Gavin MHI 2 Part 1

Question 1

Anxiety and related dsm

Answer 1

Separation, selective mutism, GAD, phobias, panic, agoraphobia, med induced. Disproportionate worry over things can be self generated, externally triggered and internally triggered

Question 2

Limbic system and urbach weithe disease

Answer 2

Regions in the frontal cortex have an impact e.g. anterior cingulate cortex, pfc, ventromedial cortex and the amygdala - main one. Feinstein 2022: patient SM amygdala was destroyed due to calcification. Did not feel fear and anxiety in response to fear stimulus

Question 3

Genetic and environmental factors of anxiety

Answer 3

Hettema 2015: genetic predisposition but not good for diagnosing spec. Hudson and rapee 2001: more controlling mothers cause more anxious children. Harlowe scared monkeys using robots- mineka 1986: some monkeys obtained food and water by pressing levers but food was delivered at the same time to yoked. Later the yoked monkeys were more anxious to stim (locus of control), others fought and seemed less comfort

Question 4

GAD and treatment

Answer 4

Excessive worry for extended period, associated with 3+ of restlessness, fatigues, diff concentrating, irritable, sleep disturbance. Wittchen 2002: most common 22% primary care. Nitsche 2009: big response in amygdala to aversive and neutral compared to controls. Paulescu 2010: exposed gad to worry sentenced, activated dorsomedial pfc and anterior cingulate in rest period but control had none. Wetherell 2013: ssei and cbt reduced worry

Question 5

Phobias

Answer 5

Fear or anxiety about an objects which always causes fear (external trigger). Cues: pavlovs associated, neutral plus scary stim-phobia when look at neutral stim. Watson and raynor 1920: conditioned little Albert. Watson used children as subjects but regretted no physical affection - boys had depression, giggling seen as maladjustment by behaviourists

Question 6

Learning theories of phobias

Answer 6

Conditioning emotional reactions is predisposed to some things more than others
Ohman 1976 phobic stimuli like snakes more able to be conditioned than non emotive like flowers when given electric shocks - evolution? (some initial reaction but left quickly)those who have threatening experiences don’t always have phobias. SA- person has negative social experience and reinforcement due to avoidant like avoiding eye contact/standing apart

Question 7

Behavioural therapies for phobias

Answer 7

Modelling: therapist performs behaviours on patients hierarchy while patient watches and then ask patient to do the same
Flooding: full on exposure, can reinforce if they leave early, have to wait for adrenalin to go down
Systematic desensitisation: relaxation techniques then makes hierarchy and builds up

Question 8

Panic disorder

Answer 8

Intense fear reaches peak within minutes, palpitations, sweating, shaking, chest pain, nearest, chills, fear of death. Interoceptive cues: link high heart rate W scared. Domschke 2008: fearful and non images to pd ps found more activity in amygdala and orvitofrontal cortex. Ehlers 1992: ps with phobias or pd showed high trait and state anxiety but pd more accurate in monitoring hr

Question 9

Panic disorder treatment

Answer 9

Botella 2007: systematic desensitisation to internal cues in response to very worked as well as real exposure and easier. Sanchez meca 2010: meta analysis of 42 studies found exposure training plus relaxation techniques are most effective

Question 10

Anxiety and phobias

Answer 10

Those with anxiety disorders are more sensitive to conditioning of phobias and unpredictable threats shackman tromp 2016. Ps did neutral, predictable and unpredictable threat tasks, anxiety have increased response to unpredictable

Question 11

Genetic inheritance of anxiety

Answer 11

Kendler 2011- twin study suggests hertitability 0.5-0.6, tambs 2009: genetic risk for phobia liked to increased risk of other anxiety disorders. Dao 2007: ties to higher neuroticism which predicts depressive and anxiety disorders

Question 12

Neurobiology of anxiety

Answer 12

Fear circuit activated during silent stimuli, medial pfc regulates amygdala and anxiety ps have less activity in pfc when viewing threatening stim Britton 2013. Serotonin helps regulate emotions

Question 13

Social cognitive influences of SA

Answer 13

Clark and wells 1995: sa have harsh views about behaviours and perceived consequences. Zanoov 2010: think about how they are presenting in a conversation not the other. Gerlach sa overestimate how much they blush, more likely to focus on internal cues like hr, more submissive and care about social hierarchy

Question 14

Ocd dsm

Answer 14

Presence of obsessions (recurrent thoughts that are intrusive) and compulsions (repetitive behaviours to reduce anxiety . Pauls: stim does to obsession and anxiety leads to ritualised behaviour for relief

Question 15

Biology of ocd

Answer 15

Caudate, orbitofrontal cortex and anterior cingulate interact/overreact. Maltby 20.5: go no go RT task, ocd brain react normally to mistakes but express during correct rejections. Marazitt 1999: ps recently in love scored high on ocd scale and low levels of serotonin compared to ocd

Question 16

Ocd treatment

Answer 16

Respond well to drug treatments zohar 88, cbt also helps. Behavioural: exposure to obsessions with relaxation techniques can be via imaging. Break down irrational beliefs and self report . TMS

Question 17

Neurological changes in treatments

Answer 17

Nakao 2005: stim Id for each patients, all had ssri and therapy showed reduced orbitofrontal and anterior cingulate activation to task. Nabeyana 20l8: therapy alone for 12 weeks reduced symptoms by 60% reduced frontal response to symptom provocation

Question 18

Hoarding dsm

Answer 18

Difficulty parting with possessions regardless of value and need to save items. Distress associated with getting rid. In dsm 94 under ocd and itself in 2013, only in icd 2022

Question 19

Cognitive behavioural model of hoarding

Answer 19

Grisham and bladwin 2015: model frost 2006: positive emotions become associated W objects, reluctance to discard due to distress and cognitive issues like memory/attention. Ps with high hoarding scored highly for adhd and worse on attention task

Question 20

Neurology of hoarding

Answer 20

An 20p9: ocd with hoarding shown objects likely to heard, high anxiety and activation in ventrimedial pfc but smaller in anterior cingulate. Tolin 2014: no go no task, ocd big orbitofrontal cortex response to correct rejection but hoarders don’t had large precentral gurus instead

Question 21

Hoarding Treatment

Answer 21

Muroff 2014: assessed cbt therapy for hoarding. Most ps showed either no or very minimal improvement, only some did show improvement
Grassi 2016: treated hoarders with anti adhd drug atomoxetine for 12 weeks, majority showed large improvements . Have to admit they have a problem

Question 22

BDD dsm and history

Answer 22

Preoccupation with perceived deficits that’s not clear to others and repetitive behaviours. Morselli 85: dysmorphobia as really miserable an fear of deformity. Freud: Russian aristocrat pankejeff for nightmares about wolves, later treatment as had obsession with his nose . Mean annual suicide attempt is 2.6%

Question 23

Biology of BDD

Answer 23

Fuesner 2010: showed ps own faves, highly aversive, increased orbito area but decreased in occipital cortex- suppression of visual info. Thompson 80: thatcher illusion showed we see face as whole but fuessner 2010: presented distorted face, control slower but bdd not-focus on details . Buchanan 2013: white matter density reduced in cc- impaired integration of detail

Question 24

BDD treatment

Answer 24

Crerand 2005: cosmetic surgery was no help in almost all cases and in some made things worse
Phillips 2013: long term follow up after 4 years, majority had a mix of ssri and therapy, had high relapse rates. Avoid mirrors and talk to those who think they are ugly

Question 25

Cognitive diffs in ocd and bdd

Answer 25

After rubbing pencil with contaminated object, rub pencil against another, normal said 6th was free of contamination but ocd said 12 still contaminated. Most worry about multiple aspects for hours a day, reduce stress by checking peasants, comparison and grooming . Body parts differe depending on couture

Question 26

Behavioural and cognitive model of ocd

Answer 26

Beh: create threat with electrodes on writer and conditioned shock with certain shapes and avoid by pressing pedal, when shocks removes, ocd pressed pedal when shape emerged- reducing threat became a habit gillan 2014. Cog: ppl with ocd try harder to suppress and make the situation worse- thinking about something as bad as the action and thinking it will make it more likely /thought action fusion: responsible for preventing harm so suppress which leads to more thoughts afterwards

Question 27

Conversion disorders dsm

Answer 27

Somatic grouped into: conversion, fictitious, somatic symptom and illness anxiety . Conversion is symptoms of layered motor/sensory function not linked to recognised cities, nothing working but have seizures . Adolescent or early adulthood . Sudden neurological symptoms W no cause , increased by anxiety depression and hormones . More common in rural and low income areas-mass hysteria

Question 28

Neurological evidence of conversion disorders

Answer 28

Ghaffar 2006: 3 ppl W disorder, simulation of affected limbs didn’t activate contra lateral primary somatosensory region but stim of unaffected acts as a distract or to overcome inhibition of unilateral stim. When both as same time, there was bilateral response so neurological not biological

Question 29

History of conversion disorder

Answer 29

Freud treated Anna o: paralysis with bad vision and hearing- hysteria said due to fathers illness. Anderson and green 2001: ps told to repress a word from a pair did worse at remembering. Increased dorsolateral pfc and decreased hippocampus. Aybeck: increased dorsolateral pfc and decreased pfc when read distressing accounts but increase in motor area (abnormal representation of body parts)

Question 30

Out of body experience

Answer 30

Blanke 2004 reported the cases of 6 patients with epilepsy associated with out of body experiences and in each case has seizures in the RTPJ
Blanke et al 2002: stimulated wide areas but found only the temporoparietal junction elicited out of body experiences, stronger current stronger experience

Question 31

Treatment of conversion Disorder

Answer 31

Hinson 2006: patients with conversion disorder given therapy focusing on early life experiences, parenting and links found improvements

Question 32

Somatic symptom dsm

Answer 32

Factitious disorder imposed on self or other, falsification of physical symptoms. Asher 51: muchausens marked by freq hospitalisation S and lying . See doctors as incompetent or uncaring,

Question 33

History of somatic

Answer 33

Baron munchhausen 1720 was well known for his stories, raspe wrote about his stories but raspe was unreliable
Munchhausen became an overnight sensation had stalkers, wide died and remarried and had a divorce, resentful of fame and didn’t want the disorder to be named after him

Question 34

Treatment for somatic

Answer 34

Depression and anxiety can be treated with medication and therapy
Huffman and stern 2003: can lead to doctors doing unnecessary procedures or make errors and feel angry or guilty about it so team should only perform procedures indicated by data

Question 35

Origins of somatic/munch

Answer 35

Adshed and buglass 2005: mothers with munch had bad attachments to won mothers and dismissive households. Gray bentovin 96: unresolved loss- loss of child or partner. Subtypes: help seekers, (want help with own issues- when child is in foster, initial anger but then relief.), doctor addicts (convinces symptoms real despite tests, false reporting and mothers not reassured) and active inducers (direct efforts to fake symptoms , mothers act as loving , resistant to therapy, disturbed marriages - studies on therapy not prevalent but need to diagnose

Question 36

Causes of dissociation

Answer 36

Stressors, sleep disruption, trauma a, begins in adolescents, can happen for years. Dissociative amnesia is unable to recall info about trauma - fuge subtype where you walk away from another life

Question 37

Illness anxiety

Answer 37

Fears of Seriuos disease with no symptoms for 6mothd, visual images of dying and anxiety when hear about others. Concern about physical symptoms and see doctors as uncaring and incompetent

Question 38

History of schizo

Answer 38

Kraepelin 1883: dementia praecox- irreversible mental deterioration with disordered thinking and departure from reality. bleuler 1911: coined schizo meaning split mind between elements of thought and feeling but not irreversible as some patients improved. Ellard 87: ps in 45 a Ute catatonia immobile but decline in next 40 years

Question 39

Schizo dsm

Answer 39

Two or more of delusions, hallucinations (must have) then grossly disorganised oe catatonic behaviour, negative symptoms (emotional expression) and disorganised speech Vary on most features as it is a heterogeneous clinical syndrome (v variable).

Question 40

Diff classifications of schizo

Answer 40

Crow 80s: 2 types, type 1 with + symptoms (hallucination, delusions, fair prognosis due to too much dopamine so reversible) and type 2 with - (affective flattening, poverty of speech due to structural issues in brain). Can change to 2 but can’t lose once gained

Question 41

Biology of schizo

Answer 41

Larger lateral ventricles p, jacob and winkeler 27: removed cerebrosoinal fluid and replaced with air to show larger ventricles, more in left but had side effects until chair developed. Johnston 75: cat scan found bigger left ventricle, confined to temporal Barca 90: - correlation between left superior temp gurus and severity of hallucinations . More activity in brocas and wernickes when heard voices

Question 42

Cytoarchitecture

Answer 42

Jakob and backmann 86: organisation of cells in entrohinal cortex (temp lobe). Disorganised structure and position of pre alpha cells -failure to migrate to final position in cortical layers. Akbarian 93: extended to frontal lobes. Berstein 98- pre Alcoa cels less well organised in etorhinal cortex

Question 43

Schizo brains in adolescence

Answer 43

Thompson 2001: grey matter lost in adolescence with schizo in parietal, temp and front. Kemptom 2012: 13 studies on lat vent enlargement and found dilutions shortly after birth

Question 44

Doubts for schizophrenia

Answer 44

Torrey 1988, 2001: schizo is a recent phenomenon and historical accounts of madness don’t match symptoms of schizo and first clear descriptions not until 17thc
Torrey and bowler 1990: schizo may be a disorder of urbanisation, relating to social upheaval and stresses which arose through the industrial revolution as more accounts in urban areas first

Question 45

Neural migration schizo

Answer 45

Bracha 92: neural and skin cells migration for fingerprints in the 2nd tri, fingerprints for twins discordant for schizo are diff but for concordat are similar. Mednick 88: record for Helsinki during flue epidemic, those in 2 tri had children more likely to have schizo. Sham 92: schzio births 10 months following foue in uk-if during 2nd tri, more likely . Conrad and scheibel 87: some viruses interfere w natural adhesiveness needed for migration in second tri. Torrey- studies found higher % of antibodies to parasitic protozoan toxoplasma gondii in schizo (via cat poo)

Question 46

Retrovirus and schizo

Answer 46

Integrate w chromsies and replicate, lie dormant and replicate again. Lillehoj 2000: primate retrovirus activity in 29% schizo. Herv-W retrovirus active in schizo 6% controls, 31% schizo activated by gondii and influenza . Activation has been associated with elevated bio markers of systemic inflammation

Question 47

Types of delusion in schizo and hallucinations

Answer 47

Fixed beliefs not amenable to change in light of conflicting evidence. Delusion of grandeur (special powers or world figure), erotomania (other is in love with you), of persecution, of reference (tv show referencing home), thought insertion/broadcasting, nihilistic delusion (dead or nothing exists). Audiitrty are most common. Tactile, taste or somatic less common (insides rotting, bugs under skin)

Question 48

Drug impacts on schizo

Answer 48

Crow 82: fluoenthixol (dopamine blocker) reduced + but not -. Amohetamine boots dopamine via stim release and inhibits uptake- can cause amohetamine psychosis. Resembles type 1. Angrist 80: drug free schizo given amphetamine, + got worse but - no change

Question 49

Schizo treatment

Answer 49

Delay and deniker 1952: chlorproazine, calming effect on schizo. Led to neuroleptic site of action strategy. Rossum 1976 suggested dopamine blocker.Creese 1976: antipsychotic potency of neuroleptics correlates w binding efficacy and antagonism for dopamine receptor subtype. Antipsychotics cause sedation, dizziness, tremors, resotenessnes, mouth movements (akasthesia). Many don’t respond well to first gen and quit due to side effects, weight gain with second gen leads to typ 2- all have minimal response

Question 50

Gennie pilarski

Answer 50

3 years of chem in college but had manic depressive episodes and committed in 1944, felt normal. Had 198 electric shock therapies twice a week and neurosurgery description got most of frontal and temporal lobes left her mute and dependent

Question 51

Hildegard of bingen

Answer 51

Chief nun, advisor to pop and kings, known as Sybil of the rhine. Polymath, physical, wrote, scientist, psychology, composer. Had hallucinations from age 3 but people accepted her

Question 52

Social effects of schizophrenia

Answer 52

Withdraw from others, one of the most stigmatised , can’t keep jobs or relationships, higher rates of substance abuse (genetic link) and suicide. Only 1% of pop, more men. Diagnosed more amongst African American, Latino (bias), appears in adolescence

Question 53

Negative symptoms

Answer 53

Lack in motivation, pleasure, closeness and expression, avolition, less motivated by goals/praise but are motivated by reducing boredom, avoiding criticism, asociality, anhedonia (lack of anticipatory pleasure not consummately/in the moment). Blunted affect, less expressive but report same emotion, alogia (reduction in speech). Disorganised speech (derailment, thought disorder,). Disorganised behaviour like agitation, dress unusually, wander off

Question 54

Schizo related disorders

Answer 54

Schizoreniform disorder is same but only for 1-6 months. Schizoaffectvie also affects mood like depression or manic. Delusional disorder

Question 55

Dopamine theory

Answer 55

Schizo due to excess dopamine, side effect symptoms similar to parkisons caused by low levels of dopamine. But o simple as only related to + symptoms. Stress tiggers excess of dopamine . Linked to low glutamate.

Question 56

Environmental factors of schizo

Answer 56

Linked to delivery complications as reduced 02 to brain, loss in gtey matter. Pfc matures late so problem doesn’t show. Cortisol increasedps dopamine . Due to excess synaptic pruning. Associated with cannabis use

Question 57

Schizo and brain matter

Answer 57

Reduction in grey matter in pfc but could be due antipsychotics, less good working Emery pfc, dendritic spines reduces, smaller hippocampus, less connectivity between networks

Question 58

Trichilomania history

Answer 58

Madness or mania, Shakespeare. Hallopeau did first case study, did not cause relief, no cure or physical cause. First an impulse control condition and now an ocd related disorder

Question 59

Trich symptoms

Answer 59

Hair pulling, hair loss that causes dysfunction, paediatric onset, more females, triggered by boredom, stress

Question 60

Trich model

Answer 60

Starts with internal or external stim, goes to anxiety/breakdown of regulatory ability which leads to hair pulling then temporary relief which reinforces. Mediating factors are inhibitory control and self awareness.

Question 61

Etiology of trich and treatment

Answer 61

Worse at stop signal task, can be conscious or automatic, can’t inhibit as well as controls. More cortical thickness in superior temp gyrus linked to issues in self awareness. Treatments are cbt, topical anaesthetics, distractions. Ssris not that effective, most is habit reversal (awareness, redirection and social support)