Exam 3 Flashcards
Definition of obsession
Recurrent intrusive thought, impulse or image that causes anxiety and can’t be dismissed or put out one’s mind
common themes of obsession
Aggression, contamination, religious/blasphemy, pathological doubt/loss, sexuality, symmetry
definition of compulsion
Repetitive action (ritual) person feels compelled to do, interferes with function & cause clinical stress
what’s required for DSM diagnosis of OCD
either obsession or compulsion
OCPD
personality disorder people are perfectionist, anal, controlling, neat-freaks
ACC and OCD
dysfunction leads to sense that something is always wrong (compulsions seek to relieve this anxiety)
serotonin and OCD
increased serotonin production can calm the ACC down
exposure & ritual prevention treatment for OCD (response rate)
86% response
antidepressant treatment of OCD (response rate)
40% response
PANDAS
immune system can get so aggressive getting rid of strep, it can attack basal ganglia (attention fixation) and its inhibitory circuits; link to OCD
definition of trauma
Exposure to actual or threatened death, serious injury, or sexual violence
major symptoms of PTSD
intrusion, avoidance, altered cognition/mood, hyperarousal (SNS)
prevalence rate of PTSD
7%
heritability of PTSD
genetic vulnerability explains 30% of incidences
adverse childhood experience study
more adverse events as a child, greater chance for issues in adulthood; shorter life expectancy for 6 or more traumatic experiences
epigenetic changes
early experience of trauma changes brain and sometimes permanently sensitizes fight/flight/freeze response
predictors of PTSD
lack of social support, perceived severity, use of physical violence in trauma, DSM comorbidity
benign world schema
if a person believes the world is a safe place experiences trauma, they face a greater risk of PTSD because traumatic event shatters their worldview
psychological predictor of suicidality
hopelessness
four elements of suicide risk assessment
ideation, intent, plan, means
social contagion
increased risk of suicide after a high-profile suicide
sleep architecture and depression
increased REM sleep, decreased slow-wave sleep (repairing to brain, replenishing of resources takes place during slow-wave sleep)
Left frontal cortex and depression
reduced left frontal activity (reduced initiative/drive to achieve goals)
inflammation and depression
cortisol short-term release is anti-inflammatory, but chronic cortisol elevation- loss of cortisol sensitivity- inflammation- immune system attacks body and brain (BDNF) - shutdown
BDNF and depression
found in hippocampus, responsible for memory consolidation; long-term cortisol release destroys BDNF/forming of new neurons
CRH (master protein)
Regulates neurotransmitter function in brain, coordinates stress response
serotonin
social drive, stress response, amygdala, anterior cingulate
dopamine
pleasure/reward, goal-directed activity, initiative, motivation (also Glutamate, norepinephrine, acetylcholine)
Beck’s cognitive model of depression
negative event - automatic thoughts( involuntary negative interpretation) + logical errors (give rise to automatic thoughts; all or nothing) + schemas (core beliefs, taken as a given; I’m unlovable) - depression
SSRIs
Prozac (fluoxetine), Paxil (paroxetine), Zoloft (sertraline), Celexa (citalopram), Lexapro (escitalopram)
SNRIs
Effexor (venlafaxine), Pristiq (desvenlafaxine), Cymbalta (duloxetine)
efficacy rates of antidepressants
full recovery 25-35%, favorable response 40-60%; meds beat placebo in fewer than half of studies
omega 3
part of TLC; anti-inflammatory, has antidepressant qualities
bright light therapy
10,000 lux
environmental mutation model
humans lived in hunter gatherer conditions for 99% of human existence, modern day Kaluli people rarely get depressed; the more modern a society, the higher rate of depression
depression symptoms
depressed mood, loss of interest/pleasure in activities, change in sleep, change in weight/appetite, loss of energy, psychomotor retardation (or agitation), excessive guilt or worthlessness, concentration difficulty, suicidality
serotonin transporter gene
determines how much serotonin a person will have; Short version of allele gene: less serotonin transporters
Long=protective, short = risk (SS has highest risk)
diathesis stress model
innate vulnerability + stressors could trigger onset of depression
perimenopause
drastic hormonal changes (levels of estrogen) increase women’s likelihood of onset of depression
symptoms of mania
1 week or more of elevated/irritable mood, & increased energy/activity & 3 or more of:
Grandiosity/inflated self-esteem (e.g., may think they are God)
Decreased need for sleep (0-4 hours a night)
Pressured speech; extreme talkativeness
Racing thoughts/flight of ideas
Extreme distractability
hypomania
symptoms of mania, but less severe and no functional impairment
mixed episode
symptoms of both mania and depression
Bipolar I
mania (with or without depression history), more disabling
Bipolar II
hypomania (with depression history)
suicidality and bipolar
At least 12% (1/8) of people with bipolar- 3 times higher than unipolar depression
heritability and bipolar
strong genetic contribution: heritability quotient > 70%
divergent thinking
start with something you know and take it somewhere new, novel
convergent thinking
connecting two distinct ideas in a novel way
amygdala and bipolar
excessive reactivity (intensity of emotion)
glutamate and bipolar
mania: this neurotransmitter is out of control in the left frontal cortex more so than the right (left>right)
depression: vice versa (left
lithium
treatment for bipolar; 1 year full remission rate 30-40% (not much higher than placebo)
anticonvulsants
Lamictal, Trileptal, Topamax
atypical antipsychotics
Risperdal, Zyprexa, Seroquel, Geodon, Abilify
kindling hypothesis
Robert Post: Each episode of depression/mania is neurotoxic (brain damaging); over time, episodes get more easily triggered and more severe
Type III Bipolar
mania induced by drugs (antidepressants, stimulants, etc)
Triggers for mania/hypomania
sleep deprivation, major life events, light
Rapid cycling
4+ episodes in a year (12 month period)
ultra-rapid cycling
episodes occur every few days or weeks (multiple times per month or per week)
Percent of people with Bipolar Disorder on disability/welfare
40%
Percent of people with Bipolar Disorder unemployed
50%
Parasuicidality
self-harm behavior
What is anhedonia?
Loss of interest/pleasure in activities
Depression Sub-types
A. Melancholic (neuro-vegetative symptoms: anergia, anhedonia, diurnal mood variation)
B. Atypical (hypersomnia, weight gain, anxiety)
C. Psychotic (delusions or hallucinations – only present during depressive episode)
How many suicide attempts are lethal?
only about 1/8 suicide attempts lethal
What percent of suicides involve firearms?
Over 50% of all suicides
Reproductive hormones and depression
- Estrogen modulates serotonin fx, sharp drops –> depression
- Progesterone ~ Allopregnanolone modulates GABA -> lowers anxiety
- Testosterone –> hits multiple transmitters –> lowers anxiety & depression
Psychodynamic Model of Depression
For Freud, depression = “anger turned inward”
Personality factors: oral or anal fixation –> dependency, perfectionism
Cognitive Model of Depression
Beck’s model: depression caused by negatively biased thoughts
• Automatic thoughts – involuntary negative interpretation of events
• Logical errors – give rise to automatic thoughts (ex: “all-or-nothing thinking”)
• Schemas – core beliefs, taken as a given (“I’m a loser; No one will ever love me”)
