Final Exam Flashcards
What initiates the “fight-or-flight” response? (A stress response)
Stress Exposure
Hypothalamus activates:
Sympathetic Nervous System and Hypothalamic-Pituitary-Adrenal (HPA) axis
Increased heart rate, increased respiration, decreased digestion
Sympathetic Nervous System
Triggers release of stress hormones, e.g., cortisol
Hypothalamic-Pituitary-Adrenal (HPA) axis
Stress response (F/F) in short term
Adaptive
Overractivation/repeated activation of the stress response in long term
Maladaptive
Symptoms begin within four weeks of traumatic event; lasts for less than one month
Acute Stress Disorder (ASD)
Symptoms may begin either shortly after the exposure to traumatic event, or months or years afterward and last for at least one month
Posttraumatic Stress Disorder
The 4 symptom clusters of PTSD
Intrusion Symptoms, Avoidance Symptoms, Negative Alterations in Cognitions & Mood Symptoms, and Alterations in Arousal & Reactivity Symptoms
Intrusive memories, nightmares, flashbacks, psychological and physiological distress at reminders
Intrusion Symptoms
Avoids memories, thoughts, feelings associated with the trauma; avoids external reminders (e.g., conversations, activities, places, people) of trauma
Avoidance Symptoms
Forgets parts of the trauma, persistent, distorted cognitions about the cause or consequences of the trauma that leads individual to blame self, diminished interest and estrangement from others
Negative Alterations in Cognitions & Mood Symptoms
Irritability, reckless or self-destructive behavior, hypervigilance, exaggerated startle response, problems with concentration, sleep problems
Alterations in Arousal & Reactivity Symptoms
Lifetime prevalence of trauma exposure:
Women = 50%
Men = 60%
Lifetime prevalence of PTSD
8%, Women = 10%, Men = 5%
T/F: Most people who experience trauma do develop PTSD
False; most people who experience trauma do not develop PTSD
Who develops PTSD?
People with childhood experiences of trauma (greater risk) and people who lack social support
Through repeated exposure to fearful situations
OR
Through repeated exposure to perception of life threats
Excessive Activation of Stress Response
Features of the trauma that predicts who develops PTSD
- Direct exposure
- Life threat/injury
- Frequency of trauma (single incident event versus multiple traumas)
Severity of Trauma
Witnessing someone being badly injured or killed
Being involved in a natural disaster or a life threatening accident
Combat exposure
Frequently experienced traumas
Prolonged Exposure (Foa) - behavioral
Cognitive Processing Therapy (Resick) - CBT
Exposure-based treatments for PTSD
Teaches you to gradually approach trauma-related memories, feelings, and situations
Prolonged Exposure (PE)
Teaches you how to evaluate and change upsetting thoughts had since trauma; would usually write about the trauma
Cognitive Processing Therapy (CPT)
Other Treatments for PTSD
Eye Movement Desensitization and Reprocessing (EMDR) and Medication (SSRIs)
A. Restriction of energy intake relative to requirements, leading to a significantly low body weight in context of age & sex
B. Intense fear of gaining weight/becoming fat, or persistent behavior that interferes with weight gain, even though significantly underweight
C. Disturbance in the way one’s body weight/shape is experienced; lack of recognition of seriousness of low body weight
Anorexia Nervosa (AN)
Subtypes of AN
Restricting Type and Binge-Eating/Purging Type
Lose weight by restricting “bad” foods (e.g., dieting, fasting), eventually restricting nearly all food
Show almost no variability in diet
No recurrent episodes of bingeing/purging in last 3 mo
Restricting Type
Lose weight by vomiting after meals, abusing laxatives or diuretics, or engaging in excessive exercise over past 3 mo
- Like those with bulimia nervosa, people with this subtype may engage in eating binges
Binge-Eating/Purging Type
90-95% female
Peak onset btwn 14-18 years
2-6% die from medical complications
Prevalence of AN
.5-2% of females, and .9% of men in Western countries
Lifetime Prevalence (AN)
- Motivated by fear of becoming obese and losing control
- Preoccupation with food
- Distorted thoughts
- Comorbid depression, anxiety, substance abuse, OCD
- Can result in medical problems such as lowered heart rate and lanugo (soft hair that covers body (think newborn))
Characteristics of AN
Defining Feature of AN
Being significantly underweight
A. Recurrent episodes of binge eating
- Eating, in a discrete time period, an amount of food that is larger than most people would eat during a similar period of time
- Sense of lack of control over eating during the episode
B. Recurrent inappropriate compensatory behavior to prevent weight gain (e.g., laxatives, vomiting, fasting, excessive exercise)
C. Both A&B occur at least once a week for 3 months
D. Self-evaluation is unduly influenced by body shape and weight
E. Does not occur during episodes of AN
Bulimia Nervosa (BN)
Usually preceded by feelings of great tension and/or powerlessness; may be pleasurable, followed by extreme self-blame, guilt, depression, and fears of weight gain and “discovery”; carried out in secret (averaging 10 a week)
Binges
90-95% female
Peak onset between 15 - 21
Typically normal weight
Prevalence of BN
1.5-5% in women (higher in college students), .5% in men
Lifetime Prevalence (BN)
A. Pattern of binge eating
B. Binge-eating episodes are associated with eating much more rapidly than normal, eating until feeling uncomfortably full, eating large amounts of food when not feeling physically hungry, eating alone bc of embarrassment by how much one is eating, feeling disgusted with oneself, depressed, or guilty afterward
C. Marked distress regarding binge eating
D. Binge eating occurs, on average, at least 1x/week for 3 mo
Binge-Eating Disorder (BED)
Approx. 3.5% in women and 2% among men
Impacts a more diverse group of individuals
Prevalence of BED
T/F: African American teenagers are 50% more likely than Caucasian teenagers to show bulimic behavior (bingeing & purging)
True
Biological factors, psychological problems (cognitive and mood disturbances), sociocultural conditions (environmental stress, societal risks, family environment)
Causes of ED
Identical twins (70%) vs fraternal twins (20%)
Genetic Component to AN
Identical twins (23%) vs fraternal twins (9%)
Genetic Component to BN
Relatives of those with an ED are up to 6 times more likely to develop the disorder; low serotonin
Genetic Component to eating disorders
Controls eating and weight; regulates feelings of hunger
Hypothalamus Dysfunction
Depression may set the stage for eating disorders
Mood Disorders
Internal mental filters or biases that increase misery, anxiety, and self consciousness; errors in thinking (Beck)
Cognitive Distortions
Changing standards of attractiveness, prejudice towards overweight individuals, abuse & racism
Societal pressures & Environmental stress
Supportive nursing care (increase patient’s diet)
Family therapy
Cognitive behavioral treatment
Poor prognosis overall
AN Treatments
Cognitive therapy (change maladaptive thoughts)
Behavioral therapy (food diary, ERP)
Interpersonal therapy (improve i-p functioning)
Antidepressant drug therapy
Poor prognosis overall
BN Treatments
Positive symptoms of Schizophrenia
Delusions, hallucinations, and disorganized thinking and speech
False beliefs
- Persecution (plotted against, spied on)
- Reference (attach personal meaning to others’ actions/objects)
- Grandeur (special powers)
- Control (patients thoughts/feelings/actions controlled by others)
Delusions
False sensory perceptions
Hallucinations
Loose associations or derailment (word salad)
Neologisms (made up word)
Perseveration (using same word/theme repeatedly)
Clang (rhyme)
Disorganized Thinking and Speech
Diminished interest, anhedonia (lack of pleasure), social withdrawal, poverty of speech (or alogia), blunted affect, avolition (or apathy)
Negative Symptoms of Schizophrenia
Awkward movements, grimaces, odd gestures, catatonia (person stays still)
Psychomotor Symptoms of Schizophrenia
late teens to 30s
Onset of Schizophrenia
Phases of Schizophrenia
Prodromal, Active, and Residual
- Higher pre-morbid functioning
- Abrupt onset (versus insidious onset)
- Onset triggered by stress
- Later onset (middle age)
Good Prognosis of Schizophrenia
Higher rates of SZ in people from lower socioeconomic status; illness causes one to have downward shift in social class
Downward Drift Theory
Genetic factors (twin research)
Virus theory
Dopamine hypothesis (too much of it in SZ)
Abnormal brain structure
Biological Causes in SZ
Family stress (high expressed emotion)
Psychological and psychosocial theories
Reduce levels of dopamine
65% effective
Side effects: extrapyramidal side effects (muscle tremors & rigidity). After one year of medication -> Tardive Dyskinesia (tic-like movements of face and arms)
Conventional (1st gen) Antipsychotic drugs
Reduce dopamine, also affect other NTs
85% effective
Fewer side effects
Atypical (2nd gen) antipsychotic drugs
A. An uninterrupted period of illness during which there is either a major depressive episode or a manic episode concurrent with Criterion A of Schizophrenia
B. Delusions or hallucinations for at least 2 weeks in the absence of a major mood episode during the lifetime of the illness
C. Sx that meet criteria for a mood episode are present for the majority of the total duration of the active and residual periods of the illness
D. Sx not due to another mental disorder, drug abuse, or medical condition
Schizoaffective Disorder
Promotes independence and responsibility
Milieu Therapy (Humanistic Model)
Operant conditioning principles; positive reinforcement for desired behaviors
Token Economy (Behavioral Model)
Acceptance and nonjudgmental approach
CBT for Schizophrenia
Engrained, enduring patterns of behavior, emotion, perception, and thought
Personality
What are the 3 clusters of personality disorders?
Cluster A: Odd/Eccentric, Cluster B: Dramatic/Emotional, Cluster C: Anxious/Fearful
Paranoid, Schizoid, Schizotypal
Cluster A: Odd/Eccentric
Antisocial, Borderline, Histrionic, Narcissistic
Cluster B: Dramatic/Emotional
Avoidant, Dependent, Obsessive-Compulsive
Cluster C: Anxious/Fearful
Pervasive distrust and suspiciousness, such that others’ motives are interpreted as malevolent
Unjustified doubts about the trustworthiness of others
Perceive attacks without justification
Paranoid Personality Disorder
Detachment from social relationships and restricted range of emotions
Indifferent to others’ praise, criticism, concerns, feelings
Little social contact with others
No oddities in speech, cognition, hallucinations, or delusions
May be related to Autism Spectrum Disorder, rather than Schizophrenia
Schizoid Personality Disorder
Interpersonal deficits and oddities in behavior or perception
Bizarre/peculiar speech, behavior, thinking and/or perception (“my teeth itch”)
Magical thinking (“it’s snowing bc I wanted it to snow”)
Milder form of schizophrenia
No strong delusions or hallucinations
Schizotypal Personality Disorder
Disregard for and violation of others’ rights or feelings, occurring since age 15
Lack of remorse, indifference to others’ pain, rationalization of behavior
Criminal behavior (break laws) and arrests
Lies, irresponsible, may be charming, and aggressive (engage in fights)
Antisocial Personality Disorder
Instability of relationships, affect, and identity
Preoccupation with avoiding abandonment, unstable identity, impulsive behaviors, parasuicidal behavior, feelings of emptiness, intense anger, dissociation
Borderline Personality Disorder
Developed by Marsha Linehan
4 modules
- Mindfulness: paying attention on purpose, in the present moment, and nonjudgmentally
- Emotion Regulation
- Distress Tolerance
- Interpersonal Effectiveness
Research shows that after this treatment there are less hospitalizations and suicidal behavior (and better mental health)
Dialectical Behavior Therapy (DBT)
Excessive emotionality and attention-seeking
Seek approval and praise from others
Feel unappreciated when not center of attention
Highly theatrical, over-dramatization
To get attention: sexually provocative, extreme emotionality, concern for appearance
Histrionic Personality Disorder
Grandiose sense of self-importance, need for admiration
Belief that they are “special” or can only be understood by high-status people
Unrealistic sense of entitlement
Interpersonally exploitive
Require excessive admiration
Narcissistic Personality Disorder
Social inhibition, feelings of inadequacy, hypersensitivity to negative evaluation
Avoids interpersonal contact for fear of rejection or disapproval
Unwilling to be with others unless guaranteed to be liked
Views self as inferior to others
Avoidant Personality Disorder
Need to be taken care of, submissive and clingy behavior, fear of separation
Uncomfortable being alone based on fears of being unable to care for themselves
Unable to assume responsibility for major life areas
Fear of expressing disagreement based on unrealistic fear of losing support or approval
Dependent Personality Disorder
Preoccupation with orderliness, control, and rules
Rigid, stubborn, and inflexible
Perfectionism that impairs task completion
Insist that others submit to their way of doing things
Different from OCD - no true obsessions or compulsions (instead, comforting rituals)
Obsessive-Compulsive Personality Disorder
Depressed mood most of the day, nearly every day as indicated by either subjective report or observed by others
Markedly diminished interest or pleasure in all, or almost all, activities most of the day, nearly every day
Equal or greater than 5 symptoms lasting at least 2 weeks
Major Depression Disorder
Low levels of norepinephrine or serotonin; abnormal levels of cortisol
Biological Etiology of Depression
Antidepressant drugs and Electroconvulsive Therapy
Biological Treatment for Depression
MAO Inhibitors, Tricyclics (1st gen), SSRI (2nd gen)
Antidepressant drugs that increase NE and/or serotonin
Depression is caused by change in the number of rewards and punishments; positive life events -> feel satisfied
Behavioral Etiology of Depression
Depressive symptoms make it more difficult to be successful
Downward Spiral
Behavioral Activation (adding positive activities that are likely to be successes)
Behavioral Treatment for Depression
Depression is caused by incorrect, negative beliefs
Cognitive Etiology for Depression
Focuses on cognitive distortions and thought processes that can lead to negative behaviors
Beck’s Cognitive Theory
Negative events are internal, global, and stable (I am a failure at everything I do and always will be)
Incorrect Attributions
Seligman
Some people feel that they have no control over rewards/punishments
Believe they’re responsible for this helplessness
Experiment with dogs and electric shocks support this model
Learned Helplessness
Identifying and correcting errors in thinking, examining and challenging assumptions, and changing thoughts then impacts feelings and behaviors
Cognitive Treatment for Depression
equal or greater to 2 symptoms lasting 2 years, including symptom of depressed mood most of the day more days than not
Lower grade, but longer lasting depression
Persistent Depressive Disorder (Dysthymia)
The presence of a manic, hypomanic, or major depressive episode
If currently in a hypomanic or major depressive episode, history of a manic episode
Bipolar Disorder
Distinct period of abnormally and persistently elevated, expansive, or irritable mood and abnormally and persistently increased goal-directed activity or energy, lasting at least 1 wk (or any length if hospitalization is necessary)
Decreased need for sleep, flight of ideas or thoughts racing, distractibility
Manic Episode
Same as manic episode, except:
- only 4 days of sx necessary
- no marked impairment in social or occupational functioning
- no hospitalization required
Hypomanic Episode
Bipolar Disorder Variants
Bipolar I, Bipolar II, Cyclothymia
Major depression and mania
Bipolar I
Major depression and hypomania
Bipolar II
Hypomanic symptoms and mild depression (for at least 2 yrs)
Cyclothymia
Neurotransmitter activity high, low serotonin
Abnormal brain structures in basal ganglia and cerebellum, and genetic factors
Etiology of Mania in BD
Mood stabilizer drugs and adjunctive psychotherapy
Treatment for Bipolar Disorder
