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exam 2 Flashcards

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1
Q

Prevalence MDD in US according to lecture

A
  • 16.2%, 2x as common in women, 3x as common in poverty
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2
Q

What to rule out when assessing depression - as discussed in the lecture-

A

Physical conditions (thyroid), Bipolar, substance induced mood disorder, biological components

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3
Q

Structured Interview and Self-Report Questionnaire for Depression

A
  • mentioned in lecture- used to assess symptoms: Structured=Hamilton Rating Scale for Depression, therapeutic session, verbal communication, can be ambiguous, self report questionnaire= Beck’s Depression Inventory II- standardized, shows deviation from norm- how do we know people are telling the truth- difficult to study because of accuracy issues
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4
Q

Major Depressive Disorder (MDD)

A
  • including symptoms of a major depressive episode- at least 1 Major depressive Episode, has experienced normal mood, can have anxiety but not hypomanic, significant distress/impairment, no other cause (medical, psychotic, substance). MDE symptoms: must have 5 for 2 weeks with depressed mood or loss of interest
    1. Depressed Mood
    2. Loss of Interest/pleasure
    3. Appetite/Weight change
    4. Sleep change
    5. Psychomostor agitation/retardation
    6. Fatigue/loss of energy
    7. Worthlessness/guilt
    8. Difficulty concentrating/indecisiveness
    9. Thoughts of Death/Suicide
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5
Q

Persistent Depressive Disorder

A
  • aka chronic depression, dysthymia, depressed mood most of the day, most days, 2 years, must have two or more of following symptoms, never without for more than 2 mos
    1. poor appetite/overeating
    2. insomnia/hypersomnia
    3. low energy/fatigue
    4. low self-esteem
    5. poor concentration/difficulty making decisions
    6. feelings of helplessness
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6
Q

Disruptive Mood Dysregulation Disorder

A
  • severe, recurrent, tantrums- 3per week, negative mood most of day, most days, present in two settings for at least 12 months, dx between 6-18, symptoms present before age 10
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7
Q

Premenstrual Dysphoric Disorder

A
  • in most menstrual cycles during past year, 5 symptoms were present in final week before menses and improved within a few days of onset. Cause significant distress or interference in functioning
    1. Mood Swings
    2. Irritability, anger, conflicts
    3. Depressed Mood/Helplessness
    4. Anxiety/on-edge
    5. Decreased Interest
    6. Difficulty Concentrating
    7. Lack of energy
    8. Changes in appetite
    9. Sleeping too much or too Little
    10. Subjective sense of overwhelmed/out of control
    11. Physical symptoms/bloating
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8
Q

Postpartum Depression

A
  • know what this is as described by the text.- 13% of women, caused by hormonal imbalance/social isolation, stress peripartum, depression/anxiety peripartum,history of depression
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9
Q

Understand CBT for depression

A

(Cognitive Therapy and Behavioral Activation Therapy). Note that these therapies have demonstrated the most empirical effectiveness in treating depression. BAT- increases activity in lateral frontal dorsal area- do fun stuff every day with a coach- Levinson, 70’s

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10
Q

Main biological treatments for depression outside of medication?

A
  • Electroconvulsive therapy, transcranial magnetic stimulation (less troublesome, but less effective), liglight therapy (seasonal- resets circadian rhythms, increased photon absorbtion, production of melatonin)
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11
Q

Classes of depression medications? Which came first? Which is most commonly used today?

A 
MAOI’s- 1957, diet restrictions, now last resort.  Work by breaking down norep, serotonin, tyramine, can spike BP.  
Tricyclics- also in 50’s, too many side effects, still used if SSRI’s don’t work.  Blocks Ach, inc Norep, serotonin. 
SSRI’s- 1980’s, block reabsorption of Seratonin
Novel Antidepressants (Wellbutrin)- work on dopamine & norep, may increase anxiety (stimulating)
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12
Q

Understand relationship between psychotropic medications, BDNF and neuroplasticity.

A
  • BDNF Protein- support growth of new neurons in the brain, depression is correlated with a decrease in the production of BDNF, antidepressants and exercise increase BDNF . Anti-depressants combined with BAT & CBT can support growth in brain areas that support happiness & motivation
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13
Q

Know the neurotransmitters implicated in depression.

A
  • deficiency of serotonin, norep
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14
Q

Define treatment resistant depression

A
  • two trials of meds don’t work. 30-60% first trial doesn’t work, 15-33% multiple interventions don’t work, 20-50% of patients are nonadherent- ECT, TMS, light tx, sleep tx, limit blue light, sleep in cool environment
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15
Q

Define Circadian Rhythm and know methods for balancing it

A
  • daily rhythm, sleep clock, can cause sleep disturbances, trigger manic episodes, tx= light box, melatonin 3 hrs before sleep- establish night ritual
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16
Q

Understand reasons behind mindfulness meditation for depression

A
  • decreases anxiety, decreases rumination about past, leads to increase in activity in left frontal lobe (related to happiness)
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17
Q

Understand Seasonal Depression and light therapy treatment

A
  • 1 ½-2 hrs daily, inc serotonin levels, increased photon absorbtion, balancing of circadian rhythm and melatonin levels
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18
Q

Know endogenous and exogenous depression as defined in the text.

A
  • exogenous (reactive) depression from reacting poorly to environmental stressors. Endogenous depression is genetically/biologically oriented- little link to environmental causes
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19
Q

Bipolar I

A
  • at least 1 manic episode (plus more is okay), rule out other disorder, may be rapid cycling or have psychotic features. Usually 3 episodes/year (more is rapid cycling), ultracycling can happen in same day, delusions/hallucinations=psych features. Symptoms: abnormally inflated/irritable mood and increased activity not caused by a substance + 3 (+4 if mood is irritable)
    1. grandiosity
    2. decreased need for sleep
    3. very talkabive/pressured speech
    4. flight of ideas
    5. distractability
    6. Increased goal-directed activity
    7. Excessive involvement in pleasurable activities that have high potential for negative consequences
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20
Q

Bipolar II

A
  • 1 hypomanic episode, 1 major depressive episode, not another disorder
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21
Q

Cyclothymia

A
  • hypomanic/depressive symptoms, no major episodes, 2 years, (1 yr in kids), significant distress/impairment, not due to other disorder
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22
Q

Know the definition of Euphoria as defined by the text.

A
  • short term intense happiness, when lingers leads to grandiosity/mania (far end of happiness/euphoria continuum)
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23
Q

Understand and be able to distinguish between manic and hypomanic episodes-

A

Manic 1 week, has distress/impairment in functioning/psychotic features
Hypomanic- 4 days, less severe, no impairment, no hospitalization, no psych features, but is a change in functioning noticeable to others

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24
Q

Understand Rapid Cycling specifier of bipolar (how many cycles/ yr compared to typical bipolar?)

A
  • typical is 3 episodes/year, more is rapid cycling, or even ultracycling
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25
Q

Neurotransmitters related to Bipolar

A
  • low serotonin & high norepinephrin
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26
Q

Bipolar medications are called?

A
  • Mood stabilizers, lithium, may be combined with anticonvulsants, antipsychotics or even antidepressants (careful not to trigger manic episode)
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27
Q

Connection between substance use and suicide?

A
  • 30% of suicides are under influence at TOD
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28
Q

What are the 3 parts involved with a professional assessment of suicide risk?

A
  • suicidal ideation (thoughts), means, intention- probably have told someone
29
Q

What is the professional response if a person is assessed to be at risk of suicide?

A

Contract, stay in communication, put a hold on plan until x, may need to intiate 5150 process

30
Q

According to the lecture, what do most people want who attempt suicide? (it is something other than wanting to die)

A

– A way to escape from current situation (cognitive distortion)

31
Q

What is considered a “cry for help” in suicide prevention? What is this an invitation to do?

A

Talking about wanting to die, feeling hopeless, trapped, a burden, worthless/lonely. Saying fatalistic things- all end soon, can’t take it anymore, etc. We should listen, address suicide openly, reduce access to means, develop safety plan, help access resources

32
Q

Know the following verbal warning signs of suicide:

A

Talking about wanting to die
Talking about feeling hopeless
Talking about feeling trapped in unbearable pain
Talking about being a burden to others

33
Q

Know the following behavioral warning signs of suicide:

A

Impulsive/ reckless behavior
Withdrawing or feeling isolated
Lack of interest in appearance and hygiene
Displaying extreme emotional/behavior changes (either suddenly much better or much worse)

34
Q

Know the 4 “tips” for suicide prevention

A
  1. Listen
  2. Ask Directly
  3. Listen for reasons for living
  4. Help the person be safe for now
35
Q

Understand developing a safety plan

A
  • accessing resources, stay in contact, get rid of means
36
Q

Define psychosis

A
  • severe impairments in perception, cognition, emotions, manifests in behavioral phenomena (delusions, hallucinations, disorganized speech)
37
Q

Schizophrenia

A
  • 2 or more for 1 month +1, 2 or 3, sx for at least 6 mos, sig decline in functioning/self care, not due to other disorders
    1. Delusions
    2. Hallucinations
    3. Disorganized Speech
    4. disorganized/catatonic behavior
    5. Negative symptoms
38
Q

Brief psychotic disorder

A
  • same sx as schiz, 1 or more sx for 1 day-1mo
39
Q

Schizophreniform

A

– 2 or more sx, 1 mo-6 mo

40
Q

Schizoaffective disorder

A
  • schizophrenia+mood episode (dep or manic), has delusions or hallucinations for more than 2 weeks in the absence of a major mood episode at some point, should have sx a majority of the time
41
Q

Delusional disorder

A
  • does not meet criteria for schiz, but has delusion(s) for more than 1 month. Other than delusion, functioning largely normal, if manic/dep episodes occur, they are brief
42
Q

Understand the three major clusters of symptoms and differences between them.

A

Positive- Delusions, hallucinations
Negative- Absence- flat affect, apathy, withdrawl, lack of pleasure
Disorganized- inappropriate reactions- disorganized speech, behavior, catatonic behavior

43
Q

Understand the difference between schizoaffective disorder and mood disorders.

A
  • psychotic episodes occur when not having a mood episode
44
Q

Generally understand the Phases of Schizophrenia. You do not need to know time periods and duration but just the general order and what happens.

A

Prodromal Phase – Days to Years
Peculiar behaviors, negative symptoms

Active Phase
Psychotic Prephase –  < 2 months
First positive symptom
Full-Blown Schizophrenia  > 6 months
Full-blown schizophrenia, many positive and negative symptoms

Residual Phase – Ongoing
After treatment. Resembles prodromal phase

45
Q

Neurotransmitters involved with schizophrenia are?

A

High Dopamine, low serotonin, GABA, glutamate

46
Q

Know the brain structures related to schizophrenia

A

dysfunction in prefrontal cortex, enlarged ventricles (loss of brain cells), esp in temporal lobe (auditory hallucinations)

47
Q

Know the following about Schizophrenia medications:

A
  • Typical - also called First Generation Antipsychotics - Intolerable side effects and only affect positive symptoms. Reduce violent behavior, block dopamine receptors
  • Atypical - also called Second Generation Antipsychotics - Less side effects. Affect positive, negative and disorganized symptoms, less relapse
48
Q

Know environmental risk factors for schizophrenia

A
  • prenatal complications- low blood flow, O2 to brain, infections. Trauma, stressful life events. Large amt of expressed emotion in family, Marijuana
49
Q

Know Milieu Therapy and Token Economy for treating psychotic disorders as described in the text.

A

Praise inpatient psychotics for self-care/positive behaviors. Token- reward these behaviors with points that can buy desired privileges

50
Q

Understand the different types of delusions

A
  • persecutory, referential- things have special meaning for me, grandiose, erotomanic, nihilistic
51
Q

Understand Substance/medication induced psychotic disorder

A
  • delusions/hallucinations, occur due to substance, cause distress/impairment, different than intoxication/withdrawal
52
Q

Generalized Anxiety Disorder

A

– most of the time, for 6+ mos, 3+ sx (1 in kids), causes impairments

1. Restlessness, easily startles
2. Easily Fatigued
3. Difficulty concentrate/mind goes blank
4. Irritability
5. Muscle tension, twitches, headaches
6. Sleep disturbances
7. Digestion issues, nausea, lightheaded, trouble breathing
53
Q

Specific Phobia Disorder

A
  • immediate fear about specific thing/situation, avoided, persistent (+6mos), caused by classical cx, observational learning, verbal instruction, genetic predisposition (resistant to extinction). Maintained through avoidance, stimulus generalization (elevators- tunnels- enclosed spaces) Treat with exposure modeling, systematic desensitization, flooding
54
Q

Social Anxiety Disorder

A
  • Anxiety about evaluation, persistent, avoids, out of proportion, 33% also dx with avoidant personality disorder
55
Q

Agoraphobia- Know the situations that bring about fear or anxiety in Agoraphobia and why they are avoided.

A
  • 2 or more of following, fear of being embarrassed/incapacitated, fear peer rejection- need companion to help them just in case, +6mos
    1. Using public transportation
    2. being in open spaces
    3. being in enclosed spaces
    4. standing in line/being in a crowd
    5. being out of the house alone
56
Q

Understand Panic Attacks

*What happens and how long they typically last.

A

-abrupt surge of intense fear, usually 4-10min- a symptom not a disorder

57
Q

Know the symptoms of a panic attack

A
  • 4 or more- increased heart rate, sweating, shaking, shortness of breath, feelings of choking, chest pain, nausea, dizzy, chills, numbness, derealization, depersonalization, fear of losing control/going crazy, fear of dying- usually happens to people who are especially physiologically aware- 1 symptom can set off attack
58
Q

Know the 2 types of panic attacks

A
  • expected and unexpected - which is required for diagnosis of panic disorder? Why?- unexpected required for dx, leads to fear of attacks, maladaptive behavior (agoraphobia), otherwise attributable to phobia disorder
59
Q

Neurotransmitters correlated with anxiety disorders.

A
  • poor fx of serotonin/GABA, extra norep
60
Q

Understand the Personality Risk Factors of anxiety disorders

A
  • behavioral inhibition (4 mos), high neuroticism, react with negative affect, type A personality types
61
Q

Know the Cognitive Risk Factors of anxiety disorders

A
  • Sustained neg beliefs about future, belief in lack of control over environment (childhood trauma/punitive), attention to threat, negative self-eval (social anx disorder), Borkovec’s cognitive model- worry reinforced b/c distracts from negative emotions
62
Q

Understand how classical conditioning and observational learning are causes of phobias

A

.- rumination, lack of control, reward/punishment- generalization, etc.

63
Q

Understand the connection between panic disorders and the Anxiety Sensitivity Index.

A

– some people misinterpret normal anxiety symptoms as a sign that something is very wrong- ie “unusual body sensations scare me” “I must be having a heart attack”- cognitive factors- high score predicts panic disorder

64
Q

Know psychological treatments of anxiety

A
  • Relaxation training, CBT- challenge & modify negative thoughts, increase ability to tolerate uncertainty, worry only during scheduled times, focus on present moment (mindfulness), phobias are maintained due to avoidance, stimulus generalization, panic control therapy- somatic symptoms in safe environment- learn to cope
65
Q

Understand Systematic desensitization and flooding for treating phobias

A
  • works through hierarchy in imagination while maintaining relaxation, then confronts real stimulus- anxiety & relaxation are incompatible. Flooding just face it and eventually anxiety recedes
66
Q

Understand Panic Control Therapy

A
  • exposure to somatic symptoms in safe environment, use of coping strategies to control sx (ie deep breathing, relaxation)
67
Q

What is Selective Mutism (to be covered on 3/23 - see PowerPoint)

A
  • consistent failure to speak in social situations in which there is an expectation, children,
68
Q

What is Separation anxiety disorder as described by the text.

A
  • children, last at least 4 wks, fear of separation from PCG, impacts normal functioning, must be developmentally inappropriate, fear of sleeping alone, nightmares about separation, may display tantrums or physical symptoms (stomachache)

Abnormal Psychology (6 decks)

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