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Abnormal Pysch > exam 2 > Flashcards

exam 2 Flashcards

1
Q

What are the three major Mood Disorders

A

3 major mood disorders
Major depressive disorder
persistent depressive disorder
Bipolar disorder

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2
Q

Major depression(unipolar depression)

A

the common cold of pyschopatholgy
lifetime prevalence is 16%
twice as many women as men experience a clinical depression
age of onset is late teens to early twenties
evidence the average age of onset is decreasing(not quite sure why)
this is in all countries

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3
Q

Symptoms of Major depression

A

Sad affect(affect=mood)
loss of interest or pleasure in usual activities (anhedonia)
weight and appetite changes
forget to eat
or eat to much
sleep disturbances
early morning awakening

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4
Q

Pyschomotor changes associated with Major depression

A

Pyschomotor changes
agitated all the time
people get very slowed down in speech in movements
**THESE CHANGES ARE OBJECTIVE (people can tell these things)
Loss of energy and fatigue
feelings of worthlessness and guilt
difficulty concentrating

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5
Q

suicidal ideation associated with Major Depression (2 kinds)

A

Active-I am going to kill myself if I don’t get better
Passive-If I just didn’t wake up tomorrow that would be okay (my kids would be better off If I were not alive)

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6
Q

Frequency/ Stats about Major Depression

A

Need to have at least one of the first two five symptoms total
YOU DO NOT NEED TO FEEL SAD IN ORDER TO BE DIAGNOSED WITH DEPRESSION
For sadness to be a symptom it has to be 14 days sad most of the day
Average duration of single episode == 5-9 months

Single vs recurrent episode
85% of single episode cases later experience a second episode
4 is the median lifetime number of episodes
the median duration of a current episode is about 4-5 months
often comorbid with anxiety(60% of those that meet criteria for major depression will be diagnosed with anxiety)

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7
Q

PERSISTENT DEPRESSIVE DISORDER (new to the dsm 5)

A

combination of depressive disorder and dysthymia

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8
Q

Criteria for persistent depressive disorder

A

depressed mood most of the day for at least 2 years
average duration is 4-5 years
TWO ADDITIONAL SYMPTOMS (many of the same symptoms as major depressive disorder)
never without depressed mood for more than two months at a time

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9
Q

Why did the DSM 5 add Persistent depressive disorder as a mood disorder

A

THE NEW DIAGNOSIS COMES FROM THE CHRONICITY OF THE SYMPTOMS NOT THE NUMBER OF SYMPTOMS
YOu only need 3 symptoms for a very long time (this is worse than having 5 or 6 symptoms for only 2 months)
Tremendous overlap between dysthymia and major depression (double depression)
95% of people with dysthymia suggests that there is a lot of overlap between dysthymia and major depression so we now call it persistent depressive disorder

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10
Q

BIPOLAR SYMPTOMS

A

1% of the population is BI polar
very rare for someone to develop bipolar disorder after 40 years of age
Course-chronice (depression and mania alternate chronically)
17% of the those with bi polar attempt suicide
NO gender difference with bi polar disorder
depressive episode are shorter milder and more frequent then major depressive disorder
manic episode may last several days or several months
rapid cylcers vs slow cyclers
If you have any mania what so ever you still diagnosed with bi polar

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11
Q

SYMPTOMS OF MANIA

A

elevated or euphoric or irritable mood
extraordinary increase in activity level
3 of the following are noticeable changed
talkativeness/rapid/speech
racing thoughts
decreased need for sleep
inflated self esteem
distractibility
involvement in impulsive activities
shopping sprees
use of alcohol and drugs

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12
Q

COMORBIDTY AND MANIA

A

2/3 of those with bipolar have anxiety
1/3 report substance abuse

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13
Q

Genetic Factors for Major depression

A

2/3x greater rate of depression in the relatives of pro bands compared to controls

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14
Q

Genetic FActors for Bipolar disorder

A

8-10% of relatives have bi polar as well
67% monozygotic
DZ 19DZ

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15
Q

Genetic facts concerning unipolar depression

A

46 mz 20% dz

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16
Q

5 HTT gene in major depression

A

this is the gene that is responsible for the brains production of serotonin transporters
proteins that help serotonin cary message from one neuron to the next

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17
Q

Heritability estimates in unipolar and bipolar depression

A

37% of variance in UNIPOLAR is thought to be genetic
80-90% of variance is Bipolar is genetic

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18
Q

Catecholamine thoery

A

major depression is a result of low epinephrine eactivy
bi polar is caused by too much norepinpehrine

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19
Q

Indoleamine theory

A

both mania and depression are caused by too little serotonin activity

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20
Q

Mono amine depletion model

A

The monoamine hypothesis of depression predicts that the underlying pathophysiologic basis of depression is a depletion in the levels of serotonin, norepinephrine, and/or dopamine in the central nervous system.

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21
Q

is dperessive associated with a change in brain activity?

A

1.) amygdala scane indicate that activity and blood flow in this area is 50% greater than those with depression
somewhat elevated activity is found in the relatives of those with depression
2.) prolonged depression leads to decreases hippocampal volume
found in never depressed people who are at high risk for depression

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22
Q

NUERO ENDOCRINE SYSTEM

A

**plays an important role in regulating a persons response to stress**
recent research has focus on over activity of the HPA axis and CORTISOL
**WHEN ONE DETECHS A THREAT THE HYPOTHALAMUS signals pituitary secretes acth
acth modulates secreation of cortisol into your blood stream.

PEOPLE WHO HAVE INCREASES LEVELS OF CORTISOL ARE READY TO FIGHT OR FLEE
IN PEOPLE WITH DEPRESSION
CORTISOL LEVELS ARE OFTEN POORLY REGULATED

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23
Q

dexamethazone suppression tests

A

dexamethazon is a steroid medication most who take it show suppression of cortisol secretion
hypothalamus is fooled into think there is already enough cortisol in ones system.
50% of depressed patients show a failure of suppression in response to the DST
ONCE THEY ARE NO LONGER DEPRESSED MOST SHOW A NORMAL RESPONSE

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24
Q

BECKS THEORY

A

depression may results from the tendency to interpret everyday events in a negative way
THEY MAKE THE WORST OUT OF everything
WHen he did therapy he noticed a lot of cognitive errors in his patients

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25
Q

Becks Cognitive Errors

A

Selective perception

MAGNIFICATION

Personalization

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26
Q

Negative cognitive Triad

A

1. thoughts about self

2. world

3. future

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27
Q

3 learned helplessness theroes

A

1.) orignial learned helplessness

Attributional reformulation

3.) hopelessness depression

28
Q

1.) orignial learned helplessness

A

depression is a result of feeling helpless and lacking a sense of control

based off early dog experiments

PROBLEM: many depressed people blame themselves for their problems

29
Q

Attributional reformulation

A

explanations for events

dimensions of attributions

  1. internal vs external attributions

internal-I failed because I didn’t study enough

external I failed because she’s a bitch

  1. stabel vs unstable

stable-

  1. global vs specific

depressed people make ISG attributions

30
Q

METALSKY STUDY

A

asked intro psych students what grade to you expect on that first mid term exam

selected a sub sample who significant lower than they expected

time 1: all depressed after failing first exam

time 2: those who made SG attributions were still depressed

those who didn’t make SG were better

**showed the durability of the negative mood in those who made SG attributions

31
Q

hopelessness depression

A

focused on a specific subset of depression - hopelessness depression

bad things are going to happen to me and there is nothing I can do about it

chain of events

  1. negative life event
  2. SG attribution (place a lot of importance on this event)
  3. other cognitive factors
  4. expectation of hopelessness
  5. hopelessness depression
32
Q

RESEARCH

A

study that followed low/high risk students

high risk = rutine SG attributions

followed both groups for two years

high risk group were four times more likely to develop an episode of major depressive disorder

33
Q

Klerman and Weissman four interpersonal problem areas that may lead to major depressive disorder

A

loss

may trigger grief reaction. Children who experience death of a parent are at high risk of developing major depressive disorder as an adult

  1. interpersonal role dispute
  2. interpersonal role transition (a good social support network)
  3. interpersonal defficits (people who lack social skills,)
34
Q

GENDER DIFFERENCES IN DEPRESSION

A

no gender differences in children
gender differences emerge around 13-15
Women also tend to have more frequent and long lasting episodes
also respond less successfully to treatment options
WHY do women become more depressed?

35
Q

5 explanations for gender differences in men and womena

A

Artifact Theory

Hormone Explanation

Life Stress Theory

Lack of Control Theory

Cognitive Vulnerabilty Stress Model

36
Q

impact of marriage on depression for males and females

A

married women in traditional marriages(STAY AT HOME AND STUFF)

have higher rates of depression than either single women or married women in equal relationship

married men in traditional marriages have lower rates of depression then men who are in egalitarian marriages

Married women who work at least part time have lower rates of depression then stay at home moms (eggs in a basket theory)

if all you do is stay at home with the kids and the kids are bad you do not get a lot of satisfaction and there is no where else to get your happiness from

37
Q

artifact theory

A

women and men are equally prone to depression but clinicians dont diagnose correctly because women are much more likely to admit to feelings of sadness in our culture(its not that men are speaking up It’s really a true fact that women

38
Q

hormone explanations

A

maybe hormone changes are causing depression (period, menapuas)

research suggests that hormone changes alone are not responsible for the high levels of depression (some women do get depressed but not all during these times)

Other people criticize this as sexist

Pre menstral disforic disorder is a new diagnosis for depression around period time

39
Q

life stress theory

A

women in our society experience more stress than men do

women face more poverty

75% of those living in poverty are women

face more menial jobs(how many male house cleaners do you know?)

less adequate housing

experience more discrimination then men do

in many homes women are responsible for higher % of house work and child care

40
Q

lack of control theory

A

women may feel less control over there lives

they are more likely to be victims (attributional formulation-learned helplessness(maybe I deserve a black eye)

41
Q

cognitive vulnerability stress model(developed by Hankin and Abramson)

A

adolescents likely to become depressed when pessimistic attributional style + stressful life event

42
Q

When it comes to depression girls differ from boys in three different ways

A

girls demonstrate ISG attributions more than boys

girls show more rumination

GIRLS ACTUALLY EXPERIENCE MORE NEGATIVE LIFE EVENTS

43
Q

Synergistic Effect

A

the combination of all these is the greater than the sum of all the others

44
Q

interpersonal therapy (interpersonal theory)

A

Treatment for unipolar depression

try to improve problem solving

trying to improve communication
treating adolescents
releaves symptoms prevents relapse

45
Q

Becks Cognitive therapy

A

trying to get the person to increase pleasurable activities
Examining invalidate automatic thoughts
change distorted thinking/biases (isg attributions)

46
Q

Behavioral activation Therapy

A

increase those pleasurable activities
this one component can be effective on its own
changing the way you think about things is not necessary

47
Q

THE THREE CATS OF ANTI DEPRESSANTS

A

MAO

Tricyclis

SSRI

48
Q

MAO (monoamine inhibitors)

A

nardil, Marplan

these were the earliest anti depressants

slow down the bodies production of MAO

those who have too high levels of Norepinephrine or Serrotonin

YOU HAVE TO RESTRICT YOUR DIET (otherwise you can get high blood pressure or sudden death )

49
Q

Tricyclics

A

trofranil Elavil

developed in the 1960s drug of choice until 1990

Correct the receptors sensitivity to norepinephrine and serotonin

they tend to be more effective than MAO inhibs

(they tend to have more problematic side effects)

(dry mouth, constipation, weight gain, sexual dysfunction)

(toxic in large doses)

50
Q

SSRI (selective serotonin reuptake inhibitors

A

prozac zoloft paxil

developed 1989

currently the most prescribed

account for more than 80% of all prescriptions

not as toxic if you take it in a large dose

(problems with orgasm and lowered sexual interest)

inhibit the reuptake of serotonin into presynaptic nerve ending increase serotoning in synaptic cleft

called selective because they have no effect on the uptake of other neurotransmitters

In general 50-70% of those who take medication get better. Which medication is going to be effective for any person is completely a mystery

51
Q

New anti depressants

A

wellbutrin
no sexual side effects
activiating effect

effexor

52
Q

Which treatment is best?

A

s therapy or anti depressant the way to go
a combination of the two increases the chance of recovery by 10-20%

53
Q

pros and cons of different treatment

A

anti depressants work fast that cbt
cbt is better at preventing relapse
especially if you have done 12 weekly session you go in once a month

54
Q

Electroconvulsive therapy

A

electric current is sent through the brain creating seizure
WHy does this work
we do not know and thus this is a controversial treatment
effectiveness (its very effective for people who are severely impressed and do not respond to medication)
higher relapse rate if you do not starting taking anti depressants following ect
possible memory loss caused by ext

55
Q

Treatment for bi polar

A

lithium

we do not know why lithium works for bi polar but it is very effective. Helps about 80% of people with bi polar have fewer manic episodes as well

between 40-60% avoid recurrence completely

Risk of relapse is 28 times greater if patients stop taking lithium

Major issue is medication compliance

50% of people with bi polar do not take their medication as prescribed or they stop taking it all together (they miss the highs) the rapid thoughts and decreased need for sleep

it helps to combine lithium treatment with psychotherapy

56
Q

Obessession

A

repetive thoughts ideas impulses or images that intrude into a persons cnscionessnot in a persons control
they do not choose to do this
they realize that this obsession is senseless but they cannot get rid o these thoughts influences or images

57
Q

compulsions

A

actions that a person feels compelled to repeat again and again
engage in compulsion in order to prevent some disaster from occurring
in order for a diagnosis of OCD you need to have recurrent obsessions or compulsions
they have to be severe enough to be time consuming
need to cause distress or impairment actions that a person feels compelled to repeat again and again
engage in compulsion in order to prevent some disaster from occurring
in order for a diagnosis of OCD you need to have recurrent obsessions or compulsions
they have to be severe enough to be time consuming
need to cau se distress or impairment

58
Q

Most common obsessions

A

Symmetry
one needs to have things in a particular order
Aggressive or horrific
obsession to hurt your child
Sexual imagery Symmetry
one needs to have things in a particular order
Aggressive or horrific
obsession to hurt your child
Sexual imagery

59
Q

MOST COMMON COMPULSIONS

A

checking
people feel compeled to check that the door is locked over and over again
cleaning behaviors
include the hand washers/shower multiple times a day/
symmetry
if you have 8 magazines they need to be ordered and fanned in a certain way

60
Q

Exposure Therapy

A

let clients listen to their silly thought over and over again
people can improve from this therapy in 3-6 months

61
Q

behavioral etiology of ocd

A

compulsions are learned behaviors that are reinforced by their consequences
consequence == anxiety goes down
ex. superstitious behavior

62
Q

4 factors that may lead some to develop OCD

A
  1. depressed mood
    increased intensity of unwanted thoughts
    increase # of unwanted thoughts
  2. Strict code of acceptability
  3. Dysfunction beliefs about responsibility and harm
  4. Dysfunctional beliefs about the control of thoughts
63
Q

2 additional characteristics that people with OCD also have

A
  1. the probability BIAS
    the belief that having a thought increases the chance of the behavior occurring
  2. Morality bias
    the view that having an imoral thought is just as bad as if you had done it
64
Q

BIOLOGICAL ETIOLOGY of OCD

A

Neurotransmitters
could be increased serotonin sensitivity

Diathesis
could be some defect in the way your brain metastasizes serotonin

Some research argue that serotonin acts as a neuromodulator
its primary function is to increase or decrease the activity of other things

65
Q

Genetic etiology of ocd

A

MZ twins have higher concordance rates as DZ twins
IT HAS A GENETIC component
Brain Scan findngs

pet scans show high activity in several areas of in the brain in OCD patients
caudate nucleus and basal ganglia
thalamus
This three part make the cortical stratal thalamic circuit
THis is where primitive impulses arise
impulses goe to caudate nucleus which filters things and only allows the most powerful impulses
if the impulses reach the thalamus t

Abnormal Pysch (5 decks)

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