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Psychopathology and Mental Health > Exam 2 > Flashcards

Exam 2 Flashcards

Chapter: 5, 6, 7

1
Q

Mood Disorders

A

Depression & Bipolar Disorders

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2
Q

Depressive Disorders

A
  1. Major Depressive Disorder (MDD)
  2. Persistent Depressive Disorder (PDD)
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3
Q

Components of Depression

A

Emotional

Cognitive

Somatic

Behavioral

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4
Q

Components of Depression: Emotional

A
  • Sad mood
  • Anhedonia: loss of interest or pleasure in usual activity
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5
Q

Anhedonia

A

The loss of interest or pleasure in usual activity

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6
Q

Components of Depression: Cognitive

A
  • Trouble concentrating/ easily distracted
  • Trouble making decisions
  • Thoughts of death/hopelessness about the future
  • Guilt
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7
Q

Components of Depression: Somatic

A
  • Fatigue/ heavy feeling
  • Changes in appetite (not eating, or excessive eating)
  • Changes in sleep
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8
Q

Components of Depression: Behavioral

A

Psychomotor Retardation:

  • Very slow movement or talking or processing (seen less in out-patient, more in in-patient)

Psychomotor Agitation:

  • Increased movement or mental activity
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9
Q

Major Depressive Disorder:

DSM-5 Diagnostic Criteria

A
  • 5+ symptoms present for at least 2 weeks:
    • Must Include: Sad Mood and/or Anhedonia)
  • Symptoms affect most of the day almost every day
    • 2+ weeks
  • Symptoms cause significant impairment/ distress (in daily life)
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10
Q

Persistent Depressive Disorder:

DSM-5 Diagnostic Criteria

A

Old name: Dysthymia

** PPD = Chronic condition**

Diagnostic Criteria:

  • Depressed mood more days than not for 2+ years
  • Additional 2+ other symptoms

Does not qualify if there a break in symptoms is 2+ months

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11
Q

Depression:

Course and frequency

A

Average Onset Age: early 30s

  • (decreased over last 50 years)

Course: ~50% recover within 6 months

COVID: depression rates rose dramatically among children/teens

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12
Q

Depression:

Prevalence (+ Disability Rates)

A

Prevalence:

  • ~16–20% of population experiences depression
  • women = 2x more likely be diagnosed w depression
    • differences in gender rates peak during adolescence)

Disability Rates:

  • Depression =10% of disability worldwide
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13
Q

Depression:

Etiology (causes)

A

Social Factors:

  • stressful life events

Psychological Factors:

  • Cognitive theories (ie: The Attribution Theory)

Biological Factors:

  • Heritability + Role of Neurotransmitters
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14
Q

Depression - Etiology (causes)

Social Factors

A

Stressful life events (ie: poverty)
predict Depressive Disorders

  • 42-67% of people report a stressful life event in year prior to depression diagnosis:
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15
Q

Depression: Etiology (causes)

Psychological Factors
(Attributions Theory)

A

Attributions Theory: depression can be caused or worsened by how people explain negative events and how they either attribute outcomes to internal or external causes.

Attribution Style:

  1. Internal, Stable, Global (Higher Depression Risk)
    • Internal: I failed bc I’m not smart enough
    • Stable: I’m not going to be able to keep a job or do well in school
    • Global: I’ll fail at everything I do in the future
  2. External, Unstable, Specific (Lower Depression Risk)
    • External: This was beyond my control
    • Unstable: This job was just too demanding for me right now
    • Specific: My next job will be a better fit for me
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16
Q

Depression - Etiology (causes)

Biological Factors
(heritability + brain)

A

Heritability: ~50%

Neurotransmitters:

  • Involved: Serotonin, Dopamine, Norepinephrine, and GABA
    • Variety of symptoms suggest involvement of different neurotransmitters
  • Serotonin = Leading Theory
    • low levels of serotonin cause depression
    • Research = Mixed (serotonin: likely not the only cause, but a reaction)
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17
Q

Depression - Etiology (Causes)

Cognitive Theories of Depression

A

Cognitive Theory: The way we think about events influences how react to them.

  • Automatic Negative Thoughts (about self & environment) play a central role in the development and duration of depression
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18
Q

Depression:

Relevant Brain Structures

A

Dorsolateral Prefrontal Cortex

Ventromedial Prefrontal Cortex

Anterior Cingulate Cortex

Amygdala

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19
Q

Depression - Relevant Brain Structures:

Dorsolateral Prefrontal Cortex

A

Function: Planning and executive functioning

Pattern: Decreased activity in some studies

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20
Q

Depression - Relevant Brain Structures:

Ventromedial Prefrontal Cortex

A

Function: Regulating emotion

Pattern: Increased activity in some studies

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21
Q

Depression - Relevant Brain Structures:

Amygdala

A

Function: emotional salience

Pattern: Increased activity in response to threat/negative stimuli

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22
Q

Depression - Relevant Brain Structures:

Anterior Cingulate Cortex

A

Function: motivation, emotion regulation

Pattern: Decreased activity

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23
Q

Depression:

Depression Treatment Types:

A

Talk Therapy + Medications

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24
Q

Depression - Treatment Types:

Talk Therapy

A

1. Cognitive Behavioral Therapy:

  • Behavioral Activation: Increased engagement with positive/pleasant activities (ex: exercise)
    • Engage in positive activities → Experience more pleasure → Improve depressed mood
  • Thoughts: Identify Cognitive Distortions + feelings (ex: Catastrophizing)

2. Mindfulness-Based Cognitive Therapy:

  • Incorporating Mindfulness Techniques into a Cognitive Domain.
  • Goal: Thoughts are not facts (observe don’t act)
  • Very useful in reducing relapse of depression
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25
Q

Depression: Treatment Types

Medication

A
  1. SSRIs → Selective Serotonin Reuptake Inhibitors
  2. SNRIs → Serotonin and Norepinephrine Reuptake Inhibitors
  3. Electroconvulsive Therapy (ECT)
  4. Transcranial-Magnetic Stimulation (TMS)
    • Applies a magnetic pulse to brain
    • For treatment-resistant depression
  5. Ketamine
    • Theory: Suppresses neurotransmitter activity & alters activation patterns & connectivity
    • Limited long-term research (Be Cautious)
    • Seems to require higher doses
  6. Exercise / Physical Activity
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26
Q

Depression: Treatment

Combinations & Comparisons of Treatments

A

Therapy + Medication:

*Combining the two is better than either alone by 10% – 20%
* Medications quicker, therapy longer-lasting effects

Cognitive Behavioral Therapy (alone):

  • As effective as medication for severe depression
    • CBT = more effective than medication at preventing relapse
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27
Q

Bipolar Disorder Types

A

Two Types:
1. Bipolar Disorder I.
2. Bipolar Disorder II.

_Bipolar I. _→ at least one Manic Episode

Bipolar II.→ Includes hypomanic episodes – not full manic episodes

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28
Q

Bipolar Disorder: Episode Types:

Manic Episode & Hypomanic Episode

A

Manic Episode: Mania that…

  • 1+ weeks, Most of the day, Nearly every day OR requires hospitalization

Hypomanic Episode:

  • 4+ days of clear changes in functioning/behavior BUT impairmentisn’t as significant
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29
Q

Bipolar Disorder:

DSM-5 Criteria: Mania/Manic Episode

A

Must have: both
1. Distinctly elevated or irritable mood
2. Abnormally increased activity or energy

Must have 3 of the following:

  • Increased goal-directed activity
  • Talkative/ rapid speech
  • Racing thoughts
  • Decreased need for sleep
  • Increased self-esteem
  • Distractibility
  • Excessive risky behavior
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30
Q

Bipolar Disorder:

Prevalence, Onset Age, Gender

A

Prevalence:

  • Bipolar I. → affects ~1% of population
  • Bipolar Types combined → ~ 4%

Average Onset Age: Between 18 - 22 years old

Gender:

  • Prevalence: No gender differences
  • Symptoms: Women report more depressive episodes
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31
Q

Bipolar Disorder - Suicide Risk

A

~ 15% of people with a diagnosis die by suicide

25% report suicide attempts

> 50% report suicidal ideation in the past 12 months

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32
Q

Bipolar Disorder:

Biological - Gene’s

A

Heritability = high.
* Ranges from 70-90% heritability

Shares genetic risk factors with schizophrenia and MDD

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33
Q

Bipolar Disorder: Etiology (causes)

Biological: Brain + Genetics

A

Heritability = high.
* Ranges from 70-90% heritability

Genetics → Shares genetic risk factors with Schizophrenia and MDD

Brain:

  • Reduced Volume: Prefrontal, & Limbic Structures
  • Increased Activation: emotion regions (amygdala + striatum)
    • increased response to high rewards
  • Mania → Hypersensitivity to dopamine receptors
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34
Q

Bipolar Disorder:

Reward Sensitivity

A

Reward Sensitivity: How motivated/excited a person is to obtain a reward

  • increased response to reward cues
  • Reward Sensitivity: Predicts BP onset & severity of symptoms
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35
Q

Bipolar Disorder:

Goal Striving

A

Goal Striving: Increased pursuit of extreme goals

  • Ie: if you do this thing you will win a million dollars
  • Atypical Goal Striving → Predicts future Mania symptoms & onset of BD
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36
Q

Bipolar Disorder: Treatments

A
  1. Medication: 1st line of treatment
  2. Talk Therapy: very useful when paired with medication
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37
Q

Bipolar Disorder Treatments: Medication

A

Medications:

  • Mood stabilizers
  • Anticonvulsants
  • Antipsychotics

Mood Stabilizer: Lithium

  • Very effective Mood Stabilizer
    * 1/3 of patients = dramatic improvement
    * 1/3 = some improvement
    * 1/3 = no improvement
  • Protective Against Suicide

Antidepressants = Risky Meds:

  • Potential to trigger Mania
    * BUT helpful when paired with Mood Stabilizers to prevent triggering mania

Risky Behaviors: Medication non-compliance is high in BD

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38
Q

Bipolar Disorder Treatments: Talk Therapy

A
  1. Psychoeducation & Family-Focused Education
  2. Social Rhythms Therapy
    • Create Routines + Life Charts to help regulate mood (ie: sleep)
    • Life Carting: Identifying personal patterns & triggers
  3. Goal Regulation
    • Break down large goals into smaller steps (goal pacing)
  4. Behavioral Activation
    • use it carefully start small, build up
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39
Q

Bipolar Disorder: Art & Creativity

A

Bipolar Disorder: x10 more prevalent in artists

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40
Q

Suicide: Who is affected?

A

Experience that cuts across disorders

  • ie: bipolar disorder, schizophrenia, depression, substance abuse, anorexia
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41
Q

Suicide: Prevalence

A

Suicide is the 11th leading cause of death

  • 2nd leading cause in ages: 10 - 35 years old
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42
Q

Suicide: Gender Differences

A
  • Men ~4x to commit suicide
  • Women are more likely to attempt suicide
  • Highest death rates in White Men
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43
Q

Suicidal Thoughts

A

Adolescents:

  • 24% of high school girls and 15% boys have serious suicidal thoughts
  • Most students that had suicidal thoughts did not act on them
  • more common in people with depression
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44
Q

Suicide:
Social & Psychological Influences

A

Social Influences:

  • Economic recessions
  • Media reports of suicide
  • Social Isolation
  • Access to means

Psychological Influences:

  • Difficulty with problem-solving
  • Hopelessness
  • Impulsivity
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45
Q

Suicide: Treatments

A
  1. Safety Protocols preventative
    • Hospitalization
    • Means Restriction (decrease access to lethal things)

2: Evidence-Based Treatments
* Dialectical Behavior Therapy (DBT)
* Cognitive Therapy for Suicide Prevention (CT-SP)

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46
Q

Suicide: Preventing Suicide

A
  1. Social / Environmental Prevention:
    • Healthcare access + Government programs
  2. Reduce stigma of mental illness
  3. Treat the associated mental health disorder
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47
Q

Anxiety:

The 5 CORE Anxiety Disorders

A
  1. Specific Phobias
  2. Social Anxiety Disorder (SAD)
  3. Generalized Anxiety Disorder (GAD)
  4. Panic Disorder
  5. Agoraphobia
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48
Q

Anxiety: Fear vs. Anxiety

A

Fear:
* Present focused: response to immediate danger/threat
* Intensity builds quickly

**Anxiety: **
* Future focused: anticipate and prepare
* ongoing feeling/worry of anticipation
* Example: Thinking about an upcoming project that’s due

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49
Q

Anxiety:

The Yerkes-Dodson Law: Inverted U-Model

A

There is an optimal level of arousal (stress) that maximizes performance

  • Low arousal = low performance
  • Moderate arousal = Optimal Performance
  • High arousal = declining performance
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50
Q

Anxiety: (fear/anxiety)

“Normal” to “Disordered”

A

Disordered when…

  1. Symptoms are pervasive and persistent
  2. It involves excessive avoidance
  3. It causes significant distress and impairment
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51
Q

Anxiety:

Comorbidity Rates

A

Internal:

  • > 50% of ppl with one anxiety disorder meet criteria for another anxiety
    disorder

External:

  • 75% meet criteria for another psychological disorder
  • 60% also have depression
52
Q

Anxiety: Prevalence

A

Anxiety Disorders = one of the most common mental disorders

BUT

  • only ~25% of people who qualify for diagnosis seek treatment (so estimates are likely off)
53
Q

Anxiety Disorders: Specific Phobia

A

Textbook Definition: Persistent, irrational, narrowly defined fears that are associated with a specific object or situation.

DSM-5 Definition: Intense, persistent fear of a specific object or situation that is excessive or unreasonable.

54
Q

Anxiety Disorders: Specific Phobia

DSM-5 Diagnostic Criteria

A
  • Immediate fearful response to phobia exposure
  • Avoidance / Endured w intense Distress
  • Persistent fear, anxiety, & avoidance: 6+ months
  • Affects daily life
55
Q

Anxiety Disorders: Specific Phobia

Prevalence

A
  • ~12% of the general population (may be an underestimation)
  • 3x more common in women
56
Q

Anxiety Disorders: Specific Phobia

Facts (course, age, comorbidity)

A
  • Chronic – phobias don’t usually go away with treatment
  • Age of onset varies widely
  • Often comorbid with other specific phobias
57
Q

Anxiety Disorders: Specific Phobia

Etiology (Causes)

A

Evolutionary Adaptation - being scared helped protect us from harm

Classical Conditioning - When a stimulus is paired with something scary, we can become conditioned to fear the stimulus.

  • ie: Baby Albert wasn’t scared of the Rat, but when it was paired with a load noise (feared stimulus) → the baby became conditioned to fear the Rat
    • phobia translated
58
Q

Anxiety Disorders: Specific Phobia

Treatments

A

Medications – NOT recommended

  • Meds = Short-Term Solution (can become a “safety behavior”)
  • Benzodiazepines = addictive & short-term solution
  • Beta Blockers = not addictive, but are short-term solutions

Cognitive Behavioral Therapy (CBT) –- Highly Effective and Quick!

  • Exposure therapy
    • In-vivo exposure (real life exposure)
    • Imaginal exposure
      Levels of exposure, slowly increase (ie: level 1 = room filled with dog toys, level 10 = petting a dog)
59
Q

Anxiety Disorders: Social Anxiety Disorder
(aka: Social Phobia)

Definition

A

DSM-5 Definition: “Fear or anxiety specific to social settings, in which the individual feels noticed, observed, or scrutinized.”

  • Social Anxiety Disorder = ALMOST identical to Specific Phobia definition in DSM-5
60
Q

Anxiety Disorders: Social Anxiety Disorder

DSM-5 Diagnostic Criteria

A
  • Fear of social rejection (and that others will notice your anxiety)
  • Social interaction cause distress
  • Social interaction is avoided or endured with intense anxiety/distress
  • Fear and anxiety are disproportionate to the situation

_KEY COMPONENT: Fear of Evaluation_

61
Q

Anxiety Disorders: Social Anxiety Disorder

Prevalence

A
  • ~12% of the general population
  • Slightly higher rates in women
62
Q

Anxiety Disorders: Social Anxiety Disorder

Facts (course, age, comorbidity, impairment)

A
  • Chronic – doesn’t usually go away with treatment
  • Onset age: Adolescents – Early Adulthood
  • High comorbidity with other anxiety disorders and depression
  • Impairment Ranges: moderate to severe
63
Q

Anxiety Disorders: Social Anxiety Disorder

Treatments

A

Medication:

  • SSRIs → Very effective
    • BUT relapse rates = high when medication is stopped

Psychological Treatments:

  • Cognitive Behavioral (Preferred method of treatment by AMA)
    • ie: exposure, rehearsal, role-play in group settings
  • Social Skills Training
    • ie: Extensive modeling of behaviors
  • Attention Bias Modification Training
    • A computer-based method that helps retreain people to focus on positive stimuli instead of negative stimuli.
    • seems to help reduce anxiety (more data needed to know how long affects last)
64
Q

Anxiety Disorders: Generalized Anxiety Disorder (GAD)

Definition

A

Textbook Definition: “Excessive and uncontrollable worry about a number of events or activities, and associated with symptoms of (physical) arousal.”

65
Q

Anxiety Disorders: Generalized Anxiety Disorder

DSM-5 Diagnostic Criteria

A
  • Excessive worry at least 50%
    • Trouble controlling these worries

At least 3 of the following:

  • Restlessness or feeling “keyed up” or on edge
  • Easily fatigued
  • Difficulty concentrating or mind going “blank”
  • Irritability
  • Muscle tension
  • Sleep disturbance (falling asleep, restless sleep)
66
Q

Anxiety Disorders: Generalized Anxiety Disorder

Prevalence

A
  • Lifetime prevalence ~ 6%
  • Gender: 2x more women than men (approximately 2:1 ratio)
67
Q

Anxiety Disorders: Generalized Anxiety Disorder

Facts (course, heritability, comorbidity)

A
  • Often a chronic condition
  • Heritability ~33%
  • Comorbidity: High overlap with MDD
68
Q

Anxiety Disorders: Generalized Anxiety Disorder

Treatment

A

Cognitive Behavioral Therapy (CBD)

  • Identify, track, and challenge worries

Mindfulness Based Cognitive Therapy

  • Focus on present moment
  • When mind wanders to ‘what ifs’, gently bring it back to present
  • Relaxation strategies
  • Identifying thoughts + emotions remembering anxieties aren’t facts
  • Self-compassion

Medications
* SSRIs
* Benzos – not a good solution

69
Q

Anxiety: Generalized Anxiety Disorder vs. Major Depression Disorder

GAD symptoms vs. MDD Symptoms)

A

Big Differences:

  • GAD = Big worries + Trouble controlling worries
  • MDD = Sad Mood + Anhedonia (difficulty experiencing pleasure)
70
Q

Anxiety Disorders: Panic Disorder/ Panic Attack

Definition

A

DSM-5 (in class) Definition: “A sudden onset of intense apprehension, terror, and/or feelings of impending doom, peaks quickly (10 minutes)”

71
Q

Anxiety Disorders: Panic Disorder

DSM-5 Diagnostic Criteria

A
  • Recurrent, unexpected panic attacks
  • Persistent worry about having another panic attack
    • or about the consequences of another attack (losing control, having heart attack, “going crazy,” etc.)
  • Significant change in behavior because of/related to attacks (ie: avoidance)
  • Can occur with or without Agoraphobia (The Fear of being in a situation difficult to escape or receive help)
72
Q

Anxiety Disorders: Panic Attack

Symptoms

A

Physical Symptoms:

  • shortness of breath, chills, chest pain, etc…

Psychological symptoms:

  • Depersonalization—feel like outside body
  • Derealization—feel like world isn’t real
  • Fear of losing control/going “crazy”
  • Fear of dying
73
Q

Anxiety Disorders: Panic Attacks / Disorder

Prevalence, gender, course

A
  • ~3-4% of the population
  • 2x as prevalent in women
  • ~20% of college students have a panic attack (most only have one)
  • Intermittent Course - goes away, but comes back
74
Q

Anxiety Disorders: Panic Attacks / Disorder

Facts

A
  • First attack usually experienced after high stress situation
  • The _response_ to panic attack determines if one develops Panic Disorder
  • Many adults who experience attack, never go on to develop Panic Disorder
75
Q

Anxiety Disorders: Panic Disorder

Treatment

A

Medication:

  • Benzodiazepines – not recommended, relapse frequent

Therapy:

  • Exposure is key – and very effective!
    • Interoceptive Exposure: exposure to physical sensations associated w panic attack
  • Goal: watch anxiety go up, cope with it, learn that you will be okay
76
Q

Anxiety:

Treatment DURING a Panic Attack

A

During a panic attack – focus on present moment

  • Focus on Breath
  • What can you see, hear, taste, smell to help bring you to present
  • wait for symptoms to lessen
77
Q

Anxiety:

Types of Exposure Therapy

A

In Vivo Exposure: Exposed to the fear in real life

Imaginal Exposure: Imagining a fear vividly

Interoceptive Exposure Triggering physical sensations to learn they are not harmful

Virtual Reality Exposure: Being exposed to the fear via VR

78
Q

Anxiety Disorders:

Agoraphobia Definition

A

The fear or anxiety about being in situations difficult to escape or receive help

79
Q

Anxiety Disorders: Agoraphobia

DSM-5 Criteria

A

Fear or anxiety about being in situations
difficult to escape or receive help

  • These situations are avoided or endured with intense fear/anxiety

Note: Often portrayed as being house bound, but it’s not necessarily the case

80
Q

Anxiety Disorders

Genes & Heritability

A
  • Anxiety = 30-60% heritable
  • Some genes may elevate risk for disorders
  • Genetic vulnerability for anxiety &
    depression may overlap
81
Q

Anxiety Disorders

Neurobiological / Relevant Brain Regions

A

Relevant Brain Regions:

  • Limbic System is Key*
    * Heightened activity in the amygdala / insula
    * Diminished activity of the prefrontal cortex in response to threatening stimuli

Neurotransmitters:

  • Serotonin and GABA are disrupted
  • Norepinephrine levels increases

Sympathetic Nervous system involved: physical symptoms

82
Q

Anxiety Disorders: Panic Disorder

Positive Feedback Loop

A

Positive Feedback Loop

When a person reacts anxiously to their physical symptoms this increases their anxiety.

83
Q

Anxiety Disorders:

Treatment Across Anxiety Disorders

A

Exposure Therapy: effective for 70–90% of clients who do it

Mindfulness/relaxation and acceptance: A promising approach

Medications: Effective, but high relapse rates when medications are stopped
(SSRIs better long-term choice)

Psychological treatments are the preferred method

84
Q

Anxiety Prevention

A

School prevention programs

  • may be helpful in reducing future anxiety symptoms / disorders BUT evidence is mixed
85
Q

Obsessive Compulsive Disorder

Definition

A

OCD = The presence of unwanted intrusive thoughts and/or habitual behaviors

86
Q

Obsessive Compulsive Disorder

DSM-5 Criteria

A

Obsessions:

  • Recurrent, persistent and unwanted thoughts, impulses or images
  • thoughts are: Intrusive, inappropriate, irrelevant/irrational
  • Thoughts are not just excessive worries about real life problems
  • Attempt to suppress, ignore thoughts or try to neutralize with some other thought /action (i.e., compulsion)

Compulsions:

  • Repetitive behaviors or mental acts that person feels driven to perform in response to an obsession or rule that must be followed

*Acts are done to reduce anxiety or distress or to prevent an obsessive thought
* they are excessive or aren’t realistically connected

87
Q

OCD Facts

Prevalence, Gender, Age of onset, Course

A

Prevalence: only ~ 1-2% of the population

Gender: Equal effect

  • Men = childhood, earlier onset, (possibly more chronic course)

Onset Age = 19.5 years

  • 25% of cases start by 14 years

Course: Chronic Condition

  • can be extremely severe and debilitating
88
Q

OCD Genetic Influence

Genetics + Comorbidity

A

Moderate genetic influences

  • Twin consistency: MZ twins = 57%, DZ twins = 22%

Comorbidity: Comorbid with mood and substance use disorders

89
Q

OCD Treatment

A

Medical Treatment:

  • SSRIs
    • Benefit about 60%
    • Relapse is common when medication is stopped (without therapy)
  • Transcranial Magnetic Stimulation (TMS)

Cognitive-Behavioral Therapy:

  • Most effective treatment for OCD
  • (ERP) Exposure and Response Prevention:
    • Very effective
      * BUT… 1/3 unwilling to begin ERP (and 1/3 who start it, drop out)

Deep brain stimulation: Only in extremely severe (treatment resistant) cases

90
Q

OCD Treatment:

Exposure & Response Prevention (ERP)

A

Set up situations that will trigger compulsions

ERP Therapy + SSRIs = Best/Most effective treatment plan

91
Q

OCD Etiology (causes)

Heritability + Brain

A

Heritability: range of 40% - 50%

Brain:

  • Frontal-Striatal Circuitry: Over activity when shown stimuli that provoke obsessions
  • Successful treatment of OCD using ERP (exposure therapy) results in less overactivity in these brain regions reduces
92
Q

OCD Cognitive Model

A

Cognitive Model: People with OCD try harder to suppress their obsessions than others.

  • White Bear Experiment: “Don’t think about the bear!!” → instruction actually makes you think about the bear WAY more.
    • Theory: Paradoxical Effect. Actively trying to suppress thoughts makes you think about them more
93
Q

OCD Psychodynamic Model

A

Obsessions/Compulsions come from unconscious conflict you are trying to suppress

94
Q

Trauma Related Disorders:

A
  1. Post-traumatic stress disorder (PTSD)
  2. Acute stress syndrome
95
Q

Dissociative Disorders

A
  1. Dissociative Amnesia
  2. Dissociative Fugue
  3. Dissociative Identity Disorder (aka Multiple Personality Disorder)
96
Q

Post-Traumatic Stress Disorder

Definition, Cause, & Symptoms

A

PTSD Definition: Recurring symptoms of numbing, re-experiencing, and hyperarousal following exposure to a traumatic stressor.

Cause = Exposure to trauma

Symptom Domains:

  1. Intrusive Memories
  2. Avoidance
  3. Negative changes in mood and thoughts
  4. Changes in physical / emotional reactions
97
Q

PTSD: What is Trauma?

DSM-5 Definition of Trauma

A

DSM-5 Trauma Definition: “Exposure to actual or threatened death, serious injury or sexual violence.”

98
Q

PTSD Symptom Domains:

Intrusive Memories

A

PTSD Symptom: Intrusive Memories

Unwanted memories of traumatic events, flashbacks or nightmares.

  • memories that cause intense discomfort in response to reminders of trauma
99
Q

PTSD Symptom Domain:

Avoidance

A

PTSD Symptom: Avoidance

Avoiding reminders of the trauma:

  • Internal Avoidance: Memories, thoughts or feelings
  • External Avoidance: People, places, activities
100
Q

PTSD Symptom Domain:

Negative Changes in Mood & Thoughts

A

PTSD Symptom: Negative Changes in Mood & Thoughts

  • Decreased Interest & Pleasure
  • Negative thoughts about self & others
  • Trouble recalling aspects of the trauma
101
Q

PTSD Symptom Domain:

Changes in Physical / Emotional Reactions

A

PTSD Symptom: Changes in Physical / Emotional Reactions

  • Irritable
  • Reckless or self-destructive behavior
  • Hyper vigilance
  • Exaggerated startle response
  • Trouble concentrating
  • Sleep disturbance
102
Q

Acute Stress Disorder

(Definition + Issues

A

Definition: Just like PTSD, but symptoms only between 3 days – 1 month

Issues w Diagnosis: Are we pathologizing/stigmatizing a common, short-term response to serious trauma? Is this harmful?

103
Q

PTSD Prevalence & Course

A

Prevalence: ~7%

  • Women = 2x more likely as men to develop ptsd
    • but men are more likely to be exposed to trauma)

Course: ~ 33% report symptoms 10 years later

104
Q

PTSD Most Common Traumas

A

Most common traumas:

  • Sexual assault
  • Accidents (man-made and natural)
  • Combat
105
Q

PTSD Comorbidity

A

Commonly Comorbid With:

  • other anxiety disorders
  • depression
  • substance abuse
106
Q

PTSD Psychosocial Risks

A
  • Self-blame
  • Conditioning / Learning:
    • flashbacks triggered by cues
      reminded of trauma (result of post-trauma Fear Conditioning)
  • Avoidance / Operant conditioning
    • avoidance initially alleviates anxiety, but keeps it long term
    • The brief alleviation of anxiety makes us avoid more → Operant Conditioning (rewarded behavior)
107
Q

PTSD - Neurobiology

A

Hippocampus: Smaller in size & less activity

  • Limbic system is also important

Heritability: No reliable data for who will develop PTSD after trauma

108
Q

PTSD: Protective Factors

A
  1. Cognitive abilities – problem solving/ reasoning skills
  2. Emotional Regulation Skills
  3. Social connectedness
  4. Active Coping
109
Q

PTSD Treatments

A

a. Medication
b. Prolonged Exposure
c. Cognitive Processing Therapy
d. EMDR (Eye-movement desensitization
and reprocessing)

110
Q

PTSD Treatment (Medical)

A

Medications:

  • SSRIs
  • Benzodiazepines - often prescribed but NOT a good approach
111
Q

PTSD Treatment (Prolonged Exposure)

A

Prolonged Exposure:

  • Building up resources - Relaxation Training
  • Imagery Rehearsal - Describing Trauma in Detail
  • Exposure - Confront feared or avoided triggers
112
Q

PTSD Treatment: Cognitive Processing
Therapy

A

more tolerable than ERP bc there is no exposure

  1. Identify Problematic Beliefs
  2. Challenge them
  3. Write about impact
  4. Process Emotions
113
Q

PTSD treatment: EMDR

A

Recalling trauma memory while focusing on specific eye movements.

  • Helps the brain reprocess the memory in a way that reduces its emotional impact

not supported by evidence, but not harmful (if it makes you go to therapy, great!)

114
Q

Dissociative Disorders

A

Dissociative Amnesia – sudden gaps in memory

Dissociative Fugue sudden extensive memory loss

Dissociative Identity Disorder having multiple personalities

115
Q

Dissociative Identity Disorder (DID)

Definition + Disclaimer

A

used to be called: Multiple Personality Disorder

Definition: “Disruptions of identity characterized by 2 or more distinct personality states (alters)”

Disclaimer:

  • Controversial
  • Research is limited
  • Info comes from select peopleD
116
Q

Dissociative Identity Disorder (DID)

DSM-5 Diagnostic Criteria

A
  1. Disruptions of identity characterized by 2 or more distinct personality states (alters):
  2. Gaps in memory of events or important personal information that is beyond ordinary forgetting
117
Q

DID Terminology

(Host, Alters, Switch, System)

A

Host ⇒ the main person (the identity that keeps other identities together)

Alters ⇒ the different Identities/ States

Switch ⇒ the transition from one personality to the other

System ⇒ collection of alters

118
Q

DID - Prevalence

A

DID Prevalence: No good data (we don’t know)

119
Q

DID - Diagnostic Age

A
  • Rarely diagnosed until adulthood
  • Most receive mental health treatment for ~7 years before diagnosis
120
Q

DID - Alters

A
  • Most people have initially 2-4 alters identified when diagnosed
    • Average number of identities after diagnosis is ~10-15 different Alters
121
Q

DID - Comorbidity Rates

A

DID = High Comorbidity Rates

Comorbid with: PTST, Depression, Substance Abuse Disorders

122
Q

DID Etiology (causes)

A

Cognitive Theories: (limited research)

  1. Trauma - Experiencing severe _early childhood trauma _
  2. Socio-cognitive Model - DID is not naturally occurring but is caused by suggestion, reinforcement in therapy or society, and role-play.

Neurobiological Causes: super limited research

  • Hippocampal + Amygdala volume differences
  • Brain activation patterns?
123
Q

DID Etiology: Socio-Cognitive Model

A

Therapists Role in Development:

  • DID could be caused or enhanced by post-trauma treatment.
    • Suggestive therapy techniques might promote symptoms in vulnerable people

Media:

  • Pre Sybil = 79 DID cases → Post Sybil = thousands…
  • TikTok + YouTube → increased interest and diagnoses (self-diagnosis increase)
124
Q

DID Etiology: Brain

A

Hippocampal + Amygdala volume differences

  • PTSD has very similar Brain changes…
  • DID is highly comorbid with PTSD
    • (hard to know if DID is just related to the PTSD …?)
  • Brain activation patterns?
    • super limited research
    • most reliable info: Prefrontal
      Dysfunction
125
Q

DID Treatment - Psychodynamic Approach

A

Psychodynamic Approach:

  • Believes DID comes from trying to block traumatic events from consciousness (repress)
  • Treatment Goal: Overcome Repression

Phase approach:
1. Stabilize / gain trust (could take years)
2. Confront and process traumatic memories and emotions
3. Manage daily living – less reliance on dissociation

  • Hypnosis = can worsen symptoms*

Overall: No well-validated treatments available

Psychopathology and Mental Health (10 decks)

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