Exam 3 Ilardi Flashcards
What is trauma?
Exposure to death, threatened death, actual.threatened serious injury, or actual/threatened sexual violence
What are the 4 ways people experience trauma
- direct exposure
- witnessing in person
- indirect exposure through a friend/relative
- Repeated indirect exposure to aversive details of the event (first-responders, paramedics)
How long do trauma symptoms need to past to become PTSD?
one month or longer
What are the 4 symptoms of PTSD?
Intrusion
Avoidance
Altered Cognition/Mood
Hyperarousal (SNS)
What is the lifetime prevalence of PTSD?
7%
What percent of the population will experience some type of trauma?
70%
What percent of the population who experiences trauma will develop full blown PTSD?
10%
What are the two stress hormones associated with trauma?
cortisol and norepinephrine
Cortisol funciton
interference with memory consolidation
Norepinephrine function
promoting the formation of new memories
in PTSD, there is abnormally low/high levels of cortisol and NE?
Low cortisol= so no suppression of traumatic memory (you remember it)
High NE= memory imprint on trauma
What are the 6 predictors of PTSD?
- genetic vulnerability (.3)
- neurological vulnerability
- lack of social support
- perceived severity of trauma
- use of physical violence in trauma
- DSM co-morbidity (2x risk with another diagnoses)
What is the adverse childhood experience study?
evidence that childhood trauma can permanently change the brain-
3x more likely to develop PTSD.
2x more likely to become clinically depressed.
20x as likely to be suicidal
aversive event=unpleasant event
What are 5 treatments of PTSD?
medication CBT EMDR (eye movement desensitization and reprocessing) psychodymanic therapy CISD?
Medications for PTSD
antidepressant and anti-anxiety. Benzos=more likely to develop PTSD (suppresses cortisol)
CBT for PTSD
graded exposure to traumatic memories, processing trauma, and modifying beliefs (making sense of yourself and what happened by coming up with new scemas)
EMDR for PTSD
eye movement desensitization and reprocessing. exposure therapy
Psychodynamic theory for PTSD
talk therapy, gradual (freud!)
CISD?
critical incident stress debriefing
DSM 5 diagnostic criteria for major depressive disorder (9)
depressed mood loss of interest/pleasure in activities changes in sleep change in weight/appetite psychomotor retardation/agitation loss of energy excessive guild/worthlessness concentration difficulty/ making decisions thoughts of death
DMS requirements for major depressive disorder diagnoses
5 or more symptoms for two or more weeks (most of the day, everyday)
1 of the 5 must be depressed mood or loss of interest/pleasure in activities
Major Depressive episode=
unipolar symptoms (go from OK to depressed to OK) episode- major feature of MDD
What is important when storing memories?
The mood state you are in at that time
Lifetime risk prevalence of major depressive disorder
23%…..maybe closer to 50 now
how much has antidepressant use gone up since 1990?
more than tripled
How many Americans are currently taking antidepressants?
1/9 americans
Aneuresis describes what?
kids who wet the beds because of antidepressants
The risk of a child having a suicidal thought ________ when on antidepressants
doubles
gender ratio of depression
2:1 F:M (1:1 during childhood and old age)
what is the highest risk of onset age?
12-24 years (45-54 for women)=peri-menopause
What is the risk of relapse of depression? After 3 episodes?
80%…..90%
What helps buffer against risk of another depressive episode?
social support
What is the cost of depression?
$50 billion a year
Depression is the leading cause of __________ globally
disability
depression increases the risk of _________ because of inflammation
cancer
How many suicides are there per year?
30,000-40,000 (more if reported correctly…not because sparing the family)
How many suicide attempts are fatal?
1/10
how many suicides involve alcohol or other disinhibiting agents?
1/2
Why do risk of suicide increase when the person starts to get better?
their energy level is up (they have the drive to actually pull the trigger)
What are the 4 elements of suicide risk?
Ideation 50%
intent
plan
means
what is the “contract for safety”
when people make a contract with a professional they says they wont end their lives during treatment
what is involuntary commitment composed of? (3 things, but really 2)
- help person identify their reason to live
2. extenuate the cost of suicide
what is social contagion?
by seeing someone else (high profile=celebrity) commit suicide it’ll increase the risk of someone who is suicidal to actually do it
what is parasuicidality?
“self harm=seems like suicidal but isnt”
parallel to suicide but isnt. some just like the endorphins from cutting
What are the 3 types of insomnia?
Onset- trouble falling asleep
Middle- trouble staying asleep
**terminal-waking up early and wont go back to asleep
what percent of depressed individuals commit suicide?
4% 1/25
what percent of suicide victims are clinically depressed?
85%
what is the second leading cause of death in young adults and adolescents?
suicide
what is the best psychological predictor of suicide?
hopelessness
chromosome 17- serotonin transporter gene component
long or short
regulates how many serotonin transporters you have
long=more, short=less
serotonin= emotion response gene (mood), social drive, stress response
(Neurobiology) what are the 3 neurotransmitter systems involved in depression?
Serotonin, social drive
dopamine, pleasure/rewards, goals, motivation
CRH- stress response protein- master protein!
what releases CRH
hypothalamus
(neuroendocrine) what are the hormones associated with depression?(3)
cortisol= stress hormone
estrogen/progesterone, testosterone=drop in mood
inflammatory hormones= shuts down stress response
What is a supplement that bring down inflammation?
Omega 3s
frontal cortex role in depression
reduction of left frontal cortex activity
sleep with depression
less slow wave, more REM. bad. (terminal insomnia!)
Depression drug treatments: SSRIs
1. Prozac=
fluoxetine
Depression drug treatments: SSRIs
2. Paxil
paroxetine
Depression drug treatments: SSRIs
3. Zoloft
setraline
Depression drug treatments: SSRIs
4. Celexa
citalopram
Depression drug treatments: SSRIs
5. Lexapro
escitalopram
Depression drug treatments : SNRIs
1. Effexor=
venlafaxine
Depression drug treatments: SSNIs
2. pristique=
desvenlafaxine
Depression drug treatments: SSNIs
3. cymbalta
duloxetine
short term recovery of SSRIs and SNRIs
25-35%
what are the 4 ranges of depression?
mild, moderate, severe, very severe
which range of depression showed the meds beating placebo?
very severe
what is the STAR*D trial?
> 4000 patients, start on Celexa, keep trying new meds until patient recovers (<6% fully recover for 1 yr.)
Tricycles
like SSRI but lethal overdose potential
imipramine/tonofranil
anitriptyline/elavil
Atypical antidepressants (2)
Wellbutrin (bupropion)
Remeron (mirtzapine)
wellbutrin
works on reward circuits of the brain
increases anxiety
can increase seizure likelihood
St. John’s Wort
herbal antidepressant (uses hypericum-increases serotonin signaling, anti-inflammatory) cheaper than meds, less side effects
Environmental mutations=
more modern=
humans used to live in hunter-gatherer conditions for 99% of existence
higher rates of depression
Ancestral environment had less stress/depression because of these built in anti-depressant factors (6)
- aerobic exercise-goals (serotonin and BDNF)
- omega 3 fatty acids (anti-inflammatory)
- natural sunlight(vitamin D, reset body clock)
- sleep (8hr target)
- social connectivity/community (no cell phones)
- engaging activity vs. idle alone time (rumination)
what is the most widely used procedure for any psyc disorder?
cognitive therapy (connecting how we think about things and how we feel about them)
who invented CT? What was his research based on from other philosophers?
aaron beck
change mind=change life
cognitive modification=behavioral activation
effects of CT long and short term
50-60% short term (same as meds)
long term- a little higher
involuntary negative interpretation of events
automatic thoughts
“all or nothing” thinking, gives rise to automatic thoughts
logical errors
mental representations about our world, core beliefs
schemas
Possible side effects of antidepressants (main 4)
anorgasmia/sexual response
emotional numbing
activation syndrome(aggression)
birth defects
how more likely are people with bipolar disorder to commit suicide?
3x more likely (12%)
What is mania?
elevated irritable mood, and increased energy/activity
DSM diagnostic criteria mania
one week or more of elevated mood
(3 of these; grandiosity self esteem, decreased need for sleep, pressured speech, racing thoughts, increased goal directed activities, extreme distractibility, increase in painful activity that emits pleasure)
funcitonal impariment
hypomania
symptoms of mania, just no functional impairment
mixed episode
symptoms of both mania and depression= deadly
Bipolar=
high and low of mania and depression
Bipolar Type I
mania (with or without depression history)
Bipolar Type II
hypomania (with depression history)
Bipolar Type III
mania induced by drugs
prevalences of bipolar disorder
4%
what can trigger bipolar?
antidepressants, stimulants (psychoactive medications)
a bad life-style, sleep deprivation, light
what percent of bipolar diagnoses are originally diagnosed with unipolar depression?
> 25%
reduced life expectancy of those with bipolar disorder
9-12 years less
% of people unemployed and on disability welfare who are bipolar
50%, 40%
bipolar is an interesting link to:
creativity (divergent thinking)
bipolar heritability=
.7 highest of any psych disorder!
Causes of bipolar disorder
genetics .7 first degree relatives excessive amygdala activity (emotions) super active dopamine circuits left frontal cortex active
What is the kindling hypothesis?
episodes of bipolar/mania are neurotoxic(brain damaging)- over time they get worse, and more severe, longer, and more easily triggered (like kindling a fire- the more you add the easier it is to light up)
rapid cycling
over time episodes tend to occur more frequently together
Treatments for bipolar disorder
mood stabilizing medicines
omega 3s
magnesium
kinda psychotherapy
major mood stabilizing medicines
lithium (30-50%) naturally occurring element in springs depakote (30-50%) anticomvulsants antidepressants- equal to placebo novel antipsychotics
Magnesium significance in bipolar disorder
anti-manic, anti-anxiety, anti-insomnia
