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Adult Psychopathology > Exam 2 > Flashcards

Exam 2 Flashcards

1
Q

A Dissociative Disorder Is

A
  • Characterized by dissociatio/ splitting off of a person’s memory or personality from consciousness
  • Declines with age
  • High rates in prostitutes, exotic dancers, and male sex offenders
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2
Q

Assessment of Dissociative Amnesia

A
  • Inability to recall important PERSONAL information (too extensive to be explained by ordinary forgetfulness
  • Not due to head injury, drugs, sleepwalking, malingering
  • Claimed in 30-40% of homicide cases
  • High hypnotizability
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3
Q

Features of Dissociative Amnesia

A
  • Uncommon (often in adolescent and young females, and in young men during wartime)
  • Sudden onset
  • Memory recovery occurs within 24hrs (40%) to 5 days (75%)
  • Amnesia usually limited to certain time period surrounding psychological, traumatic event (Amnesia for all events is or everything since traumatic event is rare)
  • Loss of memory for personal material rather than skill memories
  • During amnestic episode there is disorientation and perplexity
  • Recovery is complete recurrences are rare
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4
Q

Etiology of Dissociative Amnesia

A
  • Follows severe psychosocial stress involving threat of injury or death
  • Psychosocially distressing knowledge is repressed
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5
Q

Treatment Dissociative Amnesia

A

Hypnosis may be useful if person wants memory recovered

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6
Q

Why might a memory not return during dissociative amnesia treatment?

A

A memory is too distressing

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7
Q

Dissociative Fugue Assessment

A
  • Sudden unexpected travel away from home, unable to recall personal information
  • Assumption of new identity (partial or complete)
  • Not due to neurological factors (sleepwalking, malingering)
  • DSM-V recategorized as subtype of dissociative amnesia
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8
Q

Features Dissociative Fugue

A
  • Very rare
  • Any age
  • Cross-cultural variations
  • Lasts only hours or days, travel is limited, personality change incomplete, occasionally lasts years
  • Continuumwith dissociative amnesia and DID
  • Recovery complete, recurrences rare
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9
Q

How rare is dissociative fugue

A

<0.2%

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10
Q

What are the cross-cultural variations of Dissociative Fugue?

A
  • Pibloktoq (Inuit)
  • Grisi Siknis (Miskito of Honduras)
  • Amok (Western Pacific)
  • Demonic Possession
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11
Q

Etiology Dissociative Fugue

A
  • Severe psychological stress preceded by depression or anxiety
  • Often during wartime or natural disasters
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12
Q

Treatment Dissociative Fugue

A
  • If spontaneous recovery does not occur, try removing repression by hypnosis
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13
Q

Jeffrey Ingram

A
  • Mystery man
  • Severe case of amnesia (dissociative fugue)
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14
Q

Edward Lighthart

A
  • Mystery man 2.0
  • No idea who he is
  • Possibly induced by trauma
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15
Q

Dissociative Identity Disorder Assessment

A
  • 2+ complex integrated personalities
  • Dominant at different times
  • 20% obvious symptoms over period of time
  • 20% rarely show signs
  • 60% have long periods of quiescence and then symtpomalogy
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16
Q

Features DID

A
  • Confused with schizophrenia
  • Very rare
  • More common in late adolescence and young adult females
  • Males average 8 identities, females 15; mode is 3
  • Different types of personalities to handle different situations
  • 70% meet criteria for BPD; high rates of mood, anxiety, somatoform, susbtance, sexual, eating, and sleep disorders
  • Dominant personality has no awareness of others (other personalities have varying degrees of awareness)
  • Unique memories
  • Many suffer from headaches
  • Most personalities tend to be younger
  • Same scores IQ test but different on personality tests
  • Personality transition sudden
  • More chronic than other dissociative disorders (rarely resolves itself)
  • Culture bound (Restricted to Canada and U.S.)
  • DID is real but problems with underdiagnosis and overdiagnosis
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17
Q

Why might DID be cultural bound

A
  • Spirit posession
  • Speaking in tongues
  • Amok
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18
Q

DID is real, but problems with underdiagnosis and overdiagnosis

A
  • Rarely asessed outside North America
  • Small number of clinicians made most of the assessments
  • Traditionally most common way of assessing and eliciting a personality was through hypnosis
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19
Q

What might inadvertently create personalities in DID?

A

Hypnosis

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20
Q
A
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21
Q

Etiology DID

A
  • More common in first degree relatives
  • 90+% report history of child abuse; 75% report physical and sexual abuse
  • Highly hypnotizable, person dissociates themselves to deal with emotionally difficult situations
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22
Q

Hypnotizability is…

A

Heritable

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23
Q

Treatment DID

A

Intensive integrative therapy
- Map personality system, determine origin, function, knowledge of each personality
- Establish internal communication among personalities and agreeing to work together
- Develop therapeutic alliance with each personality and work on specific trauma
- Therapy takes 1-2 years and only 25% achieve full integration

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24
Q

What are Psychosomatic Disorders?

A
  • Physical symptoms with singificant psycholgical distress and impairment
  • Excessive distress over real physical problems, others no physical problem
  • 30-50% of patients seen by physicians
  • ‘Somatic Symptom and Related Disorders’ in DSM-5
  • ‘Somatoform Disorders’ in DSM-IV
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25
Q

DSM-IV (Psychosomatic)

A

Somatoform Disorders

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26
Q

DSM-5 (Psychosomatic)

A

Somatic Symptoms and Related Disorders

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27
Q

Somatic Symptom Disorder Assessment

A
  • 1+ bodily symptoms causing persistent less than 6 months and excessive distress
  • Excessive thoughts, feelings, and/ or behaviours related to these symptoms
    (Uncomplicated heart attack - Unecessary impairment, and excessive experience of pain associated with ailment)
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28
Q

Somatic Symptom Disorder Features

A
  • Typically have multiple physical complaints (Pain can be the only symptom)
  • Appraise symptom as more severe despite medical reassurance
  • Common symtpoms in children are abdominal pain, headache, fatigue, and nausea
  • Can occur with physical problems
  • Excessive medical consultation and intervention (medication, surgery) usually ineffective
  • Resistant to psychological referral
  • Chronic but fluctuating
  • High comorbidity with depression and anxiety
  • 5-7% prevalence
  • More common in females, older age, lower socieconomic, less education
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29
Q

Somatic Symtpom Disorder Etiology

A
  • Significant genetic contribution (runs in families)
  • Stress
  • Lack of insight
  • Secondary reward (attention received)
  • Concurrent physical illness that sensitizes them to potential problems
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30
Q

Somatic Symptom Disorder Treatment

A
  • Difficult to effectively treat
  • CBT for psychological problems
  • Antianxiety medication and antidepressants
  • Exercise
  • Relaxation training
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31
Q

Why is Somatic Symptom Disorder Difficult to Treat?

A

Unaware of their mental health because individuals are too focused on their physical well-being

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32
Q

Why is CBT useful in Somatic Symptom Disorder?

A

To challenge irrational thoughts

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33
Q

Illness Anxiety Disorder Assessment

A
  • Preoccupation with having or getting serious illness
  • Physical symptoms usually not present or very mild
  • Fear persists despite medical reassurance
  • More commonly known as hypochondria
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34
Q

Illness Anxiety Disorder Features

A
  • Common (1-10% of adult population)
  • Equal sex ratio
  • Most common between ages 20-50
  • Excessive medical consultation and intervention that is usually ineffectvie
  • Doctor shopping, frustration with medical system common
  • Often chronic
  • High comorbidity with anxiety disorders (especially panic disorder) and depression
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35
Q

Illness Anxiety Disorder Etiology

A
  • History of adverse early experiences
  • Recent psychological stress
  • Past experience with real physical disease
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36
Q

Illness Anxiety Disorder Treatment

A
  • Difficult to treat, approach the same as somatic symtpom disorder
  • CBT useful
  • Antiaxiety medication and antidepressants
  • Exercise
  • Relaxation training
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37
Q

What are some examples of illness anxiety?

A
  • Covid-19
  • Opioid Crisis
  • Mass Shootings
  • Terror Attacks
  • Zika
  • Ebola
  • End of the World (Maya Calendar)
  • H1N1
  • Global Warming
  • West Nile Virus
  • Avian Flu
  • Monster Hurricanes
  • Mad Cow Disease
  • Severe Acute Respiratory Syndrome
  • Weapons of Mass Destruction
  • Anthrax Attacks
  • Y2K
  • Meteor Impact
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38
Q

How many babies are born in the world each week?

A

2.7 million

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39
Q

How many people die every year in the U.S.

A

3,000,000

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40
Q

How many people die in Canada every year?

A

300,000

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41
Q

Annual Deaths

A
  • Smoking
  • Obesity
  • Accidents
  • Alcohol
  • Flu and Pneumonia
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42
Q

Conversion Disorder Assessment

A
  • Motor or sensory ailment cause by psychological factors
  • Not under voluntary control
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43
Q

Conversion Disorder Features

A
  • Abnormal movements/ tremors; sensory loss (blindness, deafness); pseudoseizures; speech impediment or loss of speech; paralysis
  • No evidence of any physical problems - Symptoms do not conform to known neurological pathways
  • Indifference to symptoms in some cases
  • Transient symptoms common, persistent conversion disorder rare
  • Onset any time, common in children
  • 2-3 times more common in females, low socioeconomic groups, and cultures where expression of emotional distress inhibited
  • Comorbid with dissociative disorders, anxiety, major depression, and personality disorders
  • Cross-cultural but different symptoms: bruning hands/ feet or feeling of worms in head or ants under skin symptoms more common in Africa and S. Asia
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44
Q

Conversion Disorder Etiology

A
  • A stressful life event usually the intial causing factor
  • Having an actual physical disordr with similar features is a risk factor
  • Lack of insight, repression, and secondary reward (disability sometimes prevents person from something they do not want to do. they are not able to admit this to themselves. Repression keeps the conflict out of awareness. Symtpoms maintained by rewarding consequences of avoidance and/ or attention/ sympathy received)
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44
Q

Conversion Disorder Treatment

A
  • Remove original stressor that the person may be unconsciously avoiding
  • Eliminate secondary reward
  • Reduce stress
  • Hypnosis to remove symptom
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45
Q

What is Mass Conversion Disorder?

A
  • When a group of people develop the same set of psychosomatic
  • Much rarer
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46
Q

What is the Historical Perspective on Psychosomatic Disorders?

A
  • Psychosomatic symtpoms have changed over time reflecting societal beliefs/ concerns
  • Pseudoseizures and paralysis common conversion symptoms historically, but much less common today
  • In 1890s, coincident with interest in hypnosis, many people reported being in permanent hypnotic state
  • Neurasthenia ‘nervous exhaustion’ became popular in late 1890s and continued for several decades (one of the most common diagnoses in early 1900s, but disappeared by WWI
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47
Q

What are some modern conditions that may have replaced these historical conditions?

A
  • Irritable bowel syndrome
  • Chronic fatigue
  • Fibromyalgia
  • Sick of building syndrome
  • Chemical sensitivity
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48
Q

What is the evidence that modern conditions are psychosomatic?

A
  • Demographic profile same as conversion disorder and somatic symtpom disorder (female, single, prior history of depression)
  • These conditions have high comorbidity with depression and anxiety
  • No reliable biochemical markers
  • CBT is best known treatment
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49
Q

What is the evidence that modern conditions are physical?

A
  • Some blood flow studies have shown reductions in certain areas, especially hind brain
  • Evidence of subtle neuropsychological impairment (complex info processing speed)
  • Some subtle immunologic abnormalities
  • CBT does not cure
  • Unlike depression stringently diagnosed chronic fatigue sufferers do not return to premorbid functioning at follow-up
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50
Q

What is the number of chronic fatigue sufferers that don’t returnto premorbid functioning at follow-up?

A

<10%

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51
Q

True or false: Truth likely somewhere in the middle, and dependent on the individual case

A

True

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52
Q

Assessment Phobias

A

Unreasonable fear of a specific object or situation

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53
Q

Phobias Features

A
  • Common (7-9% prevalence)
  • Twice as common in females and highest in teenagers
  • Lower in Asia, Africa, South America; lower in older people
  • People with phobias typically have more than one
  • Most common phobias are snakes and spiders; public speaking; heights; mice; flying; insects; illness/ injury/ blood; closed spaces
  • Usually evident in childhood
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54
Q

Percentage of snakes and spiders phobia

A

41%

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55
Q

Percentage of public speaking phobia

A

26%

56
Q

Percentage of heights phobia

A

19%

57
Q

Percentage of mice phobia

A

16%

58
Q

Percentage of flying phobia

A

16%

59
Q

Percentage of insect phobia

A

11%

60
Q

Causes of Phobias

A
  • Genetic (Heritability, selected through evolution - associated with survival)
  • Environmental (Classical conditioning, observational learning, operant conditioning)
61
Q

What is operant conditioning?

A

Any behaviour followed by reward is strengthened

62
Q

Treatment Phobias

A
  • Desensitization
  • Counterconditioning (Relaxation training, working towards overcoming fear)
  • Modelling
63
Q

What is counterconditioning

A

combine desensitization with relaxation training
Expose person to picture –> Practice Deep breathing and progressive muscle relaxation –> expose person to physical obect –> DB PMR –> Get closer to object –> DB PMR –> Take object –> DB PMR –> Hold object –> DB PMR –> Practice DB and PMR

64
Q

What is modelling?

A

Watching other people desensitize or interact with the feared object

65
Q

Assessment Social Phobia

A
  • Marked as persistent fear of social or performance situations in which embarassment may occur
  • AKA social anxiety
  • Important and special type of phobia
  • Very similar to avoidant personality disorder
66
Q

Features Social Phobia

A
  • Repeated avoidance of social encounters
  • 7.1% prevalence (Canada 2022), 3.0% in 2012
  • Lower outside most western countries
  • Twice as common in women
  • Decreases with age
  • Associated with depression, poor self esteem, poor social skills
  • May result in under achievement at school, work, or socially
  • Tendency to persist into adulthood
  • Associated with alcohol problems - Due to self-medication
  • Some cultures (Japan and Korea) fears concern giving offense to others rather than personally being embarassed
67
Q

Etiology Social Phobia

A
  • Significant genetic inheritance
  • Neurobiologically more reactive nervous system
  • Often precipitated/ exacerbated by stressful events
  • Often come from close-knit overprotective families
68
Q

Social Phobia Treatment

A
  • Cognitive restructuring
  • Desensitization
  • Relaxation training - DB and PMR
  • Social skills training - Practicing eye contact, conversational skills, displaying emotional warmth, complimenting others, learning to be assertive
  • Aerobic exercise - Decreases stress hormones
  • Medication
  • Yoga
69
Q

Assessment Panic Attacks & Agoraphobia

A

Recurrent unexpected periods of intense fear and panic

70
Q

Symptoms of a panic attack

A
  • Pounding heart
  • Sweating
  • Trembling
  • Shortness of breath/ choking
  • Chest pain
  • Abdominal distress
  • Dizziness
  • Derealization
  • Fear of losing control or dying
  • Chills/ hot flushes
71
Q

Features Panic Attacks & Agoraphobia

A
  • 2-3% prevalence
  • Age of onset varies between late adolescence and mid 30s
  • 2 time as common in females
  • Cross-cultural but lower prevalence in non-Western countries
  • Agoraphobia (fear of open spaces/ being in public) develops as a result of the panic attacks
  • Can have agoraphobia without panic attacks (due to worry about potentially having a panic attack)
  • Highly comorbid with depression and other anxiety disorders
72
Q

Causes of Panic Attacks and Agoraphobia

A
  • Genetic inheritance
  • Stimulant use
  • Significant stress prior to onset is common
  • Fear of fear
  • High rates of respiratory disorders (e.g., asthma)
73
Q

Treatment of Panic Attacks & Agoraphobia

A
  • Desensitization and relaxation training - most effective (breathing into paper bag to increase carbon dioxide and make heart work faster)
  • CBT useful
  • Anti-depressants (Benzodiazepines) effective in short-term
74
Q

Generalized Anxiety Features

A
  • 5.2% prevalence Canada 2022
  • Incidence increasing 2.6% 2012
  • Twice as common in women
  • Most common in middle age
  • Marked self-consciousness
  • Excessive need for reassurance
  • Chronic
  • Frequently co-occurs with depression, other anxiety problems, alcohol dependence, psychosomatic complaints, and psychophysiological problems (Headaches, high BP, ulcers)
75
Q

Causes Generalized Anxiety

A
  • Genetic contribution
  • Neurobiological overarousal
  • Stressors
  • Overprotective families
76
Q

Treatment Generalized Anxiety

A
  • CBT and Relaxation training
  • Exercise
  • Meditation
  • Medication
  • Desensitization ineffective as there are too many fears
77
Q

Assessment PTSD

A
  • Syndrome experience by some people following exposure to traumaic event
  • Intrusive recollection
  • Avoidance
  • Persistent increased arousal
  • Complex PTSD as subtype in ICD-11
78
Q

PTSD Features

A
  • 3-4% prevalence
  • Any age
  • Much higher in certain professions (frontline workers, first responders)
  • 1/3 survivors mass shootings
  • Full onset can be immediate or take may take longer (months, years)
  • Comorbid with alcoholism, psychosomatic complaints, anxiety, depression
  • Complete recovery within 3 months in 50%
79
Q

PTSD Causes

A
  • Major stress combined with personal vulnerability
  • Most people who experience trauma do not develop PTSD
  • Certain people more vulnerable (Pre-psychological problems, amnesia after traumatic event)
80
Q

Treatment PTSD

A
  • Desensitization (difficult therapy to administer, but effective)
  • CBT
  • Relaxation training
  • Exercise
  • Meditation
  • Yoga
  • Medication (appropriate for short-term management)
  • Critical Incident Stress Debriefing - Largely inneffective
  • Better to screen individuals for dissociative symtpoms
81
Q

What drugs are appropriate for short-term management?

A

Benzodiazepines

82
Q

What is Eye Movement Desensitization?

A
  • Developed by Francine Shapiro 1987
  • Focusing on traumatic memories while engaging in side-to-side eye movement
  • Controversial about importance and mechanisms of eye movement
83
Q

What is critical incident stress debriefing?

A
  • Controversial
  • Pre-incident preparedness
  • Follow-up after incident
84
Q

Assessment OCD

A
  • Chronic intrusive obsessive thoughts, urges, or images
  • Repetitive behaviours or mental acts to try and neutralize obsessions
  • No pleasure derived
85
Q

Main Features OCD

A
  • Aggressive, sexual, and religious obsessions with checking compulsions
  • Symmetry obsessions
  • Contamination obsessions
86
Q

What are compulsions?

A

Repetitive behaviours or mental acts intended to alleviate obsession

87
Q

What are the associated features to OCD?

A

Perfectionism, intolerance of uncertainty; inflated sense of responsibility and tendency to overestimate threat

88
Q

Features of OCD

A
  • 0-1.5% prevalence
  • Equal sex ratio
  • Develops in adolescence or early 20s
  • Waxing and waning course
  • Cross-cultural
  • Highly comorbid with anxiety disorders and mood disorders; also higher prevalence of tics and tourettes
  • 25% with suicide attempts
89
Q

Causes of OCD

A
  • Genetic inheritance
  • Neurobiological manifestations
  • Obsessions cause anxiety and compulsive behaviour is to alleviate anxiety, which rewards the behaviour and worsens the obsessions
90
Q

What are the neurobiological manifestations of OCD?

A

Overactivity in orbitofrontal cortex, anterior cingulate cortex, and basal ganglia

91
Q

Treatment of OCD

A
  • Desensitization with response prevention
  • Cognitive restructuring
  • Medication
  • Transcranial Magnetic Stimulation
  • Brain Surgery (Cingulotomy)
92
Q

What is the success rate from a Cingulotomy in OCD treatment

A

25-50% success (only if severe and nothing else works)

93
Q

Body Dysmorphic Disorder Assessment

A
  • Preoccupation with imagined or minor defect in appearanc casuing significant distress or impairment
  • Preoccupation is not better accounted or by another mental disorder
94
Q

Features of Body Dysmorphic Disorder

A
  • Complaints involve imagined or slight flaws (acne, wrinkles, stretch marks, facial asymmetry, nose shape, etc.)
  • Frequent mirror checking
  • Excessive grooming and camouflage
  • Insight ranges from good to absent/ delusional
  • High levels of anxiety, social avoidance, depression, perfectionism
  • High rates of suicidal behaviour
  • Frequent cosmetic surgery
  • 2-3% prevalence, slightly higher in females
  • Age 16-17 mean age of onset. 2/3 before 18
  • Chronic
  • Cross-cultural, somewhat different concerns (e.g., Koro)
95
Q

Body Dysmorphic Disorder Etiology

A
  • High rates of childhood abuse
  • Higher in 1st degree relatives of OCD
96
Q

Treatment of Body Dysmorphic Disorder

A
  • Cognitive Restructuring
  • SSRIs
  • Cosmetic surgery (rarely helpful, bandaid treatment)
97
Q

Hoarding Assessment

A
  • Persistent difficulty parting with posessions, regardless of value
  • Animal hoarding variant
98
Q

Features of Hoarding

A
  • Excessive acquisition/ shopping commonly occurs (80-90%)
  • Excessive clutter and unsanitary conditions
  • 2-6% prevalence
  • Clinical samples mostly females, studies indicate more males
  • More common in older adults (55+)
  • Starts early in life, gets worse with time
  • Chronic
  • Highly comorbid with depression and anxiety
  • Socially isolated
99
Q

Hoarding Etiology

A
  • Significant genetic inheritance (50%)
  • Stressful events
100
Q

Hoarding Treatment

A
  • Difficult to treat
  • Cognitive restructuring or group therapy
101
Q

True or False: Medication for OCD is helpful in hoarding treatment

A

False

102
Q

Major Depression Assessment

A
  • 2 weeks of depressed mood or loss of interest/ pleasure in most activities
  • 4 additional symptoms
103
Q

Additional Symtpoms of major depression

A
  • Changes in weight or appetite
  • Sleep disturbance
  • Agitation
  • Decreased energy
  • Feelings of worthlessness or guilt
  • Difficulty concentrating or making decisions
  • Recurrent thoughts of death or suicidal ideation
104
Q

What is a sign of depression in children?

A

Irritable mood

105
Q

Subtypes of major depression

A
  • Anxious
  • Psychotic
  • Seasonal
  • Post-partum
  • Chronic
106
Q

Features of Major Depression

A
  • Twice as common in women
  • 7.6% of Canadians in 2022 past year prevalence
  • Any age, higher in people <30 and lower in people >60
  • Incidence increasing - Each generation having higher rates
  • Most people have reoccurences -1/5 patients do not remit
  • Cross-cultural prevalence in pattern variable (Nerves and headaches - Latino; Weakness/ imbalance - Asian; Heart problems - Middle Eastern)
  • Highly comorbid with anxiety and substance abuse
  • Variable course –> 40% recover within 3 months and 80% within 12 months
107
Q

Suicide

A
  • 2-9% depressed patients commit; 90% have depression or other mental health disorder
  • Peaks in late spring and early summer
  • Rates increasing past 70yrs
  • 500-600 commit suicide in Alberta annually
  • Females more likely to attempt; Males 3-4 times more likely to commit
  • Large variation between countries
108
Q

What are the only things known to be effective for suicide prevention?

A
  • Physician screening for depression
  • Removing lethal methods from home
  • Ensuring person has emergency contact during suicidal ideation
  • Treating depression and associated mental health conditions
109
Q

Suicide Risk Factors

A
  • Previous attempts
  • Suicidal ideation
  • Accompanying mental disorder
  • Accompanying substance abuse
  • History of mental health problems
  • Male
  • Hopelessness
  • Severity of depression
  • Stressful life events
  • Family history of suicide or mental disorder
  • Older than 45
  • Having a plan
  • Lethality of method
  • Child abuse
  • Living alone - No social supports
110
Q

Causes of Major Depression

A
  • Genetic
  • Environmental
  • Personality and psychology
  • Culture
  • Neurobiological
111
Q

How heritable is Major Depression?

A

40-50%

112
Q

What are some environmental stressors of Major Depression?

A
  • ACEs
  • Major Adverse Life Event
  • War/ conflict
  • Poverty/ unemployment
  • Lack of control
  • Light deprivation
  • Lack of social supports
113
Q

True or False: Religion is a protective factor for Major Depression

A

True

114
Q

True or False: Males are more likely to ruminate and females are more likely to involve in distracting activites

A

False. Women Ruminate, Men engage in distracting activities

115
Q

Depression is higher in countries with ____

A

Sendentary lifestyles

116
Q

What are some Neurobiological causes?

A
  • Prolonged stress causes a release of cortisol which has neurotoxic effects producing structural changes; hippocampus damage, changes in pre-frontal cortex, greater amgdala activation, blunted Nucleus Accumbens response
  • Neurochemical changes; decrease of neurotransmitters (serotonin, dopamine, norepinephrine, epinephrine), suppression of anterior pituitary hormones –> Lowers testosterone –> Lowers dopamine
117
Q

Hippocampus Damage causes what?

A
  • Disinhibition of HPA axis to further increase in cortisol
  • Decrease neurogenesis in hippocampus
  • Increase MAO enzymes to decrease serotonin and norepinephrine
118
Q

What are some neurobiological causes in relation to major depression?

A
  • Hormonal changes
  • Sleep problems
  • Infections
  • Diet
119
Q

Treatment of Major depression

A
  • Psychotherapy
  • Exercise
  • Light
  • Diet
  • Sleep deprivation
  • Hormone supplementation
  • Medication
  • ECT
  • TMS
120
Q

What supplements aid in treating Major Depression?

A
  • B9
  • B12
  • Vitamin D
  • Omega-3 fatty acids
  • Lowered fats
121
Q

What are some medications effective for short-term treatment of Major Depression?

A
  • SSRI (Prozac)
  • Dopamine agonists
  • Norepinephrine reuptake inhibitors
  • Serotonin/ norepinephrine reuptake inhibitors
  • Reversible inhibitors of MAO-A
122
Q

Bipolar Assessment

A
  • Formerly “manic depression”
  • Mania 3 of the following:
    (Inflated self-esteem/ grandiosity, decreased sleep, pressure of speech, flight of ideas, distractability, increased involvement in activities, increased agitation, excessive involvement in pleasurable activities with potential for painful consequences)
123
Q

Bipolar Subtypes

A
  • Mood cycling
  • Anxious
  • Psychotic
  • Seasonal
  • Post-partum
  • Chronic
124
Q

Features of Bipolar

A
  • Much less common than depression
  • Increased incidence
  • Any age; equally common in men and women
  • Peak mania occurrence in summer
  • 60-70% of time preceded by or follow by major depressive episode
  • Tends to be recurrent
  • High rates of suicide
125
Q

Percentage of how many will have another manic episode

A

90%

126
Q

Rates of Suicide for Bipolar Disorder

A

2-4%

127
Q

Prevalence of Bipolar Disorder in Canada

A

2.1%

128
Q

True or False: There is an interval between episodes that decreases with each episode, even with medication

A

True

129
Q

Causes of Bipolar

A
  • Genetic
  • Similar neurobiological mechanisms to depression
  • Common pathway precipitating manic episode (Lack of sleep, travel, new relationship, change in routine, separation)
  • Diet
130
Q

Percentage of people with reduced folate diagnosed with bipolar?

A

25%

131
Q

How heritable is Bipolar?

A

75%

132
Q

Treatment of Bipolar

A
  • Mood stabilizing medication (Lithium, anticonvulsants, antipsychotics, antidepressants)
  • Vitamins and minerals
  • ECT
  • Social Rhythm Therapy
  • Psychotherapy
133
Q

What is Lithium?

A
  • Introduced in 1960s
  • Unknown mechanism
  • 50% of patients respond, 20% have no recurrences
  • May increase chronicity of problem v.s. not taking medication
  • Regular blood tests
  • Low antidepressant effect
  • Significant side effects
134
Q

What are the side effects of Lithium?

A
  • Memory problems
  • Polyuria
  • Weight gain
  • Tremor
  • Risk of tardive dyskinesia
135
Q

What is the mechanism of Lithium?

A

Lithium ions may substitute for sodium ions, but once inside neuron, lithium not pumped out by sodium pump decreasing the likelihood of an action potential

136
Q

What is EmPowerplus?

A

Multivitamin sold by Truehope out of Raymond to aid in treatment of Bipolar

137
Q

What is Social Rhythm Therapy?

A
  • Establishing regular patterns of activity and wakefulness (reduces relapse by 33%)
  • Getting person to be alert to usual precipitating factors

Adult Psychopathology (4 decks)

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