiological research
to find clues as to the etiology of disorders
the nature of experimental research: 4 components
- manipulation of independent variables (ex. therapy or no)
- random assignment
- attempt to establish causal relationship
- premium on internal validity
____ are necessary to show that independent variable is responsible for observed changes
control groups
should the control group be nearly identical to the treatment groups?
yes
what does the placebo group ensure regarding treatment?
that the treatment effect is not due to an expectation that one will improve
placebo is easy to do with ___, but less so with ___ treatment
medications ; psychological treatment
within this control, both researchers and participants are unaware of their group assignment
double blind
this is often the next step after showing that treatment is better than placebo
type group design
this type of treatment design compares different forms of treatment in similar persons (psychotherapy vs. medication vs. combination)
-addressed treatment outcome (did change occur)
comparative treatment designs
dismantling studies (breaking study into parts and removing or focusing on certain aspects) is necessary to figure out the “___” components of the treatment
“active”
-systematic study of individuals under a variety of conditions
-rigorous study of single cases: manipulations of experimental conditions and time
-repeated measurement (rather than just once before and after)
-premium on internal validity
nature of single subject design
two types of single subject design:
withdrawal design and multiple baseline design
3 components of withdrawal design:
- baseline
- treatment
- withdrawal
gives psychologists a better sense if treatment causes changes
assets of the withdrawal design
involves removing a treatment that might be helpful; risking relapse; learning that it is impossible to “withdraw” most psychological treatments (once learned, can’t force a patient to unlearn them)
liabilities
this type of single subject design is characterized by not starting and stopping treatment, but rather starting intervention at different times across settings or behaviors
multiple baseline design
assets of multiple baseline design
don’t have to withdrawal treatment
liabilities of multiple baseline design
still making conclusion of the basis of a small number of people
this research strategy examines the interaction among genes, experience, and behaviors
genetic research strategiees
genetic research strategies examine the relationship between
phenotype (observable characteristics or behaviors) and genotype (genetic make-up)
4 strategies used in genetic research:
- family studies
- adoptee studies
- twin studies
- genetic wide association studies
this genetic research strategy examines the behavioral pattern/emotional traits in family members
family studies
problem with family studies
cannot distinguish between environmental and genetic factors
this genetic research strategy allows separation of environmental and genetic factors (are children more like adoptive parents or biological parents?)
adoptee studies
there are a number of studies looking at ___ via adoption studies
crime
does research suggest some heritable component for crime?
yes
this genetic research strategy evaluates psychopathology in fraternal vs. identical twins
twin studies
risk of developing schizophrenia (given the other twin has it) for both monozygotic and dizygotic twins:
mono: 48%
di: 17%
this genetic research strategy locates the site of related genes
genetic wide association studies
studying behavior over time may help us understand ____ factors for the manifestation of a disorder
precipitating factors
studying behavior over time is important in two forms of research:
prevention research and treatment research
study of risk factors for development of disorder (biological, psychological, environmental)
importance of studying behavior for prevention research
what helps individuals recover? (ex. psychoeducation, emotional support, medication, behavioral activation)
importance of studying behavior for treatment research
two types of time-based research strategies:
cross-sectional designs and longitudinal designs
this experimental design takes a cross selection of the population across different age groups and compares on a certain characteristic
cross-sectional design
is a cross-sectional study easier or harder than a longitudinal study? does it take more or less time?
easier ; less
cross-sectional designs are ___, meaning that all assessments are at the same time
all concurring
participants in each age group
cohorts
confounding effect of age and experience
cohort effect
what is a major limitation of cross-sectional designs?
cohort effect
2 limitations of cross-sectional designs
- tell us little about how problems develop
- can tell us that two variables are related, but not causal information
this experimental design follows one group over time and assesses changes in individuals
longitudinal design
is there a cohort effect problem within longitudinal designs?
no ; no cohort effect problem
this experimental design gets us closer to understanding causality (order of relationship, depression leads to fewer friends vs. fewer friends leads to depression)
longitudinal design
5 problems with longitudinal design:
- takes a long time to do
- expensive
- must worry about patient attrition
- study topic may no longer be relevant by the time the study is complete
- cross-generational effect
people leaving the study
attrition
may not be possible to generalize study effects to other groups whose experiences are quite different
cross-generational effect
true or false: good internal validity does not equate to good external validity
true
what is the ‘cohort effect equivalent’ of longitudinal designs?
cross-generational effect
value of cross-cultural research: (2)
- can be informative
- overcomes ethnocentric research
how is studying abnormal behavior from various cultures informative?
tells us about origins and treatment of disorders from different perspectives
- clarify how psychopathology manifests in different ethnic groups (same terminology may “look” or “feel” very different across cultures
- different thresholds for abnormal behavior
- treatment exists within cultural context
3 issues in cross cultural research
components of a research program:
true or false: no one study will definitively answer the question
true or false: studies proceed by asking slightly different questions, using slightly different procedures
true ; true
are research programs conducted in stages? do research programs involve replication?
yes ; yes
scientific knowledge typically builds incrementally or radically?
incrementally
what is vital for a research program?
replication
difference between anxiety and fear
anxiety is a future oriented mood state, while fear is a present-oriented mood state
how is anxiety characterized?
marked negative effect
anxiety is characterized by ___ symptoms of tension
somatic (ex. headache, muscle ache, gastrointestinal issues)
apprehension about future danger or misfortune
anxiety
fear is characterized by an immediate ___ or ___ response to danger or threat
fight or flight
fear is characterized by strong ___/___ tendencies
avoidance/escapist
fear abruptly activates the ___ nervous system
sympathetic
true or false: anxiety and fear are normal emotional states
true
3 characteristics of anxiety disorders:
- psychological disorders
- excessive avoidance and escapist tendencies
- causes clinically significant distress and impairment
pervasive and persistent symptoms of anxiety and fear
psychological disorders
abrupt experience of intense fear or discomfort accompanied by several physical symptoms
panic attack
2 types of panic attacks, according to the DSM-5
expected and unexpected
this panic attack happens in context of obvious cue or trigger
expected panic attack
this panic attack happens in context devoid of clear cue or trigger
unexpected panic attack
is panic disorder characterized by unexpected or expected panic attacks?
both
this type of panic attack may be seen more in phobias
expected
true or false: panic attack specifier can be used for any diagnosis in DSM-5, anxiety or other (ex. depression with panic attacks)
true
how common are panic attacks? what is the 12 month prevalence?
pretty common ; 11%
how can ‘specifier’ be remembered?
as toppings on a pizza - can be added on
biological contributions to anxiety and panic:
diathesis-stress
-inherit vulnerability for anxiety and panic, not disorders
2. stress and life circumstances activate vulnerability
two biological causes and inherent vulnerabilities of anxiety and panic
- anxiety and brain circuits
- behavioral inhibition system
3 anxiety and brain circuits
GABA, noradrenergic, and serotonergic system
lower levels (GABA, serotonin) =
more anxiety
higher levels (noradrenaline) =
more anxiety
activated by signals from brain stem of unexpected events, such as major changes in bodily functioning, that might signal danger
behavioral inhibition system
what type of measures are used within the behavioral inhibition system?
self-report measures
when the ___ is activated, we tend to “freeze,” experience anxiety, and anxiously evaluate the environment for signs of danger
behavioral inhibition system (BIS)
true or false: the behavioral inhibition system is thought to be distinct from circuit involved with panic
true
when this system is aroused, it produces an immediate “alarm and escape” response
fight or flight system
how may environmental factors change the sensitivity of brain circuits?
causing one to be more or less apt to develop an anxiety disorder
this psychologist believed that anxiety is a psychological reaction to danger (but tied to early infant/childhood fears)
freud
this view characterizes anxiety and fear as a result from classical and operant conditioning and modeling (vicarious learning)
behaviorist view
early experiences with uncontrollability and/or unpredictability
-parents can, through their behavior, pass on lesson that the child had some impact on their environment, AND that the child can cope with a world that is unpredictable
psychological view
is comorbidity common across anxiety disorders?
yes
approximately ___% of patients with an anxiety disorder have another secondary diagnosis
50%
what is the most common secondary diagnosis for anxiety disorders?
major depression
excessive uncontrollable anxious apprehension and worry about a number of events of activities; worry and anxiety interfere with ability to function and/or cause distress
generalized anxiety disorders
to be diagnosed with GAD, symptoms must persist for ___ months or more
6 months
to be diagnosed with generalized anxiety disorder (GAD), an individual must have 3+ of the following symptoms: (6 total)
- restlessness
- easily fatigued
- difficulty concentrating/mind going blank
- irritability
- muscle tension
- sleep disturbance
differences between generalized anxiety disorder (GAD) and “normal worry”
more or less pervasive and distressing?
more pervasive and distressing
differences between generalized anxiety disorder (GAD) and “normal worry”
lasts longer or shorter?
lasts longer
differences between generalized anxiety disorder (GAD) and “normal worry”
occurs with or without triggers
occurs without triggers
differences between generalized anxiety disorder (GAD) and “normal worry”
do worries come with or without physical symptoms?
with physical symptoms
differences between generalized anxiety disorder (GAD) and “normal worry”
associated with ___ symptoms, such as GI distress and exaggerated startle response
somatic
generalized anxiety disorder (GAD) affects ___% of the general population
3%
females outnumber males approximately ___:___ with GAD
2:1
GAD onset is often
insidious
median age of onset for GAD
30
GAD presence ___ in middle age, and ___ later in life
peaks; declines
symptoms of GAD tend to ___ and ___ across life ; full remission is ___
wax and wane ; rare
___ onset of GAD is associated with greater comorbitity and impairment
earlier
genetic factors account for ___% of the variability of GAD
30%
temperamental factors of GAD:
___ behavioral inhibition; neuroticism
-adults who develop GAD were more emotionally-fragile children
high
are environmental factors that cause GAD clear?
no
cognitive factors of GAD
highly sensitive to threat
treatment of GAD:
are drug or psychological interventions effective?
both
2 medications used in treatment for GAD:
benzodiazepines and antidepressants
help provide immediate, short-term relief for GAD
-impairs motor and cognitive functioning, can produce dependence (psychological and physical)
-abuse potential
benzodiazepines
proving useful in treatment of GAD
-lower side effects
antidepressants
this form of treatment for GAD has better long-term benefits
-cognitive-behavioral therapy evokes and confronts anxiety provoking images and thoughts by challenging automatic, “irrational” thoughts that lead to anxiety
psychological treatment
recurrent unexpected panic attacks (discrete period of intense fear or discomfort with four or more symptoms (palpitations, sweating, trembling, sensation of shortness of breath, choking, chest pain, chills, or heat sensations, numbness/tingling, nausea, feeling dizzy, fear of dying))
panic disorder
at least one of the attacks must be followed by 1 month or more of one or both:
- persistent worry about having additional attacks or their consequences
- significant maladaptive change in behavior related to attacks
12 month prevalence of panic disorder
2-3%
___ with panic disorder are female
2/3
onset of panic disorder is often ___
acute
when does onset of panic disorder begin?
between ages 20 to 24
symptoms of panic disorder often ___ and ___ over lifespan, but tends to be ___ (if untreated)
wax and wane ; chronic
waking from sleep while experiencing panic symptoms; not usually due to dreams
nocturnal panic attacks
associated features of panic disorder:
are general physical/health concerns typical or atypical among those with panic disorder?
typical
associated features of panic disorder:
true or false: those with panic disorder tend to be sensitive to medication side effects
true
associated features of panic disorder:
do people with panic disorders have concerns about ability to function due to panic?
yes
associated features of panic disorder:
is there any link between substance use and controlling panic?
may see excessive substance use to control panic
associated features of panic disorder:
true or false: those with panic disorder avoid panic cues (ex. exercise)
true
true or false: individuals with panic disorder have a biological predisposition to be “over-reactive” to life’s events. some will have an “emergency alarm reaction” (ex. heart racing, sweating, breathing heavily) as a response to a stressor
true
medication treatment of panic disorder targets 3 systems:
serotonergic, noradrenergic, and benzodiazepine GABA systems
what are the preferred drugs used in the treatment of panic disorders?
SSRIs
are relapsee rates high or low for individuals with panic disorder after medication discontinuation?
high
what type of psychological treatment is highly effective for panic disorder?
cognitive-behavioral therapy
not going out in crowded places
agoraphobia
true or false: it is helpful to create panic (mini-panic attacks) in cognitive-behavioral therapy sessions as exposure for those with panic disorder
true
this therapy alone creates the best long-term outcome for those with panic disorder
cognitive-behavior therapy
characterized by an extreme and irrational fear of a specific object or situation
-this object/situation almost always provokes intense fear and anxiety
-fear is out of proportion with actual danger
-causes significant distress/impairment
-still go to great lengths to avoid phobic objects or endures with great distress
specific phobia
12 month prevalence of phobia
7-9% (one of the most prevalent)
this phobia has an entirely different physiological response (drop in blood pressure and heart rate)
-may have strongest heritability
-unique susceptibility to fainting
blood-injury-injection phobia
phobia of public transportation or enclosed placees (ex. planes)
situational phobia
phobia of events occurring in nature (ex. heights, storms)
natural environment phobia
phobia of animals and insects
animal phobia
these phobias do not fit into the other categories (ex. fear of choking, vomiting, clowns, etc.)
other phobias
is direct conditioning a cause of phobia?
yes
is experiencing a panic attack in a specific situation a cause of phobia?
yes
true or false: observing (vicarious learning) someone else’s fear is a cause of phobia
true
is information transmission (being told about danger) a cause of phobia?
yes
more likely to develop fear for certain objects - an inherited tendency to fear things that have always been dangerous to humans (ex. snakes, storms, heights)
biological and evolutionary vulerability
____ are highly effective in treating phobias
cognitive-behavioral therapies
this type of therapy builds an anxiety hierarchy, and can use counter-conditioning and modeling
-uses SUDS
exposure therapy
subjective units of distress
SUDS
marked fear/anxiety about one or more social situations in which individual is exposed to scrutiny/judgment of others
social anxiety
social anxiety is most common in ___/___ situations (ex. speaking, eating, using restroom, writing, typing)
social/performance
true or false: social situations must almost always provoke fear or anxiety for one to be diagnosed with social anxiety
true
out of proportion fear from social anxiety causes distress and impairment ; must last for ___ months or more
6 months
12 month prevalence of social anxiety
7%
are females or males slightly more represented than males? the ratio is close to ___:___
females ; 2:1
when does onset for social anxiety usually occur? majority have it onset between ___ and ___ years
adolescence ; 8 to 15 years
evolutionary vulnerability to social anxiety
evolved to fear disapproving faces
some individuals born with a shy, inhibited temperament. introverted individuals are chronically more aroused and thus need less stimulation. social/performance experiences may cause over-arousal
biological vulnerability to social anxiety
taught that social evaluation is important and/or dangerous via direct conditioning, observational learning, or information transmission
psychological factors that can cause social anxiety
4 medication treatments of social anxiety
- beta blockers
- tricyclic antidepressants
- monoamine oxidase inhibitors
- SSRI paxil
this blood-pressure medication dampens the fight or flight response, but is somewhat ineffective
-can be taken before giving a big talk
beta blockers
this medication reduces social anxiety (have to be on it for several weeks for it to be effective)
tricyclic antidepressants
this medication reduces anxiety
monoamine oxidase inhibitors
this medication is FDA approved for social anxiety disorder
SSRI Paxil
are relapse rates for social anxiety high or low following medication discontinuation?
high
are cognitive-behavioral therapies effective for social anxiety?
highly effective
what appears to be the most important component within cognitive-behavioral therapy for social anxiety disorder?
exposure portion
persistent, recurrent, and intrusive thoughts, images, or urges that one tries to resist or eliminate
-ex. “did i turn my stove off, did i turn my stove off…”
obsessions
feels intrusive and out of one’s own control. not consistent with “regular” thought content
ego-dystonic
repetitive thoughts or actions that a person feels driven to perform or according to rigid rules
compulsions
goal of compulsions
to prevent or reduce distress associated with the obsession
3 specifiers for OCD:
- good to fair insight
- poor insight
- absent insight/delusional
recognizes OCD beliefs may not be true
good to fair insight
OCD beliefs probably true
poor insight
convinced OCD beliefs are true
absent insight/delusional
12 month prevalence of OCD:
1.2%
most people with OCD are ___ (although more ___ have the disorder in childhood)
female ; males
OCD tends to be ___, especially if untreated
chronic
onset is typically in early ___ or ___ (mean age = 20)
-high comorbidity with ___ disorders
adolescence or adulthood ; tic disorders
are genetic factors a probable cause of OCD?
yes
is lower or greater neuroticism a cause of OCD?
greater neuroticism
having the thought becomes equated with the action
-ex. i thought about hitting that woman with my car - “i hit that woman with my car”
thought-action fusion
medication treatment of OCD:
clomipramine and other SSRIs benefit about ___%
60%
___ is used as a medication treatment for OCD in extreme cases
psychosurgery (lesion the brain only used in extreme cases)
is relapse common or uncommon with medication discontinuation for OCD?
common
this psychological treatment for OCD is most effective
cognitive-behavioral therapy
CBT for OCD involves ___ and ___ prevention
exposure and response prevention
requires exposure to actual or threatened death, serious injury, or sexual violence: directly experiencing events; witnessing, in person events; learning of events that occurred to close family member/friend; experiencing repeated or extreme exposure to aversive details of traumatic events
post traumatic stress disorder (PTSD)
recurrent, intrusive, involuntary memories; distressing dreams; dissociative reactions (flashbacks), intense distress at cues of events (internal or external) physiological reactions to cues
intrusive symptoms of PTSD
is the avoidance of stimuli associated with events common for those with PTSD? (memories, thoughts, feelings associated with events ; reminders of events)?
yes
inability to remember important details; exaggerated negative beliefs about oneself, others; world; distorted cognitions about cause (ex. blame), negative emotional states, diminished interest or participation in significant activities, detachment, or estrangement from others; anhedonia
negative alterations in thoughts or mood associated with PTSD
loss of ability to feel pleasure
anhedonia
irritability/anger; recklessness/self-destructive behavior; hypervigilance; exaggerated startle; sleep and concentration problems
alterations in arousal/reactivity associated with traumatic events
to be diagnosed with PTSD, disturbance must last ___ month or more
1 month
PTSD specifier:
with dissociative symptoms
2 dissociative symptoms
depersonalization and derealization
feel detached from oneself and one’s thoughts/feelings; behaviors
depersonalization
sense of unreality; experience of world as distorted, surreal, or dreamlike
derealization
lifetime prevalence vs. 12 month prevalence of PTSD
lifetime = 8.7%
12 month = 3.5%
higher rates of PTSD among
veterans, certain vocations (police, EMT), survivors of rape, combat, captivity, etc.
when do symptoms of PTSD usually begin?
within 3 months of trauma, although delayed expression is not uncommon
childhood emotional problems, other mental disorders; lower education, lower socioeconomic status, prior trauma, lower intelligence, female gender and younger age at time of trauma
risk factors of PTSD prior to trauma
severity of trauma, perceived life threat, personal injury, dissociation. for veterans, killing the enemy, witnessing atrocities, participating in atrocities
-peri trauma factors
risk factors for PTSD during trauma
psychological treatment of PTSD
cognitive-behavioral treatment involving graduated or massed imaginal exposure (re-experience event in safe, controlled environment)
___ may be effective in reducing the anxiety and panic associated with PTSD
SSRIs
4 types of depressive disorders
- major depressive disorder
- persistent depressive disorder (dysthymia)
- premenstrual depressive disorder
- disruptive mood dysregulation disorder
this depressive disorder has a longer duration, but less severe symptoms
persistent depressive disorder (dysthymia)
this depressive disorder refers to children who have a lot of temper tantrums
disruptive mood dysregulation disorder
3 bipolar and related disorders
- bipolar I disorder
- bipolar II disorder
- cyclothymic disorder
5 or more symptoms present during the same 2-week period and represent a change from previous functioning. At least one must be depressed mood or loss of interest/pleasure
-depressed mood most of day, nearly every day
-marked diminished interest or pleasure in all, or most activities
-significant weight loss when not dieting or gain or decrease/increase in appetite
-insomnia or hypersomnia nearly every day
-psychomotor agitation or retardation (observable to others)
-fatigue or loss of energy
-feelings of worthlessness or excessive/inappropriate guilt
-diminished ability to think clearly or concentrate; indecisive
recurrent thoughts of death, suicidal ideation, or attempt
-single episode - relatively unusual
-recurrent episodes (must be separated by two months during which criteria not met) - more common
major depressive disorder
recurrance of major depressive disorder is higher in ___ individuals, people whose last episode was ___, and people who have already had ___ episodes
younger ; severe ; multiple
depressed mood most of the day, more days than not, for at least 2 years (1 for children/adolescents)
-milder or fewer symptoms
2 of the following: poor appetite or overeating; insomnia or hypersomnia; low energy/fatigue; low self-esteem; poor concentration; difficulty making decisions; feelings of hopelessness
-can persist unchanged over long periods - greater than or equal to 20 years
dysthymia (persistent depressive disorder)
onset for dysthymia
early onset - before age 21
true or false: there is greater chonicity, poorer prognosis, and more comorbid diagnoses (ex. personality disorders, substance use) for dysthymia
true
in majority of cycles, 5 symptoms in final week before onset of menses; start to improve after onset of menses, minimal or absent in week postmenses
-affective lability (mood swings)
-irritability; anger; interpersonal conflict
-depressed mood; hopelessness
-anxiety; tension
-decreased interest in activities
-poorer concentration
-lethargy; lack of energy
-change in appetite and sleep
-feel overwhelmed or out of control
-physical symptoms (bloating; tenderness)
premenstrual dysphoric disorder
prevalence of premenstrual dysphoric disorder over 12 months
2.6%
treatment for premenstrual dysphoric disorder (3)
SSRIs, cognitive-behavioral therapy, birth control pill
essential feature of bipolar I disorder
occurrence of one or more manic episodes or mixed episodes (depression and mania)
-individuals typically have or will experience a major depressive episode
distinct period of elevated, expansive, or irritable mood and abnormally increased goal directed activity or energy: (1 week)
mania
to be diagnosed with bipolar I disorder, individuals must portray ___ of the following symptoms:
-inflated self-esteem or grandiosity
-decreased need for sleep
-more talkative; pressured speech
-flight of ideas; racing thoughts
-distractibility
-increase in goal-directed behavior
-excessive involvement in pleasurable activities
3 or more
average age of onset for bipolar I disorder
18 years
___% or more of individuals with 1 manic episode have recurrent mood episodes
90%
true or false: bipolar I disorder tends NOT to be chronic
false
suicide rate for people with bipolar I disorder verses the general population
15x higher for those with bipolar I
key difference between bipolar I and bipolar II
mania - bipolar I
hypomania - bipolar II
in order to be diagnosed with bipolar II disorder, individuals must
meet criteria for current or past hypomanic episode and current or past depressive episode
main difference from mania is that the symptoms aren’t severe enough to cause serious impairment or hospitalization
hypomania
true or false: individuals with BP-II usually come to treatment because of depression
-learn of hypomania later on (often from informants)
-many don’t receive BP-II diagnosis until after experiencing multiple depressive episodes
true
average age of onset for BP-II
mid 20s, but can begin in childhood
true or false: most people with BP-II progress to full BP-I
false
___% to ___% of BP-II cases progress to BP-I
5% to 15%
does BP-II tend to be chronic and impairing?
yes
is suicide risk for BP-II lower or higher than that for BP-I?
equally high
more chronic version of bipolar disorder (2 years or more; 1 if child/adolescent)
-numerous periods of hypomanic symptoms (that don’t meet full criteria for hypomania) and depressive symptoms (that don’t meet the criteria for major depression)
-manic or depressive mood states are present for at least half of the time (without remitting for greater than 2 months)
cyclothymic disorder
additional defining criteria for mood disorders: symptom specifiers
tense; restless; worry; catastrophic thoughts; concerns for one that will lose control
anxious distress
additional defining criteria for mood disorders: symptom specifiers
symptoms of mania or hypomania during depressive episodes (ex. grandiosity; more talkative; increased energy)
mixed features
additional defining criteria for mood disorders: symptom specifiers
mood reactivity, weight gain/appetite increase, hypersomnia, sensitivity to rejection
atypical
additional defining criteria for mood disorders: symptom specifiers
near absence of pleasure; not reactive to pleasurable stimuli; profound despair, symptoms worse in the morning; EMAs (early morning awakenings); anorexia or weight loss; guilt
melancholic
additional defining criteria for mood disorders: symptom specifiers
absence of movement - very serious
catatonic
additional defining criteria for mood disorders: symptom specifiers
mood congruent or incongruent hallucinations/delusions
psychotic
additional defining criteria for mood disorders: symptom specifiers
depressive episodes during pregnancy or within 4 weeks of childbirth
peripartum
additional defining criteria for mood disorders: symptom specifiers
pattern of relationships between onset of depressive episodes and seasons
seasonal pattern
worldwide lifetime prevalence for major depression
16.1%
worldwide lifetime prevalence for dysthymia
3.6%
worldwide lifetime prevalence for bipolar
1.3%
worldwide lifetime prevalence for cyclothymia
<1%
___ are more likely to suffer from major depression (rate changes after puberty)
females
___ disorders equally effect males and females
bipolar disorders
does the prevalence of depression vary across subcultures?
no
relation between anxiety and depression:
most depressed people are anxious, but not all anxious people are depressed
according to family studies, the rate of mood disorders is ___ in relatives of probands
high
the person with the disorder
proband
rate of mood disorders is ___ to ___ times higher in family members of a mood disordered individual
2 to 3
according to twin studies, concordance rates are ___ in identical twins
high
according to twin studies, ___ cases have a sronger genetic contribution
severe
according to twin studies, heritability rates are approximately ___ for men and women
equal
___ regulates other neurotransmitters - most targeted by antidepressants
serotonin
-low serotonin allows other neurotransmitter to vary more substantially and thus become dysregulated (too much or too little), which can lead to mood dysregulation
-balance between neurotransmitters probably more important than absolute levels
the “permissive” hypothesis
endocrine system:
elevated ___ (“stress hormone” ; increases energy, attention ; lowered pain sensitivity)
-may impact depression by reducing the ability to develop new neurons (particularly in the hippocampus)
cortisol
hallmark of most mood disorders
sleep disturbance
enter REM sleep more quickly, experience less slow wave, “deep” sleep
relation between depression and sleep
___ is strongly related to mood disorders
-poorer response to treatment
-longer time before remission
-better predictor of initial episodes than later recurrences
stress
this theory of depression is related to a lack of perceived control over life events
the learned helplessness thoery of depression
3 depressive attributional styles:
- internal attributions
- stable attributions
- global attribution
Negative outcomes are one’s own fault
internal attribution
Believing there is little room for change
Stable attributions
Believing negative events will have wide-ranging effects
global attribution
All three attributions contribute to a sense of hopelessness but it is the hopelessness that leads to ___
depression
depressed persons engage in cognitive errors
-a tendency to interpret life events negatively
aaron t. beck’s cognitive theory of depression
4 types of cognitive errors:
- arbitrary inference
- overgeneralization
- dichotomous thinking
- personalization
this cognitive error is characterized by overemphasizing the negative
arbitrary inference
this cognitive error is characterized by applying negatives to all situations
overgeneralization
cognitive error characterized by thinking in black or white
dichotomous thinking
cognitive error characterized by believing that others’ behavior is directed at you
personalization
3 components of the depressive cognitive triad (thinking negatively about…)
- think negatively about oneself
- think negatively about the world
- think negatively about the future
females over males for mood disorders ratio of ___:___
2:1
widely used medication - examples include tofranil, elavil
tricyclic medication
this medication blocks trip take (norepinephrine and other neurotransmitters)
Tricyclic medications
How long does it take for the effects of tricyclic medications to be known
2 to 8 weeks
Are negative side effects common or not common for tricyclic medications?
(Ex. Blurred vision, dry mouth, constipation, weight gain, sexual dysfunction)
Common
True or false: tricyclic medications may be lethal in excess doses
True
Enzyme that breaks down serotonin/norepinephrine
Monoamine oxidase (MAO)
MAO inhibitors ___ monoamine oxidase
Block
Are MAO inhibitors more or less effective than tricyclics?
Slightly more
Must avoid foods containing ___ while taking MAO
Tyramine
Are MAOs frequently or rarely used?
Can they interact safely or dangerously with other medications?
Rarely ; dangerously
This medication specifically blocks reuptake of serotonin
(Ex. celexa, lexapro, luvox, Paxil, Zoloft)
Selective serotonergic reuptake inhibitors (SSRIs)
True or false: SSRIs pose no unique risk of suicide or violence
True
Are side effects common for SSRIs? (Upset stomach, insomnia, physical agitation, sexual dysfunction, or lower sexual desire)
Common
Are side effects of SSRIs generally more or less tolerable than other antidepressants?
More
A type of mood stabilizer made of common salt found in the natural environment
Lithium
Primary drug of choice for bipolar disorders
Lithium
Is lithium best suited in lowering suicide risk?
Yes
True or false: Antidepressants are often problematic for BP disorders if not paired with a mood stabilizer
True
___ are also commonly used for BP disorders (tegretol and/or depakote)
___ effective at reducing suicide
Anticonvulsants ; less
Dosage of lithium carefully monitored using ___ tests
Side effects may be ___
Blood tests ; severe
