Exam content

Question 1

classification of mental disorders

Answer 1

1) Diagnostic and Statistical Manual of Mental Disorders (DSM-5-TR) -> North America
2) International Classification of Mental and Behavioral Disorders (ICD-11, issued by WHO) -> international/Europe

Question 2

diagnostic heterogenity

Answer 2

two cases that qualify for one disorder can have no shared symptoms, sometimes opposing

Question 3

psychological abnormality

Answer 3

behaviour, speech, or thought that impairs the ability of a person to function in a way that is generally expected of them in the context where the unusual functioning occurs

Question 4

psychopathology

Answer 4

scientific study of psychological abnormality and the problems faced by people who suffer from psychological disorders

Question 5

psychological disorder

Answer 5

specific manifestation of psychological abnormality, as described by some set of criteria that have been established by a panel of experts

Question 6

mental disorder

Answer 6

often used to convey the same meaning as psychopathology, but it implies a medical rather than psychological cause

Question 7

how to define abnormality?

Answer 7

1) statistical rarity
2) personal distress
3) dysfunction
4) violations of social norms
5) diagnosis by an expert

*consider everything: usually some combination of criteria is needed to identify a person’s behaviour as abnormal

Question 8

statistical rarity

Answer 8

• assumes that abnormal psychological functioning occurs rarely
• however there are some issues:
  1) rarity doesn’t always mean disordered
  2) some examples of unusual functioning are considered advantageous (ex. genius IQ)
  3) some extremely common conditions are missed

Question 9

personal distress

Answer 9

• common of many disorders, but not all (ex. manic episodes)
• distress is also a normal part of life

Question 10

personal (harmful) dysfunction

Answer 10

• abnormal behaviour only disordered if symptoms prevent proper functioning in an area of life
• does not consider effects on other people

Question 11

violation of norms

Answer 11

• violations of societal expectations of behaviours
• some issues:
  1) criminals (not meeting diagnostic criteria for any disorder) violate norms
  2) social norms change over time and cultures (ex. homosexuality used to be part of DSM)

Question 12

diagnosis by expert

Answer 12

• abnormality is defined when diagnosticians apply criteria for disorders as specified in manuals
• experts often disagree!

Question 13

which experts can legally communicate diagnoses to the patient?

Answer 13

psychiatrists, clinical psychologists

Question 14

psychiatrist vs psychologist?

Answer 14

• psychiatrist: MD, specializes in medications
• psychologist: graduate school, focus on therapy

Question 15

other professionals in mental health field

Answer 15

psychiatric nurses, occupational therapists, counsellors, registered psychotherapists, psychiatric social workers

Question 16

prehistoric concepts of abnormality

Answer 16

• supernatural explanations for disorders, ex. evil spirits, demons
• harsh treatments: trephination (skull drilling), magic, incantation

Question 17

naturalistic explanations for psychological abnormality

Answer 17

ancient greek, persian and arabian world

Question 18

ancient greek approaches to psychological abnormality

Answer 18

1) Hippocrates: considered biology; disturbances in bodily fluids (humours) caused disorders needed to be rebalanced ex. by blood letting; wandering uterus = hysteria
2) Plato: sociocultural influences on thought and behaviour (basis of not criminally responsible aka NCR)
3) Galen: first to suggest a form of psychotherapy; sympathetic listeners

Question 19

Persian and Arabian World approaches to abnormality

Answer 19

• Quran suggested compassionate attitudes
• built asylums
• Avicenna wrote one of the first medical texts that tried to describe mental disorders, emphasizing natural causes rather than supernatural

Question 20

The Dark ages of approaches to abnormality

Answer 20

• Europe in middle ages
• extreme treatments: exorcisms, burning at stake, torture
• milder: prayer, generally caring
• usually administered by clergy
• supernatural/spiritual view
• eventually Greco-Roman thought rediscovered

Question 21

beginnings of scientific approach to abnormality

Answer 21

• pressure against supernatural accounts
• consideration that physical and psychological disorders had common (biological) causes

Question 22

development of asylums/workhouses

Answer 22

• initial: cruel conditions (shackles, harsh treatments/punishments)
• some tried to integrate with society (ex. farmwork)
• reforms due to the Mental Hygiene Movement lead to compassion, clean and comfortable environment
• however state not well-equipped, leading to overcrowding and regression to cruelty

Question 23

Mental Hygiene Movement

Answer 23

• Pinel and Rush
• desire to protect and to provide humane treatment for individuals with mental illness

Question 24

understanding abnormality through biology

Answer 24

1) heredity
2) beginning of classification
3) infection

Question 25

early heredity theories

Answer 25

- degeneration theory (Morel): deviations from normal functioning are transmitted by hereditary processes - phrenology (Lombroso): shape of the skull related to inheritance of criminality (pseudoscience, but bore idea of mental mapping)

Question 26

beginning of classification (syndroms)

Answer 26

- Kraepelin's Clinical Psychiatry: attempted to classify mental illness, grouped symptoms into syndromes - also proposed that biological causes underpin mental disorders (somatogenesis)

Question 27

infection as a cause of mental disorder

Answer 27

- Krafft-Ebing suggested that general paresis of the insane (GPI) might be result of infection - now known to be syphilis

Question 28

insulin shock therapy

Answer 28

- inject enough insulin for coma/seizure - Sakel used to treat morphine addition withdrawal

Question 29

electroconvulsive therapy (ECT)

Answer 29

- introduced by Cerletti - used to treat schizophrenia - determined to only be beneficial for depressed patients - continues to be a modern treatment for depression (in safer ways, when asleep)

Question 30

modern shock therapies

Answer 30

- DBS: deep brain stimulation for depression - VNS: vagus nerve stimulation, activates PNS - rTMS: repetitive transcranial magnetic stimulation - MST: magnetic seizure therapy

Question 31

lobotomies and LSD in Canada's history

Answer 31

- lobotomies performed despite little evidence for clear benefits - Cameron's brainwashing and LSD studies had no informed consent or ethical review

Question 32

beginnings of psychopharmacology

Answer 32

- rejection of psychological perspectives, hard turn to pure biological explanations - chlorpromazine (know this!!) was a radical antipsychotic drug - lead to rapid deinstitutionalization of patients from hospitals - communities did not have resources to support -> beginning of intersection between homelessness and mental illness

Question 33

theories of abnormal behaviour

Answer 33

psychodynamic, behavioral, cognitive, biological, cross-cultural, evolutionary, humanistic -> all work together in conjunction, some try to explain all of behaviour, some focus on particular classes or disorders

Question 34

usefulness of a theory

Answer 34

- needs to generate research and increase knowledge, does not necessarily need to be true - null hypothesis testing: theories are better when they can be disproved

Question 35

single-factor theories

Answer 35

attempt to trace origins of particular disorder back to one factor

Question 36

interactionist theories

Answer 36

behaviour is product of the interaction of a variety of factors

Question 37

aims of theories about mental disorders

Answer 37

1) explain etiology 2) identify maintenance factors (not necessarily same as etiology, ex. in phobias) 3) predict the course of the disorder 4) design effective treatments

Question 38

hypnotism and birth of psychoanalysis

Answer 38

- Mesmer: hypnosis to realign disturbed magnetic fluid in body - Charcot: hypnotism - Breuer: cathartic method (talking freely under hypnosis) - Freud: psychoanalysis (root of therapy!)

Question 39

psychodynamic perspective

Answer 39

- psychosexual stages of development: fixation at a specific stage affects behaviour and personality - 'insight' in therapy is the cure - levels of consciousness: conscious, preconscious, unconscious (controls everything, inaccessible) - levels of personality: ego, superego, id - defense mechanisms: denial, displacement, sublimation, regression, repression (most fundamental according to Freud), projection, intellectualization

Question 40

evaluation of psychodynamic perspective

Answer 40

limits 1) difficult to test empirically 2) biased measures, biased population (family members) 3) biased information collection: free association, childhood recollections, adult dreams 4) biased views implying superiority of men contributions: 1) focus on early mother-infant relationship led to attachment theories 2) unconscious thoughts may be important in prejudice and stereotypes

Question 41

behavioural theories

Answer 41

- emphasize how new behaviours are acquired through gradual/continuous process of learning - people play passive role, learning directed by environment

Question 42

traditional learning theory perspective

Answer 42

- classical conditioning - still relevant in trauma, phobias, OCD, adjustment disorders

Question 43

types of reinforcement or punishment in operant conditioning

Answer 43

- positive reinforcement: adding something pleasant - negative reinforcement: removal of unpleasant stimulus - positive punishment: adding something unpleasant - negative punishment: removing something pleasant - intermittent better than continuous

Question 44

what operant conditioning principle involves avoidance?

Answer 44

negative reinforcement

Question 45

Mowrer's two-factor theory

Answer 45

1) classical conditioning establishes aversive response 2) operant conditioning reinforces avoidance

Question 46

social learning theory

Answer 46

- importance of context and vicarious learning (via observation/inference)

Question 47

Bobo doll experiment

Answer 47

1) adults interact with doll with either kindness or aggression 2) kids act similarly to the adult they observed

Question 48

hallmarks of cognitive thoeries

Answer 48

1) thinking affects emotion and behaviour 2) thoughts can be monitored and changed 3) by altering one’s thoughts, a person will experience desired behavioural and emotional change

Question 49

cognitive-behavioural model

Answer 49

- thoughts, emotions, bodily sensations, behaviour - everything bidirectionally connected in response to environment - CBT: find and change negative loops

Question 50

rational-emotive behaviour therapy (Ellis)

Answer 50

- find maladaptive, rigid beliefs that influence behaviour and emotions - combat them through argument, criticism - this was unpleasant, and did not involve independent discovery

Question 51

Beck's cognitive theory

Answer 51

- more independent experimentation compared to Ellis (socratic learning - questions) - proposed the cognitive triad: 1) dysfunctional schemas: negative representations of ourselves and world, affects view of future 2) information processing biases: negative skew towards information gathering (self-fulfilling prophecies) -> notice and adjust to modify schemas 3) automatic thoughts: find and challenge

Question 52

third wave approaces to CBT

Answer 52

1) theory and treatment based on mindfulness: acknowledge a role for cognition but not necessarily label as bad, emphasize role of attention in distress

Question 53

humanistic and existential theories

Answer 53

1) Maslow: self-actualization 2) Rogers: person-centered

Question 54

Maslow's theories

Answer 54

- hierarchy of needs - abnormality from failure to attain self-esteem for self-actualization

Question 55

Rogers' person-centered approach

Answer 55

- saw personal experience as basis for improving the self- people can be their own therapists by listening to their own needs

Question 56

biological models

Answer 56

1) genetics and behaviour: adoption studies and twin studies to separate effects of genetics and environment 2) neurotransmitters: too little or too much (production, receptors, deactivation, re-uptake) -> can sometimes be reductionist 3) PNS (specifically ANS): overactive SNS can be phobias, anxiety, while overactive PNS has protective effect 4) endocrine HPA axis: results in release of cortisol, sensitivity implicated in depression and anxiety (chronically active)

Question 57

socio-cultural influences on behaviour

Answer 57

- stigma 1) public: typical societal response that people have to stigmatized attributes (discrimination, devaluation, negative attitudes) 2) self-stigma: internalized psychological impact of public stigma - social support, ex in PTSD - gender stereotypes: ED in women - race and poverty: minorities and poor more often victims of discrimination/prejudice

Question 58

anti-stigma campaigns in Canada

Answer 58

focus on social contact and support as a means of treatment (or at least first step)

Question 59

integrative theories

Answer 59

- all are systems theories: whole is more than sum of parts 1) diathesis-stress perspective: predisposition to disorder interacts with experience to result in disorder (commonly used to explain schizophrenia) 2) biopsychosocial model: environment, psychological response and biology all interact (DSM focus)

Question 60

reasons to classify mental disorders

Answer 60

1) better understand and identify them 2) determine what treatments work for whom and what disorder, what are most effective 3) organize treatments 4) group people with similar features for research 5) heuristic based on symptom presentation 6) make predictions about disorder development 7) provide people with support/validation for their symptoms

Question 61

the ideal diagonstic system

Answer 61

1) clusters of symptoms (predictable/meaningful) 2) etiology 3) prognosis 4) predict response to treatment 5) no overlap 6) perfect cure *4-6: not true in real systems

Question 62

assessment

Answer 62

information gathered systematically in the evaluation of a condition

Question 63

diagnosis

Answer 63

determination or identification of disease/condition, statement of that finding

Question 64

diagnostic system

Answer 64

- system of rules for recognizing and grouping various types of abnormal behaviour - provides criteria for a disorder

Question 65

characteristics of strong diagnostic systems

Answer 65

- reliability: same outcome every time - inter-rater reliability: two or more people agree on someone's diagnosis - validity (needs reliability): whether a diagnostic category describes what it is supposed to and whether it predicts accurately - concurrent validity: ability to estimate individual's present standing on factors related to the disorder, but not part of it (ex. diagnosis correlation negative attentional biases in depression) - predictive validity: ability to predict future course of development

Question 66

in/out/day-patient

Answer 66

- in: staying in hospital, usually for monitoring or safety purposes - out: normal life, go to office for appointment - day: in-between, day in hospital, but don't live there

Question 67

history on classification of mental disorders

Answer 67

1) syndromes 2) WHO's ICD 3) 1st DSM: very psychoanalytic 4) DSM-II: similar problems to first 5) DSM-II, 7th printing: homosexuality removed 6) DSM-III: some structure introduced 7) DSM-III-R: revised, removed controversial diagnoses 8) DSM-IV: disorders now required clinically significant status (dysfunction or distress) 9) DSM-IV-TR: minor revision 10) DSM-5 11) DSM-5-TR

Question 68

DSM-III

Answer 68

- multi-axis model: typical disorders, personality, medical, environment, subjective statement of functioning - atheoretical - operationally defined each disorder - polythetic orientation: people could be diagnosed without having met all criteria, just have to pass threshold - research used for first time

Question 69

cons of diagnosis in general

Answer 69

- stigmatization - loss of information (continuous spectrum reduced to labelled categories or binaries)

Question 70

stigmatization example

Answer 70

- Rosenhan study 1) faked symptoms 2) admitted to mental hospital with schizophrenia, treated with isolation, dehumanized --> so much stigma, nobody noticed they were healthy 3) stop faking, released with schizophrenia in remission

Question 71

DSM-5

Answer 71

- eliminated axis system to avoid emphasis of one over the other - sections regrouped based on disorders that co-occur - personality disorders placed on main spectrum of clinical disorders, suggests that they are amenable to change and treatment - hoarding disorder seperated - some dimensional approaches (spectrum disorders)

Question 72

issues in DSM diagnosis

Answer 72

- categorical vs dimensional approach: might have people with subthreshold symptoms that are significantly impairing --> sometimes cannot get diagnosis to get treatment approved - comorbidity: more than one disorder in the same individual, some are really commonly grouped --> lines between are arbitrary - personality disorders: half are rare, also overlap with many primary disorders --> was supposed to have dimensional approach, but half abandoned (in appendix) - gender bias/sexism (ex. symptom descriptions have gender associations) - doesn't consider stress, environment or protective factors - cultural bias, some diagnoses are culturally-bound - political criticism: diagnostic criteria important for health coverage - some panel members had financial ties to drug-industries

Question 73

solutions to problems with current diagnostic systems?

Answer 73

1) promoting dimentional systems, ex. RDOC criteria: focuses on dimensions with subconstructs that underly many disorders 2) hierarchical taxonomy of psychopathology (HiTOP): subgroups of disorders based on relationship between symptoms

Question 74

RDOC criteria groups

Answer 74

negative valence, positive valence, cognitive, social, arousal/regulation

Question 75

research methods

Answer 75

experimental, quasi-experimental, correlational, case studies, single-subject, epidemiological, inheritance/genetic

Question 76

experimental design

Answer 76

- most empirical - ideally only one variable changed to test effect of changing IV on DV - random assignment - control group - null hypothesis: assumes no relationship between two variables - ethical implications: sham treatment/waitlist --> intentionally withholding treatment

Question 77

placebo effect

Answer 77

- people receiving sham treatment still get better - control: inert medication, control for time

Question 78

normative comparison

Answer 78

- compare to health controls that go through the same treatment procedure

Question 79

controlling clinical-patient interactions

Answer 79

- eliminate natural biases - single-blind: participant doesn't know what condition they are in - double-blind: neither participant nor experimenter know conditions

Question 80

internal validity

Answer 80

extent to which changes in DV were result of IV manipulation

Question 81

external validity

Answer 81

generalizability of findings

Question 82

confounds

Answer 82

additional variables that exert their influence at same time as IV, making it impossible to know which is causing the effect (low internal validity)

Question 83

quasi-experimental

Answer 83

- experimental group not randomly assigned, instead selected on the basis of certain characteristics - no manipulation of IV - everything else controlled - limits: can only make correlation conclusions, can be difficult to match participants on all factors except one that is the IV

Question 84

non-experimental designs

Answer 84

1) correlational studies 2) longitudinal studies: correlational results over time 3) case-studies and single-subject: can't generalize *none can make causal conclusions

Question 85

case study example

Answer 85

KC: anterograde/retrograde amnesia

Question 86

ABAB case study

Answer 86

- one person used as own control - remove and introduce a particular condition

Question 87

epidemiological research

Answer 87

- study of incidence/prevalence of disorders in a given population - incidence: number of new cases in a time period - prevalence: frequency of disorder at a particular point in time

Question 88

inheritance/genetic studies

Answer 88

1) family: inferences about heritability --> if proband (starting person) and relative display same diagnosis or behaviour, they are concordant, higher concordance rates suggest more heritability 2) adoption studies 3) twin studies *genetics never explains 100%, always some environmental effect, gene-environment interaction studies have intensified

Question 89

epigenetics

Answer 89

study of how environment leads to changes in DNA and therefore gene expression

Question 90

clinical significance

Answer 90

1) treatment's practical utility 2) whether symptoms are sufficiently intense for distress or dysfunction

Question 91

statistical significance

Answer 91

observed effect passes a threshold that suggests it was sufficiently unlikely to have occurred due to chance

Question 92

limitations to assessments

Answer 92

only a sample of behaviour

Question 93

what are good assessment tools dependent on?

Answer 93

- ability to accurately detect some aspect of the person being tested - knowledge of how people in general fare on such a measure for comparison purposes (ex. norms)

Question 94

test-retest reliability

Answer 94

same test generates same results for the same person

Question 95

alternate-form reliability

Answer 95

two versions of the same test give correlated scores

Question 96

internal consistency

Answer 96

degree of reliability WITHIN a test

Question 97

split-half reliability

Answer 97

if one half is correlated to the other (ex. even responses and odd responses)

Question 98

coefficient alpha

Answer 98

averaging intercorrelations of all items within a test

Question 99

face validity

Answer 99

items on test resemble characteristics of concept being measured

Question 100

content validity

Answer 100

test's items are thorough and reflect all behaviours believed to be related to the overall construct

Question 101

criterion validity

Answer 101

correlation between measure and tangible external criterion

Question 102

construct validity

Answer 102

relation of measure to another measure of same concept within a specific theoretical framework (ex. self-esteem and self-efficacy)

Question 103

clinical approach to prediction

Answer 103

- clinical intuition is most important quality to draw on all info for an accurate assessment - better when dealing with patients case-by case

Question 104

actuarial approach

Answer 104

- more objective, unbiased and scientifically validated methods - more efficient for large datasets - do not generalize to practice setting - no prediction rules for most decisions

Question 105

types of prediction

Answer 105

clinical, actuarial, machine learning/AI

Question 106

types of assessment

Answer 106

biological (neuroimaging, more for etiology over diagnosis), neuropsychological, clinical assessment (interviews), intelligence, personality, behavioural/cognitive

Question 107

biological assessment

Answer 107

- rules out underlying biological conditions - brain imaging, neuropsychological testing (individual or multi-test batteries)

Question 108

brain imaging techniques

Answer 108

EEG, CT/CAT, MEG, PET, MRI, fMRI, fNIRS

Question 109

fNIRS

Answer 109

specific frequency of IR that passes through skull but not blood

Question 110

EEG

Answer 110

- measures changes in brain current - high temporal resolution - low spatial resolution

Question 111

CT/CAT

Answer 111

- x-ray images - high spatial resolution - small radiation doses

Question 112

PET

Answer 112

- radioactive ligands in blood - can study subcortical neurons, receptors, neurotransmitters - radiation - expensive

Question 113

MEG

Answer 113

- changes in brain current (with magnetic waves) - high temporal, high spatial resolution - expensive

Question 114

MRI

Answer 114

- images brain structure - high spatial resolution - expensive

Question 115

fMRI

Answer 115

- infer brain activity by blood flow and oxygen levels - high spatial resolution - medium temporal resolution - expensive

Question 116

application of brain imaging

Answer 116

- before and after changes of psychotherapy - how those with disorder differ from controls

Question 117

neuropsychological assessment

Answer 117

- objective determination of cognitive capacity, determines how current behaviour relates to brain functioning (normal or abnormal) - intelligence, memory, learning, executive function , visuospatial function, etc. - batteries: multiple tests, long and laborious but can pinpoint specific impairments

Question 118

examples of neuropsychological assessment screening tools

Answer 118

1) bender visual-motor gestalt test: copy patterns and shapes 2) repeated battery for the assessment of NP status (RBANDS): 12 subtests that cover range of domains relevant to neurological impairment 3) montreal cognitive assessment (MoCA): brief, rapid tool for mild cognitive impairment 4) trail making test (connect numbers/letters in alternating way) 5) complex figure test: copy from memory *need to compare these to norms

Question 119

intelligence tests

Answer 119

- IQ = mental/chronological age X 100 - 15 = 1 std. deviation - Stanford-Binet Intelligence Scales - WAIS, WMS, WISC (children), WPPSI (preschool) - very good reliability and validity, stable construct over time - making block designs - Raven's progressional matricies - arithmetic, similarities

Question 120

clinical interviews

Answer 120

- unstructured: open-ended questions, facilitates rapport, poor reliability (different questions asked by different interviewers), missing relevant details - semi-structured: questions guided by prompts and decision-trees, some flexibility to get details - structured: very specific questions and order, no connection, less efficient

Question 121

personality assessment

Answer 121

- projective tests: rorschach inkblot test, thematic apperception test (psychodynamic, validity questioned) - standardized tests: MMPI, MCMI

Question 122

thematic apperception tests

Answer 122

- patient interprets strange image

Question 123

MMPI-2

Answer 123

- minnesota multiphasic personality inventory - 567 true/false questions - assesses multiple aspects of personality - profile of scores on scales of personality characteristics built by comparing psychiatric and non-psychiatric groups - contrasted approach: items were chosen only if people known to have the characteristic the scale is intended to measure responded differently to the item than did people who did not have that characteristic

Question 124

MCMI

Answer 124

- millon clinical multiaxial inventory - helps clinicians with diagnostic judgements about personality disorders and other clinical syndromes - 195 true/false questions - 25 clinical scales, 5 validity scales

Question 125

personality assessment inventory (PAI)

Answer 125

- 4-point likert scale - 11 clinical, 4 validity, 5 treatment-consideration, 2 interpersonal scales - assess symptoms (mild to severe) - ex. OCEAN

Question 126

norms

Answer 126

1) standard or pattern, expected behaviour 2) statistical representation of population, used as reference to identify what percentile an individual lies at

Question 127

down sides of self-report

Answer 127

- traits have overlap --> maybe there are no distinct parts to personality - people tend not to provide accurate reports

Question 128

response sets

Answer 128

test testing attitudes that bias self report answers

Question 129

acquiescent style

Answer 129

says yes to everything

Question 130

socially-desirable responding

Answer 130

respond to make themselves look good, minimize the bad

Question 131

demand characteristics

Answer 131

answer in a way they think the tester wants them to answer

Question 132

behavioural assessments

Answer 132

- observation - rating scales - reactivity: change in behaviour because they know they are being watched - observer drift: raters suffer from an idiosyncratic bias in their ratings over time - expensive, time-consuming

Question 133

how do tests avoid dishonest answers?

Answer 133

- sets of questions, where one has a question that everyone will answer a certain way to: ex. do you have strange beliefs about cars? if yes, do cars have their own religion? - detects malingering: amplifying mental health symptoms for a benefit

Question 134

cognitive-behavioural assessments

Answer 134

- questionnaires assessing your thoughts - self-monitoring: record own behaviours, thought, emotions - advancements with technology: real-time assessments - self-monitoring also fosters insight and awareness --> an intervention by itself

Question 135

major depressive disorder prevalence

Answer 135

5-12.5%, 50% who have one episode will have another, ~90% of those who have two or three will have more

Question 136

MDD episode length

Answer 136

average 6-9 months

Question 137

MMD onset statistics

Answer 137

- average age: early to mid-20s, now decreasing (ex. teens) - women at higher risk at all ages - comorbid with anxiety disorders (>50%) contributes to more severe and chronic depression

Question 138

MDD DSM diagnostic criteria

Answer 138

1) 5 or more of the following symptoms, one of which is depressed mood or anhedonia (both subjective or observed) - significant weight loss when not dieting or weight gain (+5%), or decrease in appetite - insomnia or hypersomnia (+/- 2hr) - psychomotor agitation or retardation (observable) - fatigue or loss of energy - feeling worthless or excessive/inappropriate guilt, which may be delusional - difficulty concentrating or indecisiveness - recurrent thoughts of death, suicidal ideation, attempt or plan *symptoms must be most of the day or nearly every day for at least a two week period in the last month 2) distress or impairment (clinically significant) 3) not due to substance or medical condition 4) no psychotic disorder 5) never had manic/hypomanic episode

Question 139

comments on MDD DSM criteria

Answer 139

- removal of bereavement exclusion could lead to increased prevalence - number of criteria is contentious - some people will have full inter-episode recovery, others have lingering symptoms

Question 140

anhedonia

Answer 140

markedly diminished interest or pleasure in all, or almost all activities (subjective or observation)

Question 141

persistent depressive disorder aka

Answer 141

dysthymia (until DSM)

Question 142

PDD prevalence

Answer 142

0.03

Question 143

double depression

Answer 143

chronic low mood (PDD) + additional episodes of depression

Question 144

examples of double depression

Answer 144

1) persistent major depressive episode (MDE): decrease in mood that stays consistent 2) intermittent MDE with current episode

Question 145

examples of PDD

Answer 145

1) dysthymic syndrome: consistent low mood 2) intermittent MDE without current episode

Question 146

PDD differences from MDD

Answer 146

- more chronic - younger age of onset - higher comorbidity - strong family history - lower levels of social support - higher stress - more dysfunctional personality traits - less likely to respond to standard treatment, often needs combination

Question 147

PDD theoretical concern

Answer 147

how differentiated is this from a normal-range of personality traits?

Question 148

PDD DSM criteria

Answer 148

1) depressed mood most of the day, for more days than not for at least 2 years 2) presence, while depressed of two or more: - poor appetite or over eating - insomnia/hypersomnia - low energy or fatigue - low self-esteem - poor concentration or indecisiveness - feelings of hopeless ness 3) during the 2-year period (1 year for children/adolescents), person has never been without symptoms in (1) or (2) for more than 2 months at a time 4) criteria for MDD may be continuously present for 2 years 5) no manic or hypomanic episode, never met criteria for cyclothymia 6) not better explained by other mood disorders or substance/medication 7) significant distress/impairment

Question 149

premenstrual dysphoric disorder (PMDD)

Answer 149

- prevalence: 1.8-5.8% - acute depressive symptoms that accompany menstrual cycle - must occur in most cycles in the past year - research focuses on hormonal mechanisms (birth control, SSRIs can help)

Question 150

other specified depressive disorder

Answer 150

1) recurrent brief depression (5+ symptoms, 2-13 days, each month for at least 1 year) 2) short-duration depressive episode (4-13 days, 5+ symptoms) 3) depressive episode with insufficient symptoms (at least two weeks)

Question 151

unspecified depressive disorder

Answer 151

- clinical impairment, but doesn't meet specific criteria - "catch-all" label

Question 152

mania

Answer 152

- distinct period of elevated, expansive or irritable mood - lasts at least one week OR any duration if hospitalization necessary or interaction with law enforcement - increased energy, decreased need for sleep, racing thoughts, pressured speech, impaired attention/concentration/judgement - can lead to altercations, reckless activities, substance use, aggression

Question 153

hypomania

Answer 153

- less severe mania, only lasting at least 4 days - can be longer if did not cause significant difficulties to warrant mania - can sometimes be hard to distinguish between feeling "good"

Question 154

mixed-state episodes

Answer 154

- rare - depression and manic/hypomanic symptoms felt at the same time

Question 155

bipolar 1 DSM criteria

Answer 155

1) manic episode 2) during manic episode, must have at least 3 symptoms (four if only irritable) present to a significant degree (noticeable change from usual): - inflated self-esteem or grandiosity - decreased need for sleep - more talkative or pressure to keep talking - flight of ideas or feeling of racing thoughts - distractibility - increase in goal-directed activity or psychomotor agitation (non-goal-directed) - excessive involvement in risky activities 3) impairment in functioning, need of hospitalization or psychotic features *no need for distress! 4) not attributable to substance/medical condition

Question 156

bipolar 1 and MDD

Answer 156

- depressive history not necessary for bipolar diagnosis - but most patients will have had MDD in the past or future

Question 157

bipolar 1 prevalence and onset

Answer 157

- prevalence: 0.8%, equal male/female - mean onset ~20, 50% show symptoms as teens

Question 158

bipolar 2 DSM criteria

Answer 158

1) hypomanic episode 2) same symptoms as bipolar 1 3) episode associated with unequivocal change in functioning that is uncharacteristic of the individual when not symptomatic 4) disturbance in mood and change in function is observable to others 5) not severe enough for impairment or hospitalization, no psychotic features 6) not attributable to substance or medication 7) one or more depressive episodes

Question 159

bipolar II prevalence

Answer 159

0.5%, equal in males/females

Question 160

progression of bipolar disorders

Answer 160

- manic symptoms often enjoyable and pleasurable at first - tend to progress into distress/impairment, where others are effected, risks have consequences, depressive episodes become more severe - hypomania/mania tends to last two weeks to four months - depressive episodes tend to last 6-9 months - suicide rates 10-15%

Question 161

cyclothymia

Answer 161

- chronic, less severe form of bipolar - hypomanic and depressive symptoms, but never reaches full DSM criteria for either (faster cycling) - at risk for developing bipolar disorders

Question 162

cyclothymia prevalence and diagnosis

Answer 162

- 0.4-1%, equal across genders - hard to get diagnosis: how to tell difference between normal fluctuation or disordered?

Question 163

rapid-cycling specifier

Answer 163

- four or more manic and or depressive episodes within a year - episodes separated by at least two months of full or partial remission, or by switch to opposite mood state

Question 164

seasonal affective disorder (SAD)

Answer 164

- recurrent depressive episodes tied to changing seasons, usually winter months with less daylight

Question 165

SAD prevalence

Answer 165

- general: 0.6-3%, 2-3% in Canada - approximately 11% with MDD have SAD

Question 166

SAD etiology

Answer 166

- focus on melatonin produced at night by pineal gland - but, medications that suppress melatonin are not very effective

Question 167

peri-partum and post-partum onset depression prevalence

Answer 167

- 10-15% of mothers with mood swings that do not resolve or are severe enough for MDD or manic episodes - 0.1% have post-partum psychosis, may lead to suicide (5%) or infanticide (4%, command hallucinations)

Question 168

peri/post partum onset depression risk factors

Answer 168

- family history of depression - previous personal depression - poor marital relationship - low social support - stressful life events concurrent/following childbirth - could adversely affect child

Question 169

biological: genetic etiology of mood disorders

Answer 169

- genetics - twin studies: high heritability of MDD (36%), huge heritability of BP (75%) - serotonin transporter gene (HTT): controls individuals reactivity to stress, short (s) allele associated with negative cognitive style and personality (higher rates of MDD in response to stress)

Question 170

heritability

Answer 170

percent of variability that can be explained by genetics

Question 171

psychological: personality etiology of mood disorders

Answer 171

1) dependency: relying on interpersonal relationships for identity; neediness, fearing abandonment, feeling helpless in relationships 2) self-criticism: particularly towards achievement, fearing failure, self-blame, inferiority, guild

Question 172

psychological: behavioural models in etiology of mood disorders

Answer 172

1) Lewinsohn's behavioural model: operant conditioning --> low rate of positive reinforcement via social and other rewards leads to extinction of those behaviours 2) Seligman's learned helplessness model: remain in unpleasant situations because they start to believe they have no control, even when escape/control options exist

Question 173

cognitive etiology of mood disorders

Answer 173

1) Ellis: irrational and distorted thoughts 2) Beck: negative bias in appraising stimuli from the environment --> cognitive distortions framework --> diathesis stress model: only after stressful event might schema start to cause difficulties

Question 174

cognitive distortions

Answer 174

- automatic thoughts because of underlying schemata about the self, world or future (negative) - awareness gives opportunity to notice and challenge them

Question 175

appraisal theory

Answer 175

1) primary: challenge (potential for gain/growth) or threat? 2) if threat, secondary appraisal: effective options (low threat) or ineffective/no options (high threat)?

Question 176

examples of cognitive distortions

Answer 176

1) all or nothing thinking 2) over generalizing 3) mental filter (attentional bias) 4) disqualifying positive 5) jumping to conclusions: mind-reading, fortune telling 6) magnification (catastrophizing) or minimization 7) emotional reasoning: assuming that because we feel a certain way, what we think must be true 8) should, must, ought (guilt with self, frustration with others) 9) labelling (self or others) 10) personalization (assuming responsibility for things that aren't your fault or blaming others for things that were your fault)

Question 177

attentional/interpersonal etiology of mood disorders

Answer 177

1) attentional bias - depressed people preferentially attend to negative info - more likely to be judged as less socially skilled because not as animated, more negative affect, angry/depressed feelings - manic people preferentially attend to positive stimuli 2) depressed people tend to seek confirmation of criticism and other negative interpersonal beliefs from others, can provoke further negative responses 3) interpersonal dependency or excessive reassurance seeking: learn to need assurance, may compound social aspect because of annoyance

Question 178

life stress perspective of mood disorders

Answer 178

- depressed people 3x as likely to experience stressful life prior to onset - sudden losses or sudden changes - nearly 75% MDD suffered major loss event 3-6 months before - life events related to reward/goal attainment predict increases in manic symptoms - early child maltreatment: negative core schemas (Beck beliefs), taxes biological systems (HPA axis, cortisol)

Question 179

biological: neurotransmitter etiology of MDD

Answer 179

- deficiency in serotonin - SSRIs thought to raise serotonin in brain, but this may not be why they are valuable as antidepressants

Question 180

biological: cascade hypothesis of depression

Answer 180

1) cortisol release during stress stimulates receptors in hippocampus 2) hippocampus inhibits HPA axis by negative feedback 3) chronic stressors result in sustained release of cortisol, breakdown of negative feedback (hippocampal degradation) supporting studies - HPA axis more reactive in females (2x depression) - greater lifetime stress experience, smaller hippocampus - child abuse associated with cell death in hippocampus and amygdala

Question 181

sleep neurophysiology and mood disorders

Answer 181

- loss of slow-wave (deep) sleep and earlier on set of REM stages in MDD - sleep deprivation can induce symptoms of mania, people suggest that BP is related to sleep dysregulation

Question 182

neuroimaging mood disorders

Answer 182

- depression associated with decreased blood flow and reduced glucose metabolism in prefrontal cortex (reversed in mania) - increased glucose metabolism in subgenual anterior cingulate cortex (ACC), seems to be related to attentional biases - increased activity in amygdala, maybe also related to attentional biases

Question 183

CBT for depression

Answer 183

- goals: increase awareness of thoughts and appraisals to events, examine their contribution to emotions - structured format, 16-20 sessions - socratic questioning, guided collaborative discovery - activity monitoring and scheduling (behavioural activation): to counteract Lewinsohn's theory, this is a critical component! - thought records to challenge distorted thinking - behavioural experiments

Question 184

CBT success with depression

Answer 184

- some evidence of being superior to psychodynamic psychotherapy - comparable results to antidepressants and IPT - lower relapse rates in the long-term

Question 185

mindfulness based cognitive therapy (MBCT)

Answer 185

- Buddhism principles - promotes non-evaluative awareness of present - detach from ruminative thinking, cultivate detached perspective - helpful for avoiding relapse

Question 186

interpersonal psychotherapy (IPT) for depression

Answer 186

- based on psychodynamic theories viewing loss and disordered attachment as underlying factors - assumes depression occurs via interpersonal context - 12-16 sessions, maintenance sessions to avoid relapse - work to resolve: 1) interpersonal disputes 2) role transitions (life changes) 3) grief 4) interpersonal deficits - efficacy similar to antidepressants

Question 187

pharmacotherapy for depression

Answer 187

1) TCAs: blocks NE or 5HT reuptake, rarely prescribed because of side effects 2) MAOIs: block MAO, prevents breakdown of NE, 5HT, DA, also rarely prescribed 3) SSRIs: primarily block reuptake of 5HT, more commonly prescribed (minor side effects: nausea, insomnia, sedation, sexual dysfunction) 4) SNRIs: block reuptake for 5HT, NE 5) medications for dopamine (stimulant-like) 6) miscellaneous actions: GABA, ketamine

Question 188

pharmacotherapy for bipolar disorder

Answer 188

- can't use antidepressants, these encourage mania 1) lithium: mechanism unkown (deactivation of GSK-3B? decreasing excitatory glutamate?) - narrow therapeutic window means regular blood draws (therapeutic dose is only slightly below toxic) - side effects: kidney, thyroid, dehydration, weight gain, hair thinning, hand tremors - careful with salt/coffee intake - 40% do not respond, becomes ineffective over time for 70% 2) anticonvulsants: originally for epilepsy - mechanism also unknown - many increase GABA - some decrease glutamate - some work on Ca2+ and Na+ channels 3) atypical antipsychotics: work on dopamine and serotonin, can cause tardive dyskinesia

Question 189

tardive dyskinesia

Answer 189

- protrusion and rolling of tongue - sucking and smacking movements of lips - chewing motion - facial dyskinesia - involuntary movements of body and extremities

Question 190

combination therapies for bipolar disorder

Answer 190

- medication first choice, but can add adjunct therapy 1) family-focused therapy (FFT): education for patient and family, communication and problem-solving training, developing positive interactions and supportive relationships 2) interpersonal and social rhythm therapy (IPSRT): regulation of routines and coping with stressful life events, targets sleep consistency, prevents relapse via sleep deprivation 3) cognitive therapy (CT): regulate sleep and daily routines, monitor mood for episode triggers, medication compliance 4) dialectical behavioural therapy (DBT): improve emotional regulation, reduced negative coping, reduced vulnerability to strong emotions

Question 191

phototherapy

Answer 191

- useful in SAD - light boxes emit a bright light of a certain intensity to mimic sunlight - patients sit in front of box for 30 min in morning - increasing temperature, serotonin production, melatonin inhibition - no side effects, <100 dollars

Question 192

treatment-resistant depression

Answer 192

- 40% fail to respond to at least two medications - consider neurosurgery

Question 193

neurosurgery and invasive procedures for depression

Answer 193

1) ECT: used for severe and treatment-resistant cases, remission rate ~90% 2) TMS: usually applied to DLPFC (dorsolateral prefrontal cortex) where there is low activity, less effective than ECT 3) vagus nerve stimulation (VNS): invasive, helps improve 5HT/NE and blood flow, works well in long-term 4) DBS: extremely invasive electrodes in reward/attention areas

Question 194

suicide stigma

Answer 194

- cultural and religious views impact prevalence - wasn't considered "legal" in some countries - stigma prevents people from seeking help

Question 195

dialectical behavioural therapy

Answer 195

- built to treat suicidality, although common for BPD - emphasizes that wo things can be true at the same time - aims for a balance between acceptance (mindfulness, distress tolerance) and change (emotional regulation, interpersonal effectiveness)

Question 196

different types of suicidal behaviour

Answer 196

1) ideation: thoughts of death, thinking of ways it could happen 2) gestures (parasuicide): behaviours that look like a suicide attempt but are not life-threatening/have no intention 3) attempts: carrying out a plan 4) completion: successful attempt 5) self-harm

Question 197

self-harm

Answer 197

- not immediately life-threatening - maladaptive ways of coping - negative reinforcement: intense release/relief after (attentional shift) - strong predictor of suicidal behaviour or mood disorder

Question 198

DBT treatment for self-harm

Answer 198

- behaviour chain analysis - look at precursors to self-harming behaviour and try to intervene sooner rather than letting feelings escalate - teach emotional regulation, mindfulness - avoid situational/emotional triggers - take focus away from painful feelings

Question 199

schizophrenia general characteristics

Answer 199

- disruption of basic psychological processes - distorted perception of reality - altered/blunted emotion - disturbances in thought, motivation and behaviour

Question 200

schizophrenia prevalence, onset, demographics

Answer 200

- prevalence: 1%, 300k in Canada - onset: 15-45 years, early 20s peak - men/women roughly equal risk, men develop earlier - abrupt or gradual onset - all socioeconomic levels, but more prevalent at low (self-fulfilling prophecy, comorbidities with depression, suicidality, substance abuse)

Question 201

most common type of hallucinations

Answer 201

auditory

Question 202

complexity of schizophrenia

Answer 202

- heterogenous in terms of symptoms - no reliable biological markers - difficult to make prognosis and prediction - what defines successful treatment? symptoms gone or disruption gone?

Question 203

factors increasing schizophrenia prevalence

Answer 203

- industrialization - rural vs urban living - environmental changes - defined disorder = more diagnoses

Question 204

schizophrenia prognosis

Answer 204

- poorer for males and those with earlier onset - chronic and relapsing disorder - longer delay for treatment worsens prognosis - favourable outcome: typically termed attenuated psychosis rather than in remission (most cases, symptoms still present, just less intense)

Question 205

schizophrenia burden on society

Answer 205

- economy: billions of dollars on inpatient services, psychiatric case management, much more direct and frequent client care required - stigma - family members usually have to act as caregivers, extra loss of productivity

Question 206

division of symptoms in schizophrenia

Answer 206

1) positive: something extra present, ex. hallucinations, delusions, disorganized speech and thoughts 2) negative: something absent or abnormal, ex. ahedonia, avolition (lack of motivation to start a task), blunted afect 3) cognitive: dysfunction in brain's regular processes, ex. memory issues, inability to process social cues, impaired sensory perception

Question 207

hallucinations

Answer 207

- realistic perceptions in the ABSENCE of external sensory input that occur while awake and conscious - underlying problem: misattribution of sensory experience and inability to discriminate between internal/external sources of information - occur in many medical disorders, and does not necessarily mean psychotic

Question 208

types of hallucinations

Answer 208

1) auditory: heard inside or outside of head 2) visual: simple or complex, cannot be an illusion or misinterpretation of existing stimulus 3) tactile 4) taste or smell: often extreme

Question 209

delusions

Answer 209

- implausible beliefs that persist despite reliable contradictory evidence - disorder of thought content - can include complex belief system or single belief - observed correlation: may develop in people who make interpretations too quickly and jump to conclusions - may also be a bias in reasoning (negative events always perceived as coming from environment or other people)

Question 210

types of delusions

Answer 210

1) persecutory/paranoid: they are being conspired against, deceived or persecuted 2) referential: events, objects or other individuals have personally relevant meanings 3) somatic: change or disturbance in personal appearance or bodily function 4) religious: unusual religious experiences or beliefs, ex. describing self as living out a biblical prophecy 5) grandiose: possession of special or divine powers, abilities or knowledge

Question 211

motor disruptions

Answer 211

- catatonia: reduction in motor responsiveness - waxy flexibility: allowing others to move their body and limbs, then maintain that position

Question 212

grossly disorganized behaviour

Answer 212

- difficulty with goal-directed behaviour - unpredictable movements - problems dressing or with hygiene - inappropriate sexual behaviour

Question 213

negative symptoms associated with...

Answer 213

deficits in academic and occupational functioning and adjusting to community

Question 214

disorganized speech and thought disorder

Answer 214

- unusual-sounding, nonsensical speech - loosening of associations: loss of logical connections between ideas - tangential thinking: moving from one topic to another quickly - more easily observable, can serve as objective index of disturbance (over symptoms like hallucinations and delusions)

Question 215

cognitive deficits as markers of schizophrenia

Answer 215

1) processing speed: slow writing symbols paired with numbers 2) sensory gating: impairment filtering out redundant info 3) verbal memory 4) dichotic listening 5) phonemic word fluency: impaired generation of words rapidly 6) ability to sustain attention: slow/inaccurate detection of specified letters

Question 216

progression of schizophrenia

Answer 216

1) premorbid 2) prodormal: clinical deterioration begins, 5-10 years before first episode 3) progression/clinical deterioration: longer period of untreated psychosis = worse prognosis, number of relapses related to greater deterioration 4) chronic residual: patients may not recover from subsequent episodes as quickly, may experience greater degrees of residual symptoms and disability

Question 217

schizophrenia DSM criteria

Answer 217

1) two or more of following, each present for a significant portion of time during 1 month: - delusions - hallucinations - disorganized speech - grossly disorganized or catatonic behaviour - negative symptoms 2) for significant portion of time since onset, level of function in one or more areas is below level prior to onset (work, interpersonal, self-care) 3) continuous signs of disturbance persist for at least 6 months: includes at least 1 month of symptoms (less if treated), may include periods of prodromal or residual symptoms (only negative symptoms or two or more symptoms with attenuated form) 4) rule out schizoaffective disorder, MDD or BP with psychotic features 5) not attributable to substance, medication or medical condition 6) if autism or communication disorder present, diagnosis can only be given if delusions or hallucinations present for one month (less if treated)

Question 218

delusional disorder

Answer 218

- one or more delusions with duration of one month or more - does not meet criteria for schizophrenia (never been met)

Question 219

brief psychotic disorder

Answer 219

- one or more of: delusions, hallucinations, disorganized speech, grossly disorganized/catatonic behaviour - at least one symptom from first three categories - 1 day to 1 month, more becomes schizophreniform disorder

Question 220

schizophreniform disorder

Answer 220

- two or more of symptoms: delusions, hallucinations, disorganized speech, grossly disorganized/catatonic behaviour, negative symptoms - at least one from first 3 - 1 month to 6 months, more becomes schizophrenia

Question 221

schizoaffective disorder DSM criteria

Answer 221

1) two or more symptoms, each present for significant amount of time during 1-month period + at least one from first three: - delusions - hallucinations - disorganized speech - grossly disorganized or catatonic behaviour - negative symptoms 2) hallucinations and delusions for two or more weeks in the absence of a major mood episode during entire life time duration of illness 3) symptoms that meet criteria for major mood episode are present for the majority of the time otherwise (including active and residual portions of illness) 4) not due to substance or medical condition 5) specifiers: - bipolar type: mania and sometimes major depression - depressive type: only major depressive episodes

Question 222

substance/medication-induced psychotic disorder

Answer 222

ex. cannabis

Question 223

other specified psychotic disorders

Answer 223

- persistent auditory hallucinations (+ nothing else) - delusions with significant overlapping mood symptoms - attenuated psychosis syndrome (below threshold) - psychotic disorder - not otherwise specified (NOS)

Question 224

MDD + psychotic features vs schizoaffective disorder

Answer 224

- MDD with PF only experience psychotic features during mood episodes - schizoaffective have 2 weeks only psychotic symptoms without mood symptoms

Question 225

bipolar disorder vs schizoaffective disorder

Answer 225

same distinction as MDD with PF

Question 226

neuropsychological and neuroimaging factors in schizophrenia

Answer 226

- suggest hypofrontality, affecting personality, self-awareness, motivation, thinking, impulsivity, social behaviour - can predict schizophrenia or indicate severity, but cannot diagnose 1) fMRI: less than 50% have reduced blood flow or metabolism in frontal area during tasks - schizophrenia could be a product of lower intellectual functioning overall (50-67% lower in patient groups) 2) MRI: third and lateral ventricles are enlarged (compression or loss of existing nerve tissue) - reduced grey matter volumes in medial temporal lobe (MTL), superior temporal lobe, prefrontal cortex --> memory processing, cognitive/executive function (but not in all patients) 3) DTI: corpus callosum and connections between frontal lobe and other areas affected (connective tissues and tracts)

Question 227

social cognition factors in schizophrenia

Answer 227

- emotional recognition (six universal) decreased (index of social functioning)

Question 228

biological factors in schizophrenia

Answer 228

1) high genetic contribution: children of two affected parents = 35% likelihood - molecular genetics research difficult to reproduce consistently - single gene only increases risk by 1-1.5% because of many interactions 2) pregnancy/birth: mother exposure to flu or illness, birth-related complications 3) family environment: family hostility, lack of support, critical attitudes, over-involvement, mood/eating disorders, high expressed negative emotion directed at family members with disorder 4) other factors: high-risk children display withdrawn/socially-reclusive, antisocial, aggressive behaviour, motor difficulties, lower intellectual capabilities

Question 229

psychoanalytic etiology of schizophrenia

Answer 229

- emotional traumas - inadequate parenting - severely rejecting mother: schizophrenogenic

Question 230

sociocultural etiology of schizophrenia

Answer 230

- strong correlation with poverty - social drift: people from lower SES get stuck bc of reduce IQ associated, more substance use, stigma, homlessness

Question 231

diathesis-stress model in schizophrenia

Answer 231

- popular explanation - biological vulnerability (inherited or acquired early in life) switched on by stress

Question 232

meehl's model

Answer 232

- most famous for schizophrenia 1) hypokrisia: biological diathesis that causes nerve cells to be abnormally reactive to incoming sensory info (can be suppressed by other genes) 2) cognitive slippage: information is disorganized, incoherent and scrambled, increases thought disorder risk (high IQ can prevent further progression) 3) aversive drift: negative symptoms from unpleasant social experiences that amplify pain, weaken pleasure and make social relationships difficult 4) schizotype: has all three predispositions, can still be spared 5) schizophrenia: more likely with exacerbating factors: shyness, anxiety, low energy, weak motivation, low ability, talent, low SES

Question 233

criticism for meehl's model

Answer 233

- complicated (not parsimonious) - lacks integration of why disorder emerges in adolescence - lack of empirical support for only three specific factors - subtle brain injuries present in areas that normally mature in adolescence may be important --> stress of maturation on weakened brain, hormonal interaction with stress - overall, neuroanatomical and neurochemical theories are more evolved

Question 234

dopamine hypothesis in schizophrenia

Answer 234

- abnormal concentrations of dopamine receptors - key medication: chlorpromazine blocks dopamine receptors (D2)

Question 235

mesolimbic pathway in SCZ

Answer 235

- reward and regulation - too much signaling = hallucinations/delusions

Question 236

mesocortical pathway in SCZ

Answer 236

- emotional and cognitive functioning, executive functions - too little signaling = negative/cognitive symptoms (hypofrontality)

Question 237

historical treatments for SCZ

Answer 237

insula coma, psychosurgery, frontal lobotomies, shocks

Question 238

typical antipsychotics

Answer 238

- dopamine receptor antagonists - ex. chlorpromazine: reduced agitation, mania, mood disturbances (positive symptoms) - may exacerbate negative/cognitive symptoms - minority benefit, others have side effects

Question 239

nigrostriatal pathway in SCZ

Answer 239

- coordinated movement - normal signaling - typical antipsychotics = low signaling = parkinsonian symptoms

Question 240

tuberoinfundivular pathway

Answer 240

- normally dopamine inhibits prolactin - typical antipsychotics = low signaling = mammary glands stimulated

Question 241

atypical antipsychotics

Answer 241

- preferred medication for SCZ - dopamine and serotonin receptor antagonists - ex. risperidone, olanzapine - fewer side effects

Question 242

psychotherapy for SCZ

Answer 242

more challenging because of complexity, commonly used as adjunct to medication

Question 243

CBT for SCZ

Answer 243

- targets: emotional disturbance, psychotic symptoms, social disabilities, risk of relapse - techniques: psychoeducation, normalization of symptoms, belief modification, coping strategy enhancement, reduce catastrophic misinterpretations (symptom management) - taught how to interpret relevant environmental events - taught to respond appropriately to social cues

Question 244

other treatments for SCZ

Answer 244

1) social skills training 2) cognitive remediation and emotion recognition training: improving memory, attention, cognitive ability through compensatory strategies, exercises, group discussions 3) family therapy: emotional communication, problem-solving, stress-related coping skills

Question 245

importance of early access, awareness and prevention in SCZ

Answer 245

- longer untreated = more distress and dysfunction - STEPS for youth: early intervention, assessment and treatment for youth with signs and symptoms of psychosis - cannabinoids produce symptoms like SCZ, has a dose-related higher risk for psychosis in later life

Question 246

grouping of mental health diagnoses

Answer 246

1) internalizing: overcontrolled behaviours, ex. anxiety, depression, OCD, specific phobias 2) externalizing: undercontrolled, ex. oppositional defiant disorder, substance abuse, conduct disorder

Question 247

p factor

Answer 247

- common root of mental health diagnoses capturing about half of variance - speculation: roots in emotion dysregulation and negative affectivity

Question 248

what is the importance of the p factor?

Answer 248

- highlights comorbidity as common - understanding mental health should be rooted in recognizing overall risk for worsening mental health

Question 249

disruptive behaviour disorders (DBDs)

Answer 249

- difficulty with rule following, impulsivity, aggression and getting in trouble - often male - oppositional defiant disorder (ODD) - conduct disorder (CD)

Question 250

ODD DSM criteria

Answer 250

1) at least 4 symptoms on most days for at least 6 months: - often loses temper - often touchy or easily annoyed - often angry and resentful - often argue with authority figures or adults - often actively refuse to defy to comply with requests from authority figures or with rules - often deliberately annoys others - often blames others for his or her mistakes or misbehaviour - child has been spiteful or vindictive at least twice within past 6 months 2) evidence of impairment: distress (individual or people around) and/or negative impact on social, educational, occupational or other areas of functioning 3) not attributable to substance use or other disorders 4) patient does not meet criteria for disruptive mood regulation disorder

Question 251

ODD severity

Answer 251

- mild = 1 setting - moderate = 2 settings - severe = 3 or more settings

Question 252

CD DSM-5 criteria

Answer 252

1) four of the following: - aggressive behaviour towards others and animals - frequent physical altercations with others - use of weapon to harm others - deliberately physically cruel to other people - deliberately physically cruel to animals - involvement in confrontational economic order crime - has perpetrated a forcible sex act on another - arson - property destruction - non-confrontational economic order crime - non-confrontational retail theft - disregarded parent's curfew prior to age 13 - run away from home at least two times - truant before age 13 (skipping school) 2) significant impairment in functioning 3) if over 18, does not meet criteria for antisocial personality disorder

Question 253

CD and ODD relationship

Answer 253

- highly correlated, can have both at once - most children with CD initially display signs of ODD - most children with ODD do not go on to have CD - separation: CD violates basic rights of others or major societal norms/rules

Question 254

ODD emergence

Answer 254

- 3-9 years - often first observed within relational context with caregivers - as severity increases, behaviours start to generalize - thus, family is main target for intervention, but genetics/environment also at play

Question 255

intervention for DBDs

Answer 255

1) parent management training (PMT) 2) CBT for older kids (cognitive capacity, less reliant on parents) 3) multisystemic therapy: work with integrated environmental systems (delivered in natural environment) *high relational focus!

Question 256

most effective intervention methods for DBDs

Answer 256

- classroom-based - family-based - limited support for individual-based

Question 257

why is it extra important to treat DBDs?

Answer 257

- early mental health risk - cascading downstream risks: APD, depression, anxiety - externalizing to internalizing disorder: DBDs cause a lot of peer isolation and decreased well-being

Question 258

patterns of anxiety (GAD) over age

Answer 258

- U-shaped curve: decrease in middle-childhood, increases in adolescence - females higher rates of anxiety only after 15+

Question 259

patterns of separation anxiety over age

Answer 259

- common in middle childhood, basically disappears by early teens - makes sense: first starting school, then get used to it

Question 260

connecting separation anxiety to generalized anxiety

Answer 260

- generalized repeaks starting when separation ends - anxiety manifests itself differently

Question 261

patterns of depression over age

Answer 261

- starts earlier in girls - low in childhood, increases around 13 - 15-18: rates peak, but level off and stabilize throughout adulthood

Question 262

why are trajectories important?

Answer 262

- better normalize symptoms and decrease stigma - early mental health complications are relatively normal and expected

Question 263

what do we learn from mental health prevalence studies?

Answer 263

- mental health seems to follow life-course perspective - mental health diagnoses affect nearly everyone - mental health diagnoses are not stable - comorbidity is common and expected - mental health complications are not rare or stigmatizing, but should be expected

Question 264

homotypic continuity

Answer 264

single diagnosis predicting the same diagnosis over time

Question 265

heterotypic continuity

Answer 265

single diagnosis predicting risk for a separate diagnosis

Question 266

early life adversity (ELA)

Answer 266

- one of the most common psychosocial risk factors for development or worsening of mental health complications and increased treatment resistance - disproportionate effect on minority racial/ethnic groups and lower SES - dose-dependent relationship - one adverse childhood experience increases odds of another

Question 267

relational health model

Answer 267

- shift from medical symptom management/treatment to relationships and community support - preventative medicine: recognizing that good wellbeing starts with early life experiences - resilience based on interconnected systems of social support

Question 268

autism spectrum disorder (ASD) prevalence and etiology

Answer 268

- 1% worldwide - huge increase in prevalence recently (from 1 in 2222) - highly heritable (40-80%)

Question 269

ASD features

Answer 269

1) persistent impairment in reciprocal social communication and social interaction 2) restricted, repetitive patterns of behaviour, interest or activities 3) symptoms present from early childhood 4) symptoms impair everyday functioning

Question 270

ASD and gender

Answer 270

- diagnosed 4x more often in males - girls with ASD at risk of being overlooked, mislabeled or identified later - could be related to different presentation in girls than boys

Question 271

ASD diagnostic measures

Answer 271

- early developmental screening: checklists, surveys, lack of eye contact and not responding to name - parent-based interview - direct observation of behaviours across different play-based scenarios

Question 272

ASD identity-first language

Answer 272

- conflict between identity-first and person-first, generally better to ask individual's preference

Question 273

ASD intervention (therapies)

Answer 273

- applied behaviour analysis (ABA): focused on behaviour management --> teach social, motor, behaviour and reasoning skills - parent training encouraged to model behaviours at home - early intensive behavioural intervention programs (EIBI)

Question 274

issues with ABA/EIBI

Answer 274

- lack of autonomy and involvement + pressure to conform to standards of typicality - movement towards naturalistic developmental behavioural interventions: natural settings, involve child, teach developmentally appropriate skills, ex. social ABCs: parent-mediated program to help with social-communication challenges

Question 275

ASD intervention (communication)

Answer 275

1) picture exchange communication system (PECS): communication through specific symbols 2) speech generating devices (SGD): portable devices that produce speech when visual graphics selected --> may be less stigmatizing to use device

Question 276

ASD intervention (self-regulation)

Answer 276

- principles of mindfulness to help with complications with self-regulation

Question 277

ADHD prevalence and etiology

Answer 277

- 8% in children and adolescence globally - strong genetic basis (74-80%) - DSM-5 biological basis: brain-based developmental disorder)

Question 278

ADHD diagnostic criteria

Answer 278

1) inattention: 6+ for <16, 5+ for 17+, symptoms present for at least 6 months and inappropriate for developmental level - often fails to give close attention to details, makes careless mistakes - often has trouble holding attention - often does not seem to listen when spoken to directly - often does not follow through on instructions or responsibilities - often has trouble organizing tasks/activities - often avoids, dislikes or is reluctant to do tasks that require mental effort over a long period of time - often loses things necessary for tasks/activities 2) hyperactivity and impulsivity: same as 1) - often fidgets, taps hands or feet, squirms in seat - often leaves seat in inappropriate situations - often runs around our climbs inappropriately (adolescents/adults = restless) - often unable to play or take part in leisure activities quietly - often "on the go" as if "driven by a motor" - often talks excessively - often blurts out an answer before question completed - often has trouble waiting their turn - often interrupts or intrudes on others

Question 279

ADHD classifications

Answer 279

1) ADHD-I: predominantly inattentive presentation 2) ADHD-H: predominantly hyperactive/impulsive presentation 3) ADHD-HI: combined presentation

Question 280

ADHD classification gender differences

Answer 280

- ADHD-I more common in girls, associated with greater difficulty in school achievement (particularly math) - ADHD-H and AHDH-HI 3x more common in boys, associated with greater conduct problems

Question 281

ADHD treatment

Answer 281

1) stimulant medication: effective in 80% of children (different medication in children vs adults) 2) parent psychoeducation: understanding symptoms and building strength-based approaches within the home 3) academic skill intervention 4) behavioural parent training *no strong evidence to suggest benefit of family, individual or social skills therapy

Question 282

ADHD diagnostic measures

Answer 282

*no one objective test can confirm or rule out ADHD, important to get comprehensive assessment 1) Conner's Rating Scale for ADHD (self-report, parent or teacher) 2) semi-structured interview 3) performance-based measures to gather evidence 4) additional data: report cards, comorbid diagnoses

Question 283

specific learning disorders (LDs)

Answer 283

persistent impairment in one of three major areas: 1) dyslexia (reading): connecting written letters to sounds, difficulties with phonemic awareness or rapid automatized naming 2) dysgraphia (written expression): thoughts to paper, difficulties with executive function, physical act of writing, common conventions of writing 3) dyscalculia (math): difficulty with number-related concepts or mathematical symbols

Question 284

why is DSM-5 not used for learning disabilities?

Answer 284

- mainly requires documented academic impairment - does not tell us how learning is impaired

Question 285

learning disability (LDAO guidelines)

Answer 285

1) demonstrated impairment in academic achievement 2) evidence of psychological process underlying challenges 3) at least average abilities essential for thinking/reasoning 4) not better accounted form for other factors

Question 286

LD prevalence rates

Answer 286

- difficult to define because of variations in criteria - affects girls/boys equally

Question 287

LD comorbidities

Answer 287

- individuals with LDs 2-3 times more likely to experience mental health complications - feelings of failure, stress of needing to fit in/appear normal, reduced sense of competency/self-efficacy compared to peers

Question 288

LD intervention

Answer 288

- multi-tiered framework: 1) full population screened for (ex. reading) ability 2) strategies taught to "at-risk" students for reading difficulties 3) those not responsive receive additional intense remediation support

Question 289

LD diagnostic measures

Answer 289

1) comprehensive test of phonological processing 2) measures of academic achievement 3) visual motor integration test (graphomotor abilities)

Question 290

simple view of reading

Answer 290

strong word recognition skills + comprehension of language = strong reading comprehension

Question 291

problem with simple view of reading

Answer 291

- this is not how reading is usually taught - balanced reading curriculum (3 cueing method: context cues encouraged, phonics discouraged (boring)

Question 292

components of an emotional experience

Answer 292

1) stimulus 2) cognitive: alterations in consciousness and specific thoughts 3) physiological: autonomic nervous system changes 4) behavioral: behaviour change 5) emotion = subjective experience

Question 293

anxiety, fear, panic (differences)

Answer 293

- anxiety = affective (emotional) state where someone feels threatened by the POTENTIAL occurrence of a FUTURE negative event - fear = response to real or perceived threat in the present, elicits fight or flight response - panic = rapid physiological response (like an "alarm" that can be triggered in absence or presence of a concrete, identifiable event

Question 294

the "anxiety equation"

Answer 294

predicted likelihood of threat / predicted ability to cope

Question 295

historical perspective on anxiety disorders

Answer 295

- neurosis: implied biological explanation, used to be classified with dissociative and somatoform disorders - Freud: repressed inappropriate thoughts caused neurotic anxiety - modern views: cognitive, behavioural, biological factors combined with environmental

Question 296

genetic etiology of anxiety disorders

Answer 296

- some heritability (23-40%) - risk in the bform of temperamental and dispositional traits: 1) behavioural inhibition: likelihood of shyness/withdrawal from unfamiliar situations 2) neuroticism - environmental influence shown to be more important

Question 297

biological (neurotransmitter) etiology of anxiety disorders

Answer 297

- serotonin, norepinephrine, GABA - benzodiazepines enhance GABA, decreases anxiety

Question 298

behavioural etiology of anxiety disorders

Answer 298

- classical and operant conditioning (two-factor theory) - social learning variants (vicarious learning)

Question 299

cognitive/attentional etiology of anxiety disorders

Answer 299

- anxious schemas + belief that one will not be able to cope - core beliefs of helplessness and vulnerability - bias in information processing: eye-tracking procedures show that they tend to focus on negative information (even in faces)

Question 300

interpersonal/social learning etiology of anxiety

Answer 300

- parents with anxiety: less warm, more critical, less granting of autonomy - parenting style may foster beliefs related to helplessness and uncontrollability (internal working model: self as worthy/unworthy of care and others as reliable/unreliable sources of support) - anxious-ambivalent attachment may predict anxiety

Question 301

Barlow's triple vulnerability model

Answer 301

1) genetic predisposition 2) non-specific psychological factors (ex. general low self-esteem, feeling lack of control) 3) specific psychological factors (ex. x is a threat, worrying is dangerous, threats must be avoided) - all lead to clinically significant psychological disorder

Question 302

diagnostic organization of anxiety disorders in DSM-5

Answer 302

1) anxiety disorders: panic disorder, agoraphobia, SAD, specific phobia, GAD 2) obsessive-compulsive and related: OCD, body dysmorphic disorder, hoarding disorder, etc. 3) trauma and stressor related: PTSD, acute stress, adjustment, etc.

Question 303

panic attack criteria

Answer 303

sudden rush of intense fear/discomfort, peaks at 10 mins with 4/13 of: - heart palpitations or accelerated heart rate - sweating - trembling or shaking - shortness of breath - feelings of choking - chest pain or discomfort - nausea or abdominal distress - dizziness, unsteady, light-headed or faint - chills or hot flashes - numbness or tingling - derealization or depersonalization - fear of losing control or going crazy - fear of dying

Question 304

panic disorder general characteristics

Answer 304

- panic attacks do not equal panic disorder! - women twice as likely - treatment usually sought years after occurrence, when symptoms get "bad enough" - often comorbid with other disorders

Question 305

panic disorder DSM-5 criteria

Answer 305

1) recurrent and unexpected panic attacks (at least two), peak within minutes, meeting criteria for panic attack 2) at least one attack followed by 1+ month of one or both: - persistent concern or worry about additional attacks or their consequences - significant maladaptive change in behaviour related to the attacks 3) not attributable to substance or medical condition 4) not better explained by other psychological disorders

Question 306

alarm theory

Answer 306

- system activated by emotional cues, creates false alarms, triggers panic attacks in neutral situations with absence of threat 1) trigger 2) perceived threat 3) apprehension 4) body sensations 5) physical/cognitive anxiety sensitivity --> physical/mental catastrophic misinterpretation <--> panic self-efficacy decreases 6) loop back to perceived threat

Question 307

agoraphobia general characteristics

Answer 307

- anxiety about being in places or situations where it is difficult to escape or where help is not readily available should a panic attack occur - highly comorbid with PD, but agoraphobia can be present without PD - avoidance and safety behaviours

Question 308

how to safety behaviours contribute to disordered anxiety?

Answer 308

validate the fear

Question 309

agoraphobia DSM-5 criteria

Answer 309

1) marked fear or anxiety about 2+ situations: - using public transportation - being in open spaces - being in enclosed spaces - standing in a line or being in a crowd - being outside the home alone 2) fear or avoidance of above because of thoughts that escape is difficult or help might not be available in the event of panic-like symptoms or other incapacitating/embarrassing symptoms 3) agoraphobic situations almost always provoke fear or anxiety 4) agoraphobic situations actively avoided, require presence of companion or are endured with intense fear/anxiety 5) fear/anxiety out of proportion 6) 6+ months persistence, clinically significant distress or impairment, no medical/substance/other condition explanation

Question 310

PD/agoraphobia assessment

Answer 310

- semi-structured interview - behavioural measurement - psychophysiological tests - self-report measures, ex. behavioural avoidance test (BAT): rating degree of anticipatory anxiety and actual level of anxiety in various situations - rule out medical conditions (hypoglycemia, hyperthyroidism)

Question 311

PD/agoraphobia genetic etiology

Answer 311

- no specific genes - increased susceptibility to biological challenges, ex. subtle increases in CO2 - higher occurrence of nocturnal panic (waking up with panic attack)

Question 312

cognitive model of PD/agoraphobia

Answer 312

1) physiological trigger or sensation 2) cognitive evaluation: threat perceived 3) cycle: anxiety, intensifying 1) because of intentional focus, catastrophic misinterpretation 4) safety/escape behaviours contribute to catastrophic misinterpretation

Question 313

specific phobia general characteristics

Answer 313

- marked and persistent fear/avoidance of specific objects or situations - excessive, disproportionate fear - significant interference with life

Question 314

specific phobia subtypes/specifiers (5)

Answer 314

1) animal 2) natural environment 3) blood-injection-injury (bodily harm, medical treatment) 4) situational 5) other

Question 315

specific phobia prevalence

Answer 315

- 12.5% in past year, 18.4% lifetime - women almost 2x higher, with subjectively greater degree of fear - women typically report phobias of animal and situations - genetic heritability 35-51% - fear of animals most common

Question 316

specific phobia DSM-5 criteria

Answer 316

1) marked fear/anxiety about a specific object or situation 2) phobic subject almost always provokes immediate fear/anxiety 3) phobic subject actively avoided or endured with intense fear/anxiety 4) fear/anxiety out of proportion to actual threat and sociocultural context 5) fear/anxiety/avoidance is persistent, lasting 6+ months 6) fear/anxiety/avoidance causes clinically significant distress or impairment 7) not explained by other mental disorders

Question 317

etiology of phobias

Answer 317

1) classical/operant conditioning 2) non-associative model 3) biological preparedness theory 4) disgust sensitivity

Question 318

criticism of classical/operant conditioning explanation for phobias

Answer 318

equipotentiality premise: everything should then have an equal chance to have a phobia for, not true

Question 319

non-associative model

Answer 319

- evolutionarily equipped to fear certain stimuli over others - phobias exist to start out - explains infant stranger anxiety - most people habituate to feared stimuli, unless they do not have enough exposure to object/situation

Question 320

biological preparedness theory

Answer 320

- natural selection equips us with potential to develop phobia of objects/situations that presented threats to our species over time - associative learning still required to develop the phobia in this theory

Question 321

disgust sensitivity

Answer 321

- may be involved in specific phobias and OCD moreso than other anxiety disorders - how susceptible to being disgusted by variety of stimuli - people not just afraid of things, but appraise the object as being able to do disgusting things - may be important treatment outcome (decreasing this correlated with decreasing phobia)

Question 322

social anxiety disorder general characteristics

Answer 322

- distinguished from general shyness: intensely afraid of social and/or performance situations - fear showing signs of anxiety or worry that they will behave in a socially inept way and then be judged or criticized - interpersonal disorder - late childhood/adolescence onset

Question 323

SAD genetic etiology

Answer 323

- genetic factors ~50%, behavioural inhibition (temperament)

Question 324

SAD biological etiology

Answer 324

brain structures: - fear recognition and conditioning involved (amygdala) - anxious arousal/stress (HPA axis, dysregulation of serotonin, NE, etc.) - tendency to monitor own neg. affect (prefrontal, orbitofrontal cortex)

Question 325

SAD environmental factors

Answer 325

- victimization during childhood (linked to dysregulated HPA axis) - intrusive and overprotective parents

Question 326

SAD cognitive factors

Answer 326

- neg. beliefs about self and others (dishonest self-disclosure) - abnormal or biased processing of social info - high threat monitoring - high self-consciousness

Question 327

SAD and social skills

Answer 327

- actual deficit in skills leads to self-perpetuating interpersonal cycle - avoidance and eventual peer rejection = further anxiety and depression

Question 328

SAD DSM-5 criteria

Answer 328

1) marked fear/anxiety about 1+ social situations in which individual is exposed to possible scrutiny by others (social interactions, being observed, performing) 2) fear that they will act in a way or show anxiety symptoms that will be negatively evaluated 3) social situations almost always provoke fear/anxiety 4) social situations avoided or endured with intense fear/anxiety 5) fear/anxiety acknowledged as out of proportion to actual threat and sociocultural context 6) persistent (6+ months), clinically significant distress/impairment, not attributable to substances, medications, other disorders *if medical condition present, fear/anxiety/avoidance is unrelated or excessive

Question 329

GAD risk factors and role of cognition

Answer 329

- intolerance of uncertainty: 1) trigger: novelty, ambiguity, unpredictability 2) uncertainty 3) catastrophic misinterpretation of uncertainty 4) worry <-> anxiety <-> safety behaviours

Question 330

how does worry act as negative reinforcement in anxiety?

Answer 330

- verbal aspects of worry dampen arousal in short-term - worrying becomes learned behaviour

Question 331

when is worrying common (i.e. not pathological)?

Answer 331

1) specific things rather than most/many things 2) intensity of worry matches situation 3) linked to functional problem solving and belief that you can cope with the outcomes

Question 332

GAD prevalence

Answer 332

9% lifetime, more common in females

Question 333

GAD DSM-5 criteria

Answer 333

1) excessive anxiety/worry occurring more days than not for 6+ months about a number of life areas 2) hard to control the worry 3) anxiety/worry associated with 3+ symptoms, with at least some following 1) - restlessness or feeling keyed up/on edge - easily fatigued - difficulty concentrating, mind going blank - irritability - muscle tension - sleep disturbance *a lot of overlap with depression! 4) clinically significant distress or impairment, not attributable to substance/medication/other disorder

Question 334

GAD pharmacotherapy treatment

Answer 334

1) older: benzodiazepines (GABA enhancer) --> non-specific effect, risk of dependency, acts as negative reinforcement, counteracts CBT 2) older antidepressants: MAOIs, TCAs --> lower use because of side-effects 3) newer antidepressants: SSRIs, SNRIs, NDRIs --> most well-researched and prescribed

Question 335

GAD CBT techniques

Answer 335

- focus on managing thoughts and behaviours (often have faulty thinking: overestimating risk, probability and severity of threats and underestimating ability to cope) - socratic questioning and collaborative empiricism - thought record, behavioural experiments - notice and limit safety behaviours - classify worries as productive (engage and problem solve) and unproductive (welcome/tolerate short-term anxiety on purpose)

Question 336

thought reacords

Answer 336

1) situation 2) feelings 3) automatic thoughts 4) case for thoughts 5) case against thoughts 6) alternative balanced thought 7) re-rate moods

Question 337

GAD exposure techniques

Answer 337

1) systematic desensitization: unlearning association by pairing relaxation response with feared stimulus (counter-conditioning and extinction) 2) contemporary: approaching anxiety-provoking situations and experiencing anxiety on purpose without engaging in safety behaviours --> body learns the anxiety itself isn't dangerous and situation is not a threat

Question 338

flooding vs gradual habituation

Answer 338

- exposure to most extreme right away = flooding

Question 339

exposure techniques

Answer 339

1) in vivo exposures: real life situations, images, videos, VR = phobias, panic, SAD, GAD 2) imagery exposure (using imagination): GAD, PTSD 3) exposure and response prevention: choosing not to respond with compulsive behaviour (OCD, BDD) 4) interoceptive exposure: induce bodily sensations (panic/SAD)

Question 340

exposure hierarchy

Answer 340

- gradual habituation

Question 341

single session exposure

Answer 341

- flooding

Question 342

SUDs

Answer 342

subjective units of distress

Question 343

other techniques for GAD

Answer 343

- social groups - pet therapy

Question 344

overall treatment choices for PD, specific phobia, SAD, GAD

Answer 344

1) PD: CBT, then SSRIs/anxiolytics (anti-anxiety drugs) 2) SP: in-vivo exposure, CBT 3) SAD: group CBT, regular CBT, medications (ex. propanolol, a beta-blocker) 4) BAD: CBT, them medications (sometimes combined)

Question 345

obsessions in OCD

Answer 345

- recurrent, intrusive and uncontrollable thoughts, impulses or ideas that the individual finds disturbing and anxiety-provoking - can be about: uncertainty, sexuality, violence/harm, contamination, religion, perfection, relationships

Question 346

compulsions in OCD

Answer 346

- repetitive behaviours or mental acts that a person performs to reduce anxiety/distress caused by obsession or a feared outcome - rigid guidelines - don't always have logical connection to obsession

Question 347

rituals

Answer 347

- action performed repeatedly and/or according to some set pattern - ex. handwashing, cleaning, ordering: common because contamination is easy to worry about and address - ex. repeated checking, reassurance seeking

Question 348

neutralizations

Answer 348

- brief, usually covert behaviours or mental acts performed to "undo" or "negate" the obsessive thought - ex. thinking about being health, someone's safety, happy memories - ex. adding "not" to obsession - counting thoughts

Question 349

OCD DSM-5 criteria

Answer 349

1) presence of obsessions, compulsions or both (obsessions without compulsions is rare) - obsessions: a) recurrent or persistent thoughts, urges or images that are intrusive or unwanted and cause distress/anxiety b) attempts to suppress, ignore, or neutralize with some other thought or action - compulsions: a) repetitive behaviours or mental acts that the individual feels compelled to perform in response to an obsession or rules b) used to prevent or reduce anxiety, or prevent event/situation, ad are clearly excessive 2) obsessions or compulsions are time consuming (>1hr/day) or cause clinically significant distress/impairment 3) symptoms not attributable to substance or medical condition 4) not better explained by other disorders *no minimum amount of time!

Question 350

insight in OCD

Answer 350

- continuum ranging from poor (lack of awareness) to good (being fully aware of potential absurdity of symptoms) - added as a specifier to diagnosis

Question 351

OCD genetic basis

Answer 351

- strong heritability ~50%

Question 352

OCD and mental processing

Answer 352

- dysfunction in frontal cortex prevents processing and organizing relevant info - distracted by irrelevant details - poor self-monitoring (ritual/worry blurry memory) - unable to initiate appropriate behaviour change - linked to 5-HT dysregulation, but not fully understood

Question 353

OCD and memory confidence

Answer 353

- repeated checking lowers memory confidence, which intensifies doubt and sustains repeated checking

Question 354

OCD cognitive-behavioural model of etiology

Answer 354

- obsessions caused by person's reaction to their own harmless intrusive thoughts - catastrophic misinterpretations (ex. that thought means i am a danger or at fault) - unhelpful efforts to control intrusions (ex. thought suppression) - disorder initiated and maintained via maladaptive attempts to cope (compulsions) and negative reinforcement of compulsive behaviour

Question 355

role of faulty appraisals in OCD

Answer 355

- self-reinforcing cycle 1) trigger 2) intrusive thought 3) appraisal (needed for anxiety!) 4) compulsion 5) relief (neg. reinforcement), which validates 3)

Question 356

examples of appraisals in OCD

Answer 356

- generally: what does the thought mean? why does having the thought matter? - only an evil person would think this - thinking this means it is likely to happen - it is my responsibility to fix this - i cannot tolerate not knowing - this is likely to happen

Question 357

body dysmorphic disorder

Answer 357

- preoccupation with one or more perceived defects or flaws in their physical appearance (believe it looks ugly, unattractive, abnormal or deformed) - perceived flaws not observable or appear slight to others - rule out actual disfiguration and general body dissatisfaction - individuals spend lots of time thinking, looking at or doing various behaviours to the body part - similar to OCD: may have repetitive behaviours or obsessive thinking about the consequence of such a flaw - many seek reassurance, treatment or cosmetic surgery - high suicide rate - mean onset 16-17, equal M/F ratio

Question 358

body dysmorphic disorder DSM criteria

Answer 358

1) preoccupation with one or more perceived defects or flaws in physical appearance that are not observable or appear slight to others 2) at some point, individual performs repetitive behaviours or mental acts in response to concerns 3) preoccupation causes clinically significant distress/impairment in social, occupational or other important area 4) preoccupation not better explained by body fat concerns or an eating disorder

Question 359

muscle dysmorphia

Answer 359

- specifier of body dysmorphic disorder - more common in males - preoccupied by idea that body build is too small or insufficiently muscular

Question 360

hoarding disorder prevalence

Answer 360

- higher for those middle aged or older - higher for those with comorbidities - highly genetic (~50%) - often have experienced major loss - poverty is risk factor - often present: indecisiveness, avoidance, difficulty planning and organizing tasks, distractability - poses a massive health and safety hazard (ex. fires)

Question 361

hoarding disorder DSM criteria

Answer 361

1) persistent difficulty discarding or parting with possessions, regardless of actual value 2) difficulty due to perceived need to save the items, there is distress when asked to discard them 3) leads to accumulation of possessions that congest and clutter active living areas, compromising intended use. if becomes uncluttered, by another person 4) causes significant distress/impairment, including maintaining a safe environment for self and others 5) not attributable to medical condition 6) not better accounted for by another mental disorder

Question 362

animal hoarding

Answer 362

subtype of hoarding disorder

Question 363

treatment approaches for OCD/BDD

Answer 363

- exposure and response prevention is first choice (CBT) - SSRI sometimes in combination, especially for severe cases - mindfulness-based approaches helpful for relapse prevention

Question 364

treatment for hoarding disorder

Answer 364

- CBT with motivational interviewing - motivational interviewing: helps clients consider how hoarding behaviours fit with their own values and goals in lives, find motivation to change - CT: clients explore dysfunctional beliefs about possessions, notice their thoughts and behaviours, assess their validity and accuracy - practice letting go: exposure

Question 365

cognitive therapy for OCD

Answer 365

- challenge faulty appraisals, ignore actual content of obsessions! - cognitive restructuring via thought records - explore false sense of responsibility via responsibility pies - examine likelihood or risk of concerns via continuums

Question 366

cognitive therapy for BDD

Answer 366

- learn body image does not = physical appearance - evaluate distorted thoughts about one's own body and the imagined consequences

Question 367

exposure and response prevention (ERP)

Answer 367

- exposure to situations that trigger obsessive thoughts, anxiety and urge to engage in compulsions - experience anxiety while it lasts without engaging in any rituals, neutralization, reassurance seeking or safety behaviours - extinguishes cycle and/or negative reinforcement of compulsions - reduces threat response to trigger or obsessive thought - does NOT directly reduce frequency of intrusive thoughts, but this may naturally happen

Question 368

history of PTSD

Answer 368

- syndrome of psychological symptoms after life threatening events - WWI: "shell shock" thought to be related to cowardice - seen as immoral character flaw

Question 369

what is considered "trauma" in PTSD?

Answer 369

- aka criterion A traumatic event - involved one of: 1) actual or threatened death or serious injury 2) threat to the integrity of self or others - experienced with intense fear, helplessness or horror - has the potential to lead to PTSD, but does not guarantee

Question 370

PTSD DSM criteria

Answer 370

1) symptoms occur after the exposure of a traumatic event: - experiencing - witness - learn about it happening to a close person (must be violent or accidental) - repeated/extreme exposure to aversive details (does not apply to media unless work related, needs to be unwilling exposure) 2) 1 or more symptoms involving re-experiencing symptoms 3) 1 or more symptoms involving persistent avoidance 4) 2 or more negative alterations in cognitive function and mood 5) 2 or more hypervigilance symptoms 6) last at least one month 7) significant stress/impairment 8) unrelated to substance or medical condition

Question 371

what does it mean to say that PTSD is a disorder of non-recovery?

Answer 371

- no natural recovery - symptoms after trauma are normal, but if they persist and cause distress/dysfunction, it becomes disordered

Question 372

categories of PTSD symptoms

Answer 372

1) recurrent re-experiencing of the event 2) persistent emotional or physiological arousal in response to reminders 3) maladaptive changes in thinking patterns and mood 4) hyperarousal and hyperreactivity

Question 373

PTSD gender differences

Answer 373

- women more likely to develop - men: events often related to injuries/death, natural disaster, physical attacks, war, being threatened, held captive/kidnapping - women: events more often related to rape, sexual molestation, neglect, physical abuse

Question 374

PTSD risk factors

Answer 374

1) pre-event: low SES, low education, low IQ, previous psychiatric history, childhood adversity (abuse) 2) post-event: severity of symptoms, lack of social support, additional stressors 3) interpersonal trauma more likely to provoke PTSD 4) high comorbidity 5) abnormalities in brain volume (smaller hippocampus), dysregulated endocrine function (HPA axis/cortisol) --> cause or effect?

Question 375

distinguishing feature of flashbacks

Answer 375

- lose where you are, think you are back in the memory

Question 376

PTSD treatment approaches

Answer 376

1) exposure therapy: emphasis on imaginal exposures, can include in-vivo if feasible 2) CBT: cognitive restructuring of maladaptive beliefs (test and examine) 3) medication 4) last resort: invasive treatment options ex. DBS

Question 377

acute stress disorder

Answer 377

- similar to PTSD except duration is 3 days to 1 month after trauma exposure - may become PTSD

Question 378

adjustment disorder DSM criteria

Answer 378

1) development of emotional or behavioural symptoms in response to identifiable stressor(s) within 3 months of the onset of the stressor 2) symptoms or behaviours are clinically significant, with one or more of: - marked distress that is out of proportion to the stressor's severity or intensity, taking into account context and cultural factors - significant impairment in social, occupational, or other important areas of functioning 3) does not meet the criteria for another mental disorder and is not an exacerbation of a preexisting one 4) do not represent normal bereavement 5) once stress or consequences have been terminated, symptoms do not persist for more than an additional 6 months (if they do, some other unspecified disorder)

Question 379

criticism of adjustment disorder

Answer 379

- maybe too flexible/catch-all

Question 380

adjustment disorder specifiers

Answer 380

- mood or anxiety symptoms

Question 381

history of dissociative and somatic symptoms disorders

Answer 381

- hysteria - demonic possession - Freud: conversion of anxiety into physical symptoms to avoid internal conflict and responsibilities

Question 382

categories of dissociative disorders

Answer 382

1) dissociative amnesia 2) dissociative identity disorder 3) depersonalization/derealization

Question 383

commonalities between dissociative disorders

Answer 383

- severe maladaptive disruptions or alterations of identity, memory and consciousness that are experienced as being beyond one's control - dissociation: lack of normal integration of one or more aspects of psychological functioning (identity, memory, consciousness, sensorimotor, behaviour)

Question 384

dissociative amnesia primary symptoms

Answer 384

- inability to recall significant personal info in the absence of medical/physical impairment - more common among psychiatric patients than general public

Question 385

dissociative amnesia DSM criteria

Answer 385

1) inability to recall autobiographic info, usually of a traumatic or stressful nature, that is inconsistent with ordinary forgetting - often localized or selective amnesia for a specific event or events - OR generalized amnesia for identity and life history 2) symptoms cause significant distress or impairment in social, occupational or other important areas of functioning 3) not attributable to substance, neurological or medical condition 4) not better explained by DID, PTSD, acute stress disorder, somatic symptom or major/mild neurocognitive disorder

Question 386

dissociative fugue

Answer 386

- specifier for dissociative amnesia - sudden travel away from home in addition to memory loss - can be acute (days) or chronic (months to years) - stressful experiences usually act as precipitating factors - extremely rare

Question 387

depersonalization

Answer 387

- distinct sense of unreality and detachment from thoughts, feelings, sensations, actions, body

Question 388

derealization

Answer 388

- feelings of unreality and detachment from one's surroundings

Question 389

depersonalization/derealization disorder

Answer 389

1) presence of persistent or recurrent experiences of depersonalization, derealization or both 2) during experiences, reality testing (knowing who you are) remains intact - if not = flashback or hallucination 3) symptoms cause clinically significant distress or impairment 4) not attributable to substance or medical condition 4) not better explained by other disorders

Question 390

common intervention for dissociation

Answer 390

- grounding: reconnect to senses in present moment - acute intervention

Question 391

dissociative identity disorder characteristics

Answer 391

- host, alters and switching (multiple personalities) - average diagnostic age = 29-35

Question 392

DID comorbidities

Answer 392

- depression - anxiety - substance abuse disorder - self-injury - non-epileptic seizures

Question 393

DID brain regions

Answer 393

- orbitofrontal cortex - hippocampus - parahippocampal gyrus - amygdala

Question 394

DID DSM criteria

Answer 394

1) may be self-reported or observed: disruption of identity with two or more distinct personality traits with: - marked discontinuity in sense of self and agency - related alterations in affect, behaviour, consciousness, memory, perception, cognition and/or sensorimotor functioning 2) recurrent, significant gaps in recall of everyday events, important personal info, and/or traumatic events (inconsistent with ordinary forgetting) 3) clinically significant distress/impairment 4) not a normal part of broadly accepted cultural or religious practice or pretend play in children

Question 395

danger of memory recovery

Answer 395

- repressed memories are real but clinical approaches to find them are more likely to induce false memory - contemporary research: fMRI for true vs false memories

Question 396

DID trauma model of etiology

Answer 396

- diathesis-stress - personality traits: high hypnotisability, fantasy proneness, openness to altered states of consciousness - dissociation as a defense mechanism for trauma

Question 397

DID and attachment theory

Answer 397

- disorganized attachment as babies = more vulnerable to developing DID

Question 398

DID socio-cognitive model of etiology

Answer 398

- iatrogenic: manufactured or amplified by therapy - culture/media influenced (increased) prevalence

Question 399

types of somatic symptom and related disorders

Answer 399

1) somatic symptom disorder 2) illness anxiety disorder 3) conversion disorder 4) factitious disorder *all share predominant focus on bodily concerns --> dysfunction and distress associated with it is the disorder!

Question 400

hypochondriasis

Answer 400

- older concept: preoccupation with fear of having a serious medical disease - now split into two other categories: somatic symptom and illness anxiety disorder

Question 401

somatic symptom vs illness anxiety disorder

Answer 401

- somatic: has significant symptoms including pain, can have (or not) a diagnosed illness - illness anxiety: no significant bodily symptoms

Question 402

subtypes of illness anxiety disorder

Answer 402

- care-seeking - care-avoidant

Question 403

somatic symptom disorder DSM criteria

Answer 403

1) 1+ somatic symptoms that are distressing or result in dysfunction 2) excessive thoughts, feelings or behaviours related to the somatic symptom or associated health concerns; at least one of: - disproportionate and persistent thoughts about the severity of one's symptoms - persistently high anxiety about health or symptoms - excessive time and energy devoted to symptoms or health concerns 3) state of being symptomatic is persistent, typically more than 6 months (although somatic symptoms may come and go)

Question 404

somatic symptom disorder specifiers

Answer 404

1) with predominant pain 2) persistent: more than 6 months

Question 405

illness anxiety disorder DSM criteria

Answer 405

1) preoccupation with having or acquiring a serious illness 2) somatic symptoms not present OR if present, only mild. if another medical condition is present or high risk, preoccupation is excessive or disproportionate 3) high level of anxiety about health, individual is easily alarmed by personal health status 4) excessive health-related behaviours or maladaptive avoidance 5) at least 6 months, although specific feared illness may change

Question 406

conversion disorder characteristics

Answer 406

- aka functional neurological symptom disorder - features: 1) loss of functioning in body part 2) no underlying medical abnormality 3) psychological factors associated with condition - viewed as form of dissociative disorder (high comorbidity + high scores of dissociative experiences, hypnotizability, childhood abuse and trauma)

Question 407

conversion disorder DSM

Answer 407

1) 1+ symptoms of altered voluntary motor or sensory functioning 2) clinical findings provide evidence of incompatibility between the symptoms and recognized neurological or medical conditions 3) symptom or deficit not better explained by other medical or mental disorder 4) significant distress or dysfunction or warrants medical evaluation

Question 408

factitious disorder characteristics

Answer 408

- aka munchausen syndrome - features: 1) faking symptoms of illness 2) symptoms include physiological and/or psychiatric 3) aim to gain sympathy, care and attention - conscious of faking (voluntary)

Question 409

distinction between somatic symptom disorders

Answer 409

1) involuntary - physical symptoms = somatic symptom disorder - neurological symptoms = conversion - preoccupation with symptoms = illness anxiety 2) voluntary - wants sick role (abstract goal) = factitious disorder - wants direct, specific gain = malingering (not a disorder!)

Question 410

factitious disorder DSM criteria

Answer 410

1) falsification of physical or psychological signs or symptoms, or induction of injury or disease, associated with identified deception 2) individual presents themself to others as ill, impaired or injured 3) deceptive behaviour evident even in the absence of obvious external rewards 4) behaviour not better explained by other mental disorder

Question 411

etiology of somatic symptom and related disorders

Answer 411

1) psychoanalytic: conversion of anxiety associated with unconscious conflicts 2) physiological: HPA axis 3) cognitive: dysfunctional beliefs about illness 4) personality traits 5) early life experiences 6) social learning: adopting the sick role (imitation or by experience)

Question 412

spectrum of eating behaviours

Answer 412

- restriction and control of appetite - normalcy - lack of control and an excessive appetite (at least some period)

Question 413

why weren't eating disorders studied until the 1980s (DSM III)?

Answer 413

- cultural changes in 60-70s promoting thin ideal - anorexia nervosa was in DSM I but remained very rare - bulimia introduced in III - binge eating disorder in V

Question 414

early understanding of anorexia nervosa

Answer 414

- 1870s: first described as women who deliberately sought to lose weight - other independent descriptions including symptoms like: significant weight loss, slow pulse rate, skin changes, loss of menstruation (perversions of ego, excluded men) - differentiated from hysteria - one viewed as a form of hysteria --> psychological reactions to food and eating - treatment plan: force feeding

Question 415

feeding/eating disorders

Answer 415

- avoidant/restrictive food intake disorder (ARFID) - pica - rumination disorder - anorexia nervosa - bulimia nervosa - binge eating disorder - other specified (formerly EDNOS) - unspecified (least informative)

Question 416

ARFID

Answer 416

- pathological "picky eating" leading to nutritional deficiency (distress and dysfunction) - most common in children - criteria: 1) disturbance in eating (lack of interest, avoidance based on sensory characteristics, concern about aversive consequences) as manifested by failure to meet appropriate nutritional/energy needs: significant weight loss, nutritional deficiency, dependence on enteral feeding or oral supplements, interference with psychosocial functioning 2) not better explained by lack of available food or cultural practices 3) not associated with AN/BN (no evidence of shape/weight concerns) 4) not attributable to another medical condition or mental disorder

Question 417

pica

Answer 417

- repetitive eating of non-food (no nutritional) substances that leads to distress/dysfunction (ex. danger) - ex. ice, dirt, paint chips, clay, paper - 1/4 of children, 1/2 of pregnant women - patients claim they eat because of cravings, to reduce nausea or because they like the taste - could be due to nutrient deficiency

Question 418

rumination disorder

Answer 418

- regurgitation (voluntary or involuntary) and re-chewing of food followed by re-swallowing or spitting out - more common in infants and young children, but also observed in adults

Question 419

anorexia nervosa general characteristics

Answer 419

- intense fear of gaining weight or becoming fat (irrational, because despite low weight) - restriction: calories or food refusal, may involve rituals - compensatory measures after eating (excessive exercise, hyperactivity that also might be due to malnutrition, purging) - conflicts between parents/children are common, leading to secretive behaviors - disturbance in body image: general dissatisfaction (overall weight or shape is unacceptable or distressing), patients perceive body parts to be bigger than they actually are - low self-esteem - hypervigilance in assessing their body

Question 420

purging

Answer 420

- behaviors used to maintain weight loss - self-induced vomiting - laxatives - overuse of enemas and diuretics (ex. digestive teas)

Question 421

AN DSM criteria

Answer 421

1) restriction of energy intake relative to requirements, leading to significantly low body weight 2) intense fear of gaining weight or of becoming fat, OR persistent behavior that interferes with weight gain, even though at a significantly low weight 3) disturbance in the way which one's body weight or shape is experienced, undue influence of body weight or shape on self evaluation OR persistent lack of recognition of the seriousness of the current body weight

Question 422

AN subtypes

Answer 422

1) restricting: in last 3 months, has not engaged in recurrent binge eating or purging - weight loss is primarily through dieting, fasting and/or excessive exercise 2) binge eating/purging: in last 3 months, has engaged in recurrent binge eating or purging

Question 423

AN changes from DSM IV

Answer 423

- removed amenorrhea criteria - males can officially get disorder

Question 424

assessing criterion A for AN

Answer 424

- use BMI to determine severity - have to adjust for age, sex, ethnicity

Question 425

binge-eating disorder general characteristics

Answer 425

- typically overweight because NO compensatory ritual - weekly objective binges: eating large amount of food in less than two hours, usually perceived as being out of control - the most common ED

Question 426

objective vs subjective binge?

Answer 426

- no firm threshold - clinician has to decide - often, bimodal distribution: binging is well beyond threshold

Question 427

binge eating disorder DSM

Answer 427

1) recurrent objective binge eating 2) binge eating episodes are associated with 3+ of: - eating more rapidly than normal - eating until uncomfortably full - eating large amounts even when not physically hungry - eating alone because of embarrassment - feeling guilty, disgusted or depressed after 3) marked distress regarding binges 4) binges occur at least once a week for 3 months on average 5) binging not a compensatory behavior as in BN, and does not occur exclusively during course of BN or AN

Question 428

BN characteristics

Answer 428

- binging coupled with compensatory behaviors (fasting, exercise, purging) DESIGNED to prevent weight gain - low self-esteem - weight and body shape becomes primary variable to self-evaluation - social isolation and depression - usually normal BMI (harder to detect problem) - binge usually associated with physical discomfort and guilt/worry

Question 429

purging in BN

Answer 429

- might alleviate feelings (ex. vomiting to reduce physical discomfort in stomach) - has medical consequences: impaired renal function, CV difficulties (ex. arrhythmias)

Question 430

alternative reasons for binges

Answer 430

- escape from self-awareness - high expectations of themselves, constant monitoring and failing to meet often unrealistic standards - awareness = anxiety, depression = motivation to escape via sensory overload from binging

Question 431

vicious diet cycle

Answer 431

1) diet 2) famine response: lose weight from lean muscle and fat, reduced metabolic rate, increase in fat storage 3) fall off 4) feast response: reduced metabolic rate, loss of muscle, regain weight from fat 5) overweight and repeat

Question 432

BN DSM criteria

Answer 432

1) recurrent episodes of binge eating, characterized by both of: - eating more food than a normal person would eat in a given time period ex. 2 hrs - sense of lack of control 2) recurrent inappropriate compensatory behaviors to prevent weight gain 3) on average, occurs ate least once a week for three months 4) self-evaluation unduly influenced by body shape and weight 5) disturbance does not occur exclusively during episodes of AN

Question 433

AN vs BN

Answer 433

- body weight: AN < BN - restriction more prevalent in AN - purging in AN is for weight loss, not as compensation - in BN, purging and binging coupled more closely in time + no weight loss typically

Question 434

EDNOS examples

Answer 434

1) atypical AN: all criteria met except weight normal 2) BN or BED with low frequency or limited duration 3) purging disorder: no binging 4) night eating syndrome: binging at specific times at night

Question 435

assessment and diagnostic considerations in eating disorders

Answer 435

- rule out medical conditions: ex. Kleine-Levin symptom, GI problems, HIV - rule out other mental disorders: MDD, phobias - can only have on ED at a time

Question 436

criticisms of pre DSM-5 ED diagnosis

Answer 436

- ED should be rated as one disorder on a continuum of severity (research suggests) - 50% people who have AN will also develop BN or other bulimic problems at some point in their life - people often switch from one category to another and back (decreases utility of diagnosis) - most AN in teens, BN in late teens-early adulthood, BED in adults --> dimension of age might be involved as well

Question 437

alternative models for ED

Answer 437

1) age 2) weight 3) anxiety seems more related to AN, depression to BN/BED 4) distinct physiological consequences

Question 438

incidence and prevalence of ED

Answer 438

- some research suggesting in creasing prevalence - could be due to more awareness or changes to DSM-5 - most common in teen women

Question 439

ED prognosis

Answer 439

- highest mortality rate (starvation, dehydration and nutritional complications - variable treatment response: only 50% able to stop binging/purging, high relapse rates, commonly requires in and outpatient treatment - people might switch diagnoses after recovering from one - treatment can be too late or lethal if corrected too quickly (refeeding syndrome)

Question 440

consequences of ED

Answer 440

- significant physical and psychological consequences - most are reversible over time

Question 441

lanugo

Answer 441

- peach fuzz to maintain warmth

Question 442

Russell's sign

Answer 442

- patterns of scars/signs on knuckles resulting from purges

Question 443

genetic etiology of EDs

Answer 443

- predisposition may be genetic - possible link to reduced density of serotonin transporters - gender differences in serotonergic system may make women more susceptible (dysregulated serotonin more likely, dieting alters brain serotonin more significantly in women compared to men)

Question 444

sociocultural factors in ED

Answer 444

- thin ideals increased dramatically, even though body weight has increased over time --> discrepancy leads to negative affect (guilt/shame), body dissatisfaction, dieting, exercise - internalization of media images is risk factor, fueled by social media - for men: ideal is to become more muscular

Question 445

are EDs culturally-bound?

Answer 445

- AN/BN occur more frequently in westernized culture - AN does not appear to be culturally bound - however, weight concerns and BN may be - culture-bound = syndrome restricted to a limited number of cultures by reason of certain of their psychosocial features

Question 446

family factors in ED

Answer 446

- family communication about weight, food, thinness and dieting can be risk factor - ex. mothers who diet or who are dissatisfied with weight/appearance are more likely to have daughters that are similar - critical, coercive, emphasize weight/appearance = worse outcomes for ED - ex. daughters with ED rated less attractive by mothers, perceived lack of care from them - ex. children with mothers with ED have higher concerns about weight, shape and diets (also higher negative affect)

Question 447

personality/individual differences in ED

Answer 447

1) AN/BN: perfectionism, obsessiveness, compliance, lack of awareness of feelings/emotions (alexithymia), negative self view 2) BN: impulsivity 3) other IDs: low self-esteem, identity disturbance, depressive affect, poor body image, dieting, excessive exercise *some research suggests BPD/OCPD symptoms in EDs

Question 448

maturational factors in ED

Answer 448

- puberty takes females farther away from ideal weight + different levels of body fat - puberty also increases their awareness of sex roles, consent, dating, sexuality, negative portrayal of overly sexual women in media --> more stressful for females

Question 449

adverse events in ED

Answer 449

- traumatic events affect self-esteem, body image and sense of control - high rates of sexual trauma or abuse in EDs - some studies suggest trauma is more strongly associated with bulimic behavior as opposed to restriction

Question 450

integrative models for EDs

Answer 450

- integrate many of the risk factors and other models

Question 451

ED in males?

Answer 451

- lower prevalence - men exposed to less diet-related info - men tend to want to increase weight (muscle mass) - some evidence that EDs are higher in LGBTQ+ individuals, but body dissatisfaction is a more prominent predictor

Question 452

biological approaches to treating EDs

Answer 452

- AN: SSRIs may exacerbate eating symptoms (side effect = decreased appetite), so best treatment is to increase weight through food (safe and gradual) and develop normalized eating patterns (ex. by group meals) - BN/BED: SSRIs can improve, but CBT is better

Question 453

CBT for EDs

Answer 453

- three stages: 1) establish regular pattern of eating: psychoeducation, models of EDs and connection between restriction/binges, self-monitoring, food diaries 2) normalized eating without dieting: behavioural strategies for meal planning, stimulus control, problem-solving to reduce stressors/negative affect, modifying dysfunctional thoughts and beliefs (especially about weight/shape) 3) strategies to maintain change and prevent relapse, ex. mindfulness

Question 454

other ED therapies

Answer 454

1) IPT: maladaptive personal relationships and ways of interacting with each other (doesn't actually target eating behaviour!) 2) nutritional therapy and meal support 3) family therapy: explore whole family dynamic and gives responsibility for recovery to patient and relatives

Question 455

prevention interventions for EDs

Answer 455

- self-help and internet-based protocols about eating - campaigns/school programs to reduce dissatisfaction with body image, especially among girls

Question 456

history of addiction

Answer 456

1) pre-industrial = morally responsible 2) WWII = moral/disease 3) late 90s = brain disease model of addiction (BDMA) = biological 4) current = debate about brain disease

Question 457

current definitions of addiction

Answer 457

1) disease/BDMA 2) moral 3) psychological: personal deficiencies (sensitivities) 4) learning 5) spiritual 6) nature: innate drive 7) sociological: environmental deficiencies, ex. SES 8) disorder-of-choice 9) biopsychosocial

Question 458

categories of substance use disorders

Answer 458

1) substance use: - alcohol - cannabis - PCP/other hallucinogen - inhalant - opioid - sedative/hypnotic/anxiolytic - stimulant - tobacco - other/unspecified 2) behavioural use: - problem gambling - internet gaming 3) absent: - caffeine use - polysubstance use

Question 459

why was addiction reintroduced into DSM-V?

Answer 459

- know that a number of behaviors can also be addictive

Question 460

substance abuse vs dependence in DSM IV

Answer 460

- abuse = 1 of 4 abuse symptoms (relatively less severe) - dependence = 3 of 7 dependence symptoms (would trump abuse)

Question 461

diagnostic indicators of substance abuse

Answer 461

1) impairment of control 2) social impairment 3) risky use 4) pharmacological dependence (tolerance and withdrawal)

Question 462

tolerance

Answer 462

need increased amounts to achieve same effect

Question 463

withdrawal

Answer 463

- unpleasant and sometimes dangerous symptoms when substance is removed from body - ex. nausea, headache, tremors - result of changes that body has undergone in order to adapt to continued presence of drug

Question 464

substance-induced disorders

Answer 464

symptoms only occur during substance use

Question 465

impairment of control (1-4)

Answer 465

1) substance taken in larger amounts or over longer period than intended 2) persistent desire or unsuccessful attempts to cut down or control use 3) great deal of time is spent obtaining, using or recovering from substance 4) craving or strong desire/urge to use (that controls behavior)

Question 466

social impairment (5-7)

Answer 466

5) recurrent use resulting in failure to fulfill major obligations at work, school or home 6) continued use despite persistent/recurrent social or interpersonal problems caused by substance effects 7) important social, occupational or recreational activities are given up or reduced because of substance use

Question 467

risky use indicators (8-9)

Answer 467

8) recurrent use in situations where it is physically dangerous 9) use despite knowledge of persistent or recurrent effect on physical or psychological problems

Question 468

pharmacological dependence (10-11)

Answer 468

10) tolerance to the substance 11) withdrawal syndrome

Question 469

alcohol withdrawal and reinforcement

Answer 469

- negative reinforcement: drinking again reduces withdrawal

Question 470

alcohol withdrawal length

Answer 470

- can last up to 1 year

Question 471

alcohol/substance use disorder DSM criteria

Answer 471

1) problematic pattern of usage leading to clinically significant impairment or distress, must have 2+ of symptoms within a 12 month period

Question 472

SUD severity

Answer 472

- based on symptom count - mild = 2-3 - moderate = 4-5 - severe = 6+

Question 473

other substance use disorders

Answer 473

1) substance intoxication: lasts only for time intoxicated 2) substance withdrawal 3) substance or medication-induced [category] disorder (ex. cannabis-induced psychotic disorder)

Question 474

polysubstance abuse

Answer 474

- no longer disorder in DSM - when 2+ substances are misused simultaneously - fairly common among SUD patients

Question 475

alcohol use trends

Answer 475

- many cultures have underlying social acceptability to drink and be drunk - use peaks in mid-twenties, higher among single, high-income and post-secondary education - however, the heaviest drinkers are low education and out of work

Question 476

alcohol use categories

Answer 476

1) light infrequent: low # and frequency 2) light frequent: low #, high frequency 3) heavy infrequent: high #, low frequency 4) heavy frequent: high # and frequency (riskiest group)

Question 477

AUDIT

Answer 477

popular screening scale (free) for risk of AUD --> relationship between consumption levels and overall risk for AUD

Question 478

binge drinking

Answer 478

5+ drinks in one sitting

Question 479

updated government of Canada guidelines for alcohol use

Answer 479

- no risk = 0 drinks per week - any amount of drinks increases risk of harm (cumulatively) - body weight not considered here or in DSM!

Question 480

how does alcohol work?

Answer 480

- active ingredient = ethyl alcohol - effects: anxiety reduction, euphoria, sense of well-being, reduced inhibitions - passes into blood from stomach, most absorbed by small intestine - rate and peak level of absorption depend on how quickly alcohol gets through stomach and intestine - concentration expressed in blood alcohol level (BAL)

Question 481

blackouts from alcohol use

Answer 481

- drinking quickly and on empty stomach - person cannot recall key details or entire events

Question 482

short-term effects of alcohol

Answer 482

hangovers, sleep disruption, DUI, impulsive behaviors

Question 483

social effects of alcohol

Answer 483

- can affect relationships and social life physical ,health, happiness, finances, homelife/marriage, work/school, legal problems

Question 484

fetal alcohol spectrum disorder

Answer 484

- mothers drinking during pregnancy associated with physical abnormalities and cognitive deficits - fetal alcohol syndrome is the most severe form

Question 485

(Wernicke-)Korsakoff's syndrome

Answer 485

- serious cases of alcohol use - cell loss in hypothalamus, thalamus and hippocampus - impaired memory/loss of contact with reality - aka "Wet Brain"

Question 486

biological/genetic etiology of AUD

Answer 486

- enzyme levels: aldehyde dehydrogenase (metabolizes alcohol) reduced in Asian-descent individuals - physiological sensitivity to rewarding properties of alcohol - neurotransmitters: GABA, serotonin, beta-endorphin - genes: GABA, glutamate, serotonin, dopamine, cholinergic, opioid systems - MZ > DZ twin concordance rate, stronger for males - males at higher risk generally

Question 487

psychological factors in AUD

Answer 487

- "addictive personality": behavioral disinhibition, negative emotionality, neuroticism - theories: 1) tension-reduction hypothesis: negative reinforcement 2) alcohol expectancy theory: alcohol-related cognitive beliefs 3) classical conditioning and behavioral tolerance (feel more functional even when intoxicated)

Question 488

sociocultural factors in AUD

Answer 488

- rite of passage, sign of maturity, cultural or family tradition, attitudes - adolescent drinking typically mirrors parent patterns (ex. coping with stress)

Question 489

sedatives, hypnotics, anxiolytics (barbs/benzos)

Answer 489

- CNS depressants - barbituric acid first treatment of anxiety and tension --> parent compound of barbiturate drugs, high addiction potential - benzodiazapenes are new class of drugs, but still have moderate potential for addiction (esp because of neg. reinforcment) - dangerous when combined with other depressants (ex. alcohol) because of synergistic effects (can cause death)

Question 490

effects of barbs/benzos

Answer 490

- small doses = mild euphoria - larger doses = slurred speech, poor coordination, impairment of judgment and concentration, sleep - chronic use: depression, fatigue, mood swings, paranoia, memory/judgement impairment

Question 491

abstinence syndrome

Answer 491

- caused by benzodiazepine withdrawal - insomnia, headaches, aching, anxiety, depression - can last for months - in serious cases, abrupt discontinuation can cause delirium, convulsions, death

Question 492

tobacco (nicotine)

Answer 492

- small but potent dose of nicotine in cigarettes - fast acting because enters through inhalation, transported quickly to brain - many long-term health risks, even with second-hand smoke

Question 493

nicotine effects

Answer 493

- pure: interferes with thinking and problem solving, agitation and irritability, mood changes - cigarettes: increases alertness, improves mood = positive reinforcement

Question 494

tobacco dependence

Answer 494

- considered highly addictive - most addiction is to prevent withdrawal (negative reinforcement) - lots of time spent obtaining cigarettes, most people recognize health consequences but continue regardless - some people might be more sensitive to nicotine (related to effect on dopaminergic neurons)

Question 495

tobacco and alcohol effect

Answer 495

- synergistic - alcohol stimulates dopamine release indirectly at cell body and terminals - nicotine mimics Ach at nicotinic receptors to directly activate dopamine cells

Question 496

amphetamines

Answer 496

- mimic adrenaline - originally for medical purposes: asthma, ADHD, narcolepsy, suppressing appetite for obesity - two forms: methamphetamine and dextroamphetamine (legally prescribed)

Question 497

amphetamine effects

Answer 497

- low dose: increase alertness, focus attention, improved performance on cog. tasks (popular for truckers, athletes and students) - high: exhilaration, extroversion, confidence - very high: agitation and anxiety - chronic: hallucinations, delirium, paranoia (toxic psychosis) - physical: increased/irregular heartbeat, fluctuations in BP, hot/cold flashes, nausea, weakness, dilation, weight loss, seizures, confusion, coma - potential for violent and aggressive behavior while on drug

Question 498

amphetamine tolerance, dependence and withdrawal

Answer 498

- ecstasy: debate over whether there is a permanent depletion of serotonin in the long term - amphetamine tolerance and dependence: quick because of crashing (fatigue, irritability, sadness, cravings) - withdrawal: apathy and prolonged sleeping

Question 499

cocaine effects

Answer 499

- low dose: euphoria, confidence, alert, talkative, reduced appetite, increased excitement and energy - high: poor muscle control, confusion, anxiety, anger, mood swings, aggression, anhedonia, weight loss, insomnia, toxic psychosis - physical: increased blood pressure and temperature, irregular heartbeat, chest pain, nausea, blurred vision, fever, muscle spasms, convulsions, coma, death

Question 500

cocaine

Answer 500

- used to reduce fatigue and induce euphoria (triggers dopamine release) - originally in many drinks, cigarettes, used occasionally as local anesthetic - snorting increases metabolism rate - short-acting, wears off quicky

Question 501

cocaine dependence and withdrawal

Answer 501

- huge crash: intense cravings, depression, paranoia, fatigue - can take more than a month to get rid of withdrawal

Question 502

caffeine

Answer 502

- also a stimulant - dopamine, serotonin and NE

Question 503

caffeine effects

Answer 503

- 1-2 doses: increase attention, problem-solving skills, improves mood - 6-7 doses: muscle tremors, agitation, excessive talkativeness, disorganized thinking, rapid/irregular heartbeat (resembles hypomania)

Question 504

caffeine dependence

Answer 504

- >350mg used per day - leads to unpleasant withdrawal symptoms

Question 505

opioid types

Answer 505

1) morphine (severe pain)/codeine (small doses in cough syrups and painkillers): refined from opium 2) semi-synthetic: derived from natural opiates 3) synthetic forms: manufactured 4) endogenous form in humans: endorphins

Question 506

opioid function

Answer 506

CNS depressant

Question 507

prescription opioid abuse

Answer 507

- major problem in Canada

Question 508

opioid effects

Answer 508

- mimic endorphins, affecting brain and spinal cord - low doses: euphoria, relaxation, appetite suppressant, restlessness, nausea and vomiting - high: dangerous, constricted pupils, blue/cold skin, slow breathing, coma, respiratory depression - chronic: respiratory and pulmonary problems, endocarditis, abscesses, liver disease, brain damage, HIV (needles)

Question 509

opioid overdoses

Answer 509

- easy because of tolerance (especially behavioral body tolerance)

Question 510

opioid dependency

Answer 510

- severe withdrawal symptoms, begin ~8hrs - 36hrs: muscle twitching, cramps, hot flashes, HR/BP fluctuations, sleeplessness, vomiting, diarrhea - can last for 10 days - milder opiates often used to cope

Question 511

cannabis effects

Answer 511

- depressant (lowered inhibitions) and stimulant (increased HR) - low: mild changes in perception, enhancement of physical experiences, mildly euphoric, sociability, well-being, relaxation (some have bad reactions) - large doses can produce hallucinations, problems with complex motor skills, short-term memory, reaction-time and attention - long-term: lung problems, cancer risk, psychosis risk - chronic problem: amotivational syndrome

Question 512

cannabis tolerance and withdrawal

Answer 512

- milder withdrawal effects - irritability, anxiety, loss of appetite, restlessness, sleep disturbances, anger/aggression

Question 513

amotivational syndrome

Answer 513

- apathy, detachment and abandonment of school/work - brain function altered by chronic cannabis use - may also be related to depression

Question 514

marijuana therapeutic effects

Answer 514

- low doses alleviate nausea, encourage eating and relieves pressure in eyes - THC is main active ingredient, binds to endogenous endocannabinoid receptors

Question 515

hallucinogens

Answer 515

- change person's mental state by inducing perceptual and sensory distortions - many ways to ingest - effects are fast and short-acting

Question 516

hallucinogen effects

Answer 516

- subjective effects: depending on expectations, personality, setting (ex. uncomfortable or unsafe may lead to intense fear/anxiety that can escalate into panic/psychotic episodes) - sensory experiences: vivid visual hallucinations, perceptual distortions, synesthesia - physiological effect: excites CNS, mimics manic episode, increases 5HT in brain, dilated pupils, increased HR/BP, increased alertness - risk of injury comes from experience on drug

Question 517

problem gambling prevalence

Answer 517

- higher risk for males and being indigenous

Question 518

problem gaming interventions

Answer 518

- focus on motivation for change - internet-based CBT has preliminary efficacy for reducing problem gaming

Question 519

gambling disorder DSM criteria

Answer 519

1) persistent and recurrent problematic gambling, impairment/distress, 4+ of the following in 12-month period: - needs to gamble with increasing amounts of money for desired excitement - restless/irritable when attempting to cut down or stop - repeated unsuccessful efforts to control gambling - often preoccupied with gambling - often gambles when feeling distressed - after losing money, returns to get even - lies to conceal extent of gambling - has jeopardized or lost a significant relationship, job, educational or career opportunity - relies on others for money to relieve financial situations caused by gambling 2) not better explained by mania

Question 520

internet gaming disorder criticism

Answer 520

- internet = tries to acknowledge interpersonal aspect, but leaves out other video games

Question 521

internet gaming disorder prevalence

Answer 521

- risk for adolescent males

Question 522

internet gaming disorder DSM

Answer 522

1) 5+ within 12 months: - preoccupation with internet games - withdrawal symptoms - tolerance - unsuccessful attempts to control participation - loss of interest in other activities - excessive use despite knowledge of psychosocial problems - deceived family members/therapists, etc. - use to escape - lost significant relationship, job or educational/career opportunity

Question 523

SUD routine treatment

Answer 523

- inpatient program focusing on biological dependence (withdrawal) - person allowed to detoxify under medical supervision, sometimes includes prescriptions to wean off drugs - then, psychological dependence treatment: education, individual counselling, group therapy for social skills and communication - abstinence is generally the goal, but harm reduction or moderation may be more optimal/realistic

Question 524

AUD pharmacotherapy

Answer 524

- benzodiazepines - GABA antagonist to reduce cravings - GABA agonist to reduce withdrawal - inhibitors of alcohol dehydrogenase = more negative effects of alcohol

Question 525

alcoholics/narcotics anonymous

Answer 525

- addiction seen as a disease - goal is complete abstinence - focus on person as powerless and need for religion or higher power

Question 526

SMART recovery programs

Answer 526

- secular, flexible and empirically supported - focus on skill building - goal can be either abstinence or harm reduction

Question 527

behavior therapy for SUD

Answer 527

- increase awareness of cues and associated influences - aversive conditioning - contingency management: rules for rewards and punishments for small steps - practices behavioral coping and how to develop contingency contracts

Question 528

cognitive/behavioral self-management for SUD

Answer 528

- restructuring thoughts about drinking (utility, meaning) - recognizing and being aware of patterns - monitoring and SMART goals

Question 529

relapse prevention in SUD

Answer 529

- post-treatment - relapse seen as inadequate cognitive and behavioral coping skills - help individuals recognized distorted self-defeating thoughts and learn from relapse (cognitive restructuring around guilt/failure) - build resilience

Question 530

marital/family therapy for SUD

Answer 530

- focus on relationship - patterns of interaction can maintain substance use behaviors (ex. codependence)

Question 531

brief interventions for SUD

Answer 531

- designed to explore concerns about changing (ex. pros/cons) - motivational interviewing to seek and encourage readiness for change

Question 532

stages of motivation for change

Answer 532

1) precontemplation: denial of consequences, not considering change 2) contemplation: ambivalence, some hesitations 3) preparation: decided to make change 4) action 5) maintenance (6) relapse)

Question 533

treatment for nicotine use disorder

Answer 533

- psychological: counseling, online or community support groups, self-help materials (mostly behavioral or cognitive) - some support for hypnosis - nicotine replacement products: reduce cravings and withdrawal, breaks behavioral habits between smoking and environment - some medications

Question 534

cocaine use treatment

Answer 534

- similar therapy to general SUD - some medication to combat short-term withdrawal

Question 535

opioid biological treatment

Answer 535

- naltrexone: opioid antagonist that interferes with binding - methadone: heroin replacement to reduce cravings after withdrawal - these biological interventions work best with other adjunct programs

Question 536

harm-reduction techniques

Answer 536

- don't reduce use frequency - safe injection sites, often coupled with counseling - needle exchange programs (reduce risk of HIV and hepatitis C)

Question 537

non-abstinent support groups

Answer 537

- abstinence achieved in very low percentage of people who attend abstinent-goal programs

Question 538

traits vs states

Answer 538

- traits = consistent across situations, persistent - states = temporary, conditional or transient patterns

Question 539

personality disorder general definition

Answer 539

- maladaptive patterns of personality traits - enduring pattern of inner experience and behavior that deviates from normal range - pervasive, rigid and inflexible across situations and people - onset = adolescence or early adulthood - stable over time, leading to distress/impairment, including in other people - restricted range of traits compared to those without PDs

Question 540

six formal criteria for defining PDs

Answer 540

1) pattern of behavior manifested in at least two of: cognition, emotion, interpersonal functioning or impulse control 2) enduring pattern of behavior, rigid and consistent across a broad range of personal and social situations 3) behavior should lead to significant distress in social, occupational or other important areas of functioning ex. relationships 4) stability and long duration of symptoms with onset in adolescence or earlier 5) behavior cannot be accounted for by another mental disorder 6) behavioral patterns not the result of substance or medical condition

Question 541

egosyntonic vs egodystonic

Answer 541

- syntonic = not viewed as problematic or impairing, instead consistent with one's self-image/goals - dystonic = cause distress and are viewed as problematic, in conflict with who they are or want to be

Question 542

clusters of PDs

Answer 542

1) odd and eccentric: paranoid, schizoid, schizotypal 2) dramatic, emotional or erratic: antisocial, borderline, histrionic, narcissistic (highly heterogenous cluster, may be underreported) 3) anxious and fearful: avoidant, dependent, obsessive-compulsive (may be overrepresented by self-report questionnaires)

Question 543

previous PDs now removed from DSM

Answer 543

- depressive personality - passive-aggressive (negativistic) - sadistic - self-defeating (masochistic)

Question 544

why is consideration of PD important?

Answer 544

- could disrupt alliance between therapist and client - can be mistaken for Axis I condition and/or can worsen Axis I condition - prognosis is somewhat poor (although improving)

Question 545

PD prevalence rates

Answer 545

- difficult to determine - high in outpatient samples, even higher in inpatient - very high in prisons (largely because of ASPD) - some gender disparities: females = avoidant, dependent, paranoid, borderline; males = antisocial)

Question 546

paranoid personality disorder

Answer 546

- pervasive distrust and suspiciousness of others, such that their motives are interpreted as malevolent - beginning in early adulthood - present in a variety of contexts - 4+ symptoms

Question 547

schizoid personality disorder

Answer 547

- pervasive pattern of detachment from social relationships - restricted range of expression of emotions in interpersonal settings - beginning by early adulthood - present in variety of contexts - 4+ symptoms

Question 548

schizotypal personality disorder

Answer 548

- pervasive social/interpersonal deficits - acute discomfort with and reduced capacity for close relationships - cognitive or perceptual distortions (but not to the degree of delusions or hallucinations) - eccentricities of behavior - beginning early adulthood - present in variety of contexts - 5+ symptoms

Question 549

schizotypal vs psychotic disorder

Answer 549

- some overlap - difference is severity and quality of symptoms

Question 550

histrionic personality disorder

Answer 550

- pervasive pattern of excessive emotionality and attention seeking - beginning by early adulthood - variety of contexts - 5+ of the following

Question 551

narcissitic personality disorder

Answer 551

- pervasive pattern of grandiosity (in fantasy or behavior) - need for admiration - lack of empathy - beginning by early adulthood - variety of contexts - 5+ of the following

Question 552

avoidant personality disorder

Answer 552

- pervasive pattern of social inhibition - feelings of inadequacy - hypersensitivity to negative evaluation - beginning by early adulthood - variety of contexts - 4+ of the following

Question 553

dependent personality disorder

Answer 553

- pervasive and excessive need to be taken care of - leads to submissive and clinging behavior - fears of separation - beginning by early adulthood - variety of contexts - 5+ of the following

Question 554

obsessive-compulsive personality disorder

Answer 554

- pervasive pattern of preoccupation with orderliness, perfectionism and mental and interpersonal control - comes at the expense of flexibility, openness, and efficiency - beginning by early adulthood - variety of contexts - 4+ of the following

Question 555

issues with treatment for PDs

Answer 555

- most patients are not upset by symptoms and do not seek treatment, high dropout rates - comorbid PDs worsens prognosis of Axis I conditions - challenge for the therapist given relationship difficulties - barriers: lack of training, complexity of disorder

Question 556

how to improve treatment for PDs

Answer 556

- conceptualize PD as both biological and psychological - assess the individual's amenability to treatment (how likely they are to stay in) - effective treatment is flexible and tailored - goal is to improve personality-style functioning: flexibility and adaptability

Question 557

pharmacological treatments for PDs

Answer 557

- no first line options: antidepressants, anxiolytics and antipsychotics are common - ASPD/BPD: combo of medications - schizotypal PD: typical antipsychotic and antidepressants

Question 558

object-relations therapy for PD

Answer 558

- differentiation of self from close others (individuation) - relationship between client and therapist helps supportively confront patients defenses and distortions - long-term, usually 1+ years

Question 559

CBT for PDs

Answer 559

- cognitive restructuring of core beliefs - examining flexibility of beliefs - behavioral experiments - similar to schema therapy and transference-focused therapy

Question 560

psychopathy

Answer 560

- broader constellation of symptoms related to emotional, interpersonal, behavioral features rooted in *inability to experience empathy and remorse* - often more criminality and selectively impulsive compared to ASPD (which is more aggression/impulsivity) - usually target people who are easy to manipulate

Question 561

ASPD DSM criteria

Answer 561

1) pervasive pattern of disregard for and violation of the rights of others, occurring since 15, 3+ of: - failure to conform to social norms regarding lawful behaviors, indicated by repeatedly performing acts that are grounds for arrest - deceitfulness for personal profit or pleasure: repeated lying, use of aliases, conning others - impulsivity or failure to plan ahead - irritability and aggressiveness: repeated physical fights or assaults - reckless disregard for safety of self or others - consistent irresponsibility: failure to sustain consistent work behavior or honor financial obligations - lack of remorse: being indifferent to or rationalizing having hurt, mistreated or stolen from another 2) 18+ 3) evidence of CD before 15+ (does not have to be diagnosed) 4) rule out psychotic disorders

Question 562

ASPD etiology

Answer 562

1) family systems: parenting behaviors 2) genetics: aggressive and impulsive markers with high heritability 3) environment: "criminogenic" = poor parenting, neglect, abuse 4) fearless hypothesis: higher threshold for fear 5) emotional/physical abuse: punishment not contingent with behavior leads to indifference from physical punishment or being oppositional to attempts at controlling them

Question 563

ASPD treatment

Answer 563

- burnout tends to happen around 40s - usually delivered in forensic hospitals or prisons - structured programmatic materials for psychoeducation, beliefs about aggression/antisocial attitudes, developing self-regulation, assertiveness, substance use, problem-solving - short-term use of psychotropic medications sometimes helps

Question 564

responsivity factor in ASPD

Answer 564

- treatment works better when matched to a patient's needs and interpersonal style

Question 565

machiavellianism

Answer 565

callous, manipulative, amoral and deceptive behavior to achieve power in politics and society

Question 566

psychopathy etiology

Answer 566

- insensitivity to emotional content of information = abnormal PFC, hippocampus, basal ganglia, amygdala - different means of processing emotional material to compensate for absence of appropriate limbic input - lower serotonin and increased dopamine - moderate levels of heritability - association with early emotional deprivation

Question 567

psychopathy prognosis

Answer 567

- typically lifelong - precursors include callous/unemotional traits seen in childhood CD/ODD

Question 568

"borderline" term

Answer 568

- border between neurosis and psychosis - new term suggested is pervasive emotion dysregulation disorder --> this is the core feature - suggested to be more of an emotional disorder vs PD

Question 569

common dimensions in BPD

Answer 569

1) affective instability and dysregulation (most common) 2) identity disturbance / disturbed sense of self 3) interpersonal hypersensitivity 4) behavioral dyscontrol (impulsivity)

Question 570

psychotic features in BPD?

Answer 570

- none - perceptual disturbances and strong beliefs can occur, but more consistent with dissociation

Question 571

BPD prevalence

Answer 571

- more common in women - after ~1- years, about half no longer have pattern of behavior that meets full BPD criteria

Question 572

BPD DSM criteria

Answer 572

1) pervasive pattern of instability of interpersonal relationships, self-image and affects and marked impulsivity beginning early adulthood, present in variety of contexts, 5+ of: - frantic efforts to avoid real or imagined abandonment - pattern of unstable and intense interpersonal relationships: alternating between extremes of idealization and devaluation ("splitting") - identity disturbance - impulsivity in at least two areas that are potentially self-damaging - recurrent suicidal behavior, gestures, threats, or self-mutilation - affective instability due to marked reactivity of mood - chronic feelings of emptiness - inappropriate, intense anger or difficulty controlling anger - transient, stress-related paranoid ideation or sever dissociative symptoms

Question 573

BPD vs BP-II

Answer 573

- quick shifts in BPD (~few hours), almost never lasts a day

Question 574

diagnostic comorbidity of BPD

Answer 574

- high - suggests complex emotional disorder

Question 575

emotion dysregulation in BPD

Answer 575

- under normative conditions, inability to change in a desired way: emotional cues, experiences, actions, verbal responses, nonverbal expressions - seen as consequences of inability to cope effectively in cognitive way --> high utilization of psychiatric services

Question 576

development of emotion dysregulation in BPD

Answer 576

- diathesis-stress model 1) biological/temperament = emotionally sensitive 2) psychological/social = invalidating environments that exacerbate biological vulnerability, shaping thoughts about emotion/expression and limiting opportunities to learn appropriate regulation

Question 577

DBT rationale

Answer 577

- CBT was difficult because pushing people to change without acceptance is difficult - shows promise for multiple conditions in decreasing emotion dysregulation

Question 578

DBT foundations

Answer 578

1) Rogerian: provide source of validation and nonjudgmental support 2) learning theory: behavior patterns become established through classical learning mechanisms 3) zen buddhism: suffering results from particular attachment to things, nonjudgmental acceptance of reality reduces this 4) CBT: change is required and necessary to feel better, focus on skills-based learning, exercises and activities

Question 579

DBT general overview

Answer 579

- individual and group sessions each week - 6 months to a year - telephone consult in crisis times (problem-solving coaching) - team consultation meetings for therapists - ancillary treatments (pharmacotherapy, inpatient, day treatment, etc.)

Question 580

DBT goal hierarchy

Answer 580

1) reduce suicidal behavior 2) reduce therapy interfering behavior 3) reduce behaviors that interfere with quality of life 4) increase behavioral and emotion regulation skills 5) decrease post-traumatic stress behaviors 6) increase self-respect behaviors

Question 581

DBT main principle

Answer 581

- dialectic: process of achieving balance between two opposing processes - pushing hard for change vs. acceptance of problems as they are - communication is needed for balance

Question 582

core strategies of DBT

Answer 582

1) validation 2) commitment 3) behavioral chain analysis 4) problem-solving

Question 583

validation in DBT

Answer 583

- communicating that something about the client's behavior makes sense or is understandable within the current context

Question 584

commitment in DBT

Answer 584

- getting patients to commit to change (clear) - explore pros and cons - Devil's advocate - foot in the door, door in the face - connect to prior commitments - freedom to choose - generate hope and/or cheerlead

Question 585

behavioral chain analysis in DBT

Answer 585

- make patients more aware of their emotions, thoughts, feelings and behaviors 1) identify behavior 2) identify vulnerabilities 3) identify prompting events 4) identify links between prompting event and behavior 5) identify consequences

Question 586

problem-solving in DBT

Answer 586

- after behavioral chain analysis - implement to avoid recurrence of the behavior - increase environmental safety or teach distress tolerance skills

Question 587

PD diagnostic issues (related to etiology and treatment efficacy)

Answer 587

- are they disorders or just traits? - difficulty in defining disorders that is unbiased, reliable and leads to effective treatment/predictions

Question 588

gender/cultural issues with PD diagnosis

Answer 588

- potential confounds - ex. spirit beliefs may be schizotypal, but can also be cultural - ex. emotional PD diagnosed more often in Hispanic individuals (show emotions more) - ex. schizotypal more often diagnosed in African-Americans - sex stereotypes: histronic for women, hesitant to diagnosis males as histronic or females as antisocial

Question 589

reliability of PD diagnosis

Answer 589

- poor across clinicians and measures used - requires thorough evaluation, therefore not always completed - some conditions may not be as chronic as once believed

Question 590

comorbidity and diagnostic criteria overlap in PD

Answer 590

- similar symptoms in one or more PDs when they should be distinct - some vague criteria - highly comorbid with Axis 1 conditions

Question 591

proposed dimensional model for PD

Answer 591

- deleting dependent, histronic, paranoid and schizoid - because of symptom overlap and biases - already absent from ICD

Question 592

attachment theory etiology of PD

Answer 592

- children learn to relate to others by the way their parents relate to them - positive = skills and confidence to relate effectively with others - negative = lack confidence in relationships

Question 593

cognitive-behavioral etiology of PDs

Answer 593

- schemas and compensatory strategies to prevent belief from being activated - coping manners may have been adaptive in childhood, but no longer are in adulthood - parents may model inappropriate styles or unintentionally reinforce the opposite of the desired behavior

Question 594

biological etiology of PDs

Answer 594

- strongest evidence for antisocial PD - some dimensions: cognitive-perceptual organization, impulsivity/aggression spectrum, affective stability-instability, anxiety-inhibition - transmission of non-disorder specific genetic risk factors (relatives of disordered individual sometimes have PDs)

Question 595

course takeaways

Answer 595

1) dividing line between normal and abnormal is unclear 2) DSM is still just a guideline 3) the essential ingredients of therapy are not unique to therapy