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psycopathology > Lecture 10 Anxiety abd Obsessive Compulsive Disorders+DLA (Block 2) > Flashcards

Lecture 10 Anxiety abd Obsessive Compulsive Disorders+DLA (Block 2) Flashcards

1
Q

What does Neuropsychology examine?

A

The function of different parts of the human brain (I.e. the brain-mind connection)

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2
Q

Explain the Gazzaniga Split-brain Studies(comeback)

A

Corpus callosum is severed so the left and right hemispheres cannot communicate with each other

The left hemisphere and chicken sees a snow scene and points to a picture of a snow shovel. The right hemisphere sees a snow scene and points to a picture of a snow shovel. Both hemispheres see the chosen pictures

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3
Q

What has the brain evolved to do?

A

Safely enclosed within the skull, must acquire the data via limited sense systems, selectively process that information, and output instructions through biological motor systems

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4
Q

How has the brain evolved to process information?

A

“Brain modules” evolved to process information in ways that worked well in the environment that our ancestors found themselves in

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5
Q

There are cognitive modules for:

A

Language processing

Facial processing and recognition

Visual processing

Tracking social hierarchy

Mental Associations

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6
Q

How does cognitive lens trick us? How do we know we are being tricked?

A

Our cognitive lens forms a permanent “lens” by which we view the world, tricking us into thinking there is no lens and instead reality

Clever methodology, experiments and self-observations of conflict allow us to glimpses of the lens that shape our thinking

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7
Q

Why is virtually everyone prejudice in some way?

A
  • Prejudice is based on implicit associations
  • the brain is hard-wired for associations, the repeated co-presentation of two things(conditioning) can lead to a non-conscious (and possibly non-logical) connection between them
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8
Q

Why does the brain use implicit associations ?

A

They are used by the brain to save time and energy

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9
Q

Define anxiety

A

A feeling of worry, nervousness, fear or unease about something specific or non-specific

This includes fear if everyday situations that interfere with daily activities, are difficult to control, and are out of proportion to the actual danger

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10
Q

Describe Anxiety etiology

A
  • Not fully understood
  • Genetic disposition- Diathesis stress model
  • Sensitive nervous system(genetic and/or environmental)
  • “Disorder of regulation of the autonomic nervous system and thoughts that arise as interpretation of that Dysregulation”-Dr. Barbara Landon
  • Lack of skills to control, interpret and address symptoms
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11
Q

What are the risk factors of Anxiety?

A
  • Family history
  • Personality
  • Trauma
  • Serious illness
  • Stress buildup/ overtaxed resources
  • Other mental health disorder (e.g. depression)
  • Drugs or alcohol
  • Avoidance
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12
Q

Describe the physiological background of anxiety?

A
  • Sympathetic/parasympathetic
    • Racing heart
    • Fast breathing
    • Sweating
  • Fight /Flight/freeze response
  • HPA axis
  • OCD : feedback loops in the brain
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13
Q

What is abnormal anxiety?

A
  • Elicited by inappropriate cues (or no cues)
  • inappropriate in intensity
  • inappropriate in duration(usually 6+ months)
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14
Q

What is a neurotic?

A

A descriptor referring to these conditions (anxious, ritualistic)

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15
Q

Some amount of anxiety is________

A

Beneficial

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16
Q

Describe types of anxiety treatments

A
  • Cognitive therapy
  • Breath training (modify nervous system activity)
  • Behavioral therapy(e.g.desensitization, exposure therapy)
  • medications
    • Antidepressants (e.g. SSRIs)
    • Benzodiazepines
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17
Q

What is panic disorder?

A
  • Recurrent and unexpected panic attacks (number of episodes not specified)
  • for atleast 1 month, individual must show either :
    - Fear of future panic attacks or its implications

Or

      -  a significant change in behavior related to the attacks (e.g. avoiding exercise)
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18
Q

Describe a panic attack

A

intense feeling of dread or fear with symptoms such as:

  • Cardiac symptoms Gastrointestinal symptoms
  • sweating Feeling faint
  • Trembling Feeling detached
  • Shortness of breath Fear of losing control
  • Choking. Fear of dying
  • chest pain. Tingling/numbness
  • Chills/hot flushes
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19
Q

Describe the onset of a panic attack

A

Abrupt onset, episode peak within minutes

Often mistaken for heart attack, leading to ER visits

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20
Q

How does classical conditioning explain panic attacks?

A

Panic is a Condition response to a neutral stimulus that has been paired with a stimulus that has been paired with a stimulus that naturally produces fear (UCS)

UCS= frightening stimulus

UR= panic

Neutral stimulus= bodily sensations that are present when frightening stimulus occurs

CS= bodily sensations. CR= panic

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21
Q

Describe the treatment of panic disorder

A
  • CBT - break the association between the bodily symptoms (e.g. rapid heart rate) and the induction of panic attacks
  • Systemic Desensitization- expose patient to physical symptoms without allowing panic to occur(via relaxation techniques)

Pharmological=

Antidepressants (SSRIs)
Sedatives= benzodiazepines such as Xanax

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22
Q

How has the eye evolved to perform its function?

A

Absorbing and trans ducking electromagnetic energy

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23
Q

How has the inner ear evolved to perform its specific function?

A

Absorbing and transducung physical shockwaves

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24
Q

How has the alveoli evolved to perform its function?

A

Exchanging gases between the atmosphere and the blood

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25
Q

What is the function of the left ventricle?

A

Expelling blood through the aorta and into the arteries

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26
Q

What is agarophobia?

A
  • Fear/avoidance because escape (or rescue) may be difficult if incapacitating/embarrassing symptoms develop
  • often seen with panic disorder but can be stand-alone
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27
Q

What are the symptoms of agarophobia?

A

Persistent and excessive fear of 2+ of the following:

  • Using public transportation
  • Being in open spaces
  • Being in enclosed spaces
  • Standing in line or being in a crowd
  • Being outside of the home alone
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28
Q

What is specific phobia?

A

A persisten, excessive and disproportional fear of an object or situation

Fear response invariably occurs when exposed to the stimulus, or the person avoids the phobic situation

The fear causes causes marked distress or impairment in functioning

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29
Q

What are the subtypes of specific phobia ?

A
  • animal
  • natural-environment
  • situational
  • blood-injection-injury
  • other
30
Q

Give the etiology of specific phobia

A

A phobia is a classically conditioned response (I.e. neutral stimulus is paired with a naturally occurring fear-producing stimulus)

-Psychotherapeutic treatment consists of Systematic Desensitization or Exposure Therapy

31
Q

What is social anxiety disorder?

A

Excessive, persistent and unrealistic fear of social situations involving possible scrutiny by others: fear of negative evaluation

The social situations are avoided or endured with intense fear or anxiety

32
Q

Describe the social anxiety disorder specifier-“performance only”

A

This is when the fear is restricted to speaking or performing in public

33
Q

What are the treatment options of Social anxiety?

A
  • Cognitive therapy
  • Behavioral therapy
  • Pharmological:

Antidepressants(e.g. SSRIs)
Anti-hypertensives(e.g. beta-blockers) for short term management of physical anxiety symptoms

34
Q

What is Generalized Anxiety Disorder( GAD)?

A

Uncontrolled persistent anxiety about multiple events

35
Q

Explain the symptoms and diagnosis of generalized anxiety disorder

A

Several(3+) of the following:

  • relentless, on edge
  • lower concentration
  • muscle tension
  • fatigued
  • irritability
  • insomnia

Don’t diagnose this disorder if the worry is better explained by another disorder

Usually see physician due to physical symptoms

36
Q

How can GAD be treated?

A

Cognitive therapy: reduce bias toward assuming negative outcomes by challenging automatic thoughts to reduce anxiety

Behavioral therapy: relaxation techniques. Use biofeedback to learn to relax muscle tension as GAD patients tend to be chronically

37
Q

What is separation anxiety disorder?

A

Excessive anxiety concerning separation from those who, the person is attached

38
Q

What are the symptoms of Separation Anxiety Disorder?

A

Person experiences marked distress(mental and physical) about such things as:

  • anticipated or actual separation
  • harm befalling attachment figure or self that leads to separation
  • going out (e.g, to school, sleeping away) because of separation fears )

Symptoms persist +1 month

39
Q

What are treatment options of separation anxiety disorder?

A

Reward separation and token economies

40
Q

Describe the onset and course of separation anxiety disorder

A
  • Separation anxiety is normal but should be outgrown after age 3 as attachment solidifies
  • Usually diagnosed around 7-8 years old
  • Even when symptoms resolve, problems with anxiety in general may persist
41
Q

What is selective autism?

A
  • refusal to speak in specific situations despite fluent speech in other context
  • written communication and social play may also be affected
  • symptoms must persist 1+ month hint first month of school)
  • Not due to lack of language knowledge or a communication disorder(e.g. stuttering )
42
Q

What is the onset and course of selective autism?

A

5-6 years old with most improving by age 10

43
Q

Describe the etiology of selective autism

A

Psychologically-determined refusal to speak due to social anxiety

44
Q

What is the treatment for selective autism?

A

Usually behavioral principles utilized( shaping, desensitization, token economies)

45
Q

Describe anxiety disorder differentials

A

A variety of medical conditions can cause anxiety disorders, which should be ruled out:

A. Anxiety Disorders due to General Medical Condition (e.g. thyroid problems, menopause)

B. Substance-induced Anxiety Disorders(e.g. caffeine)

Just because someone has panic attacks doesn’t mean the diagnosis is “Panic Disorder”. Panic attacks may be part of a different anxiety disorder

To make a correct diagnosis, you need to know what triggers the symptoms and whether additional symptoms are present

46
Q

What is the trigger of panic disorder?

A

Random

47
Q

What is the trigger of Agoraphobia?

A

“Difficult to escape/rescue” situations

48
Q

What is the trigger for a specific phobia?

A

A specific object/situation (not social/ performance)

49
Q

What is the trigger of social anxiety?

A

A social performance/ setting

50
Q

What is the trigger of GAD?

A

Many potential triggers (exclusion diagnosis)

51
Q

What is the trigger of Separation Anxiety?

A

Separation from attachment figure

52
Q

What is the trigger of selective mutism?

A

Speaking (manifested by mutism)

53
Q

What are the Obsessive compulsive and related disorders?

A
  • Obsessive-Compulsive Disorder
  • Hoarding Disorder
  • Body Dysmorphic Disorder
  • Excoriation Disorder
  • Trichotillmania
54
Q

What are the Obsessive-Compulsive Disorder symptoms?

A
  1. Recurrent obsessions and/or compulsions
  2. Obsessions /compulsions are time consuming, distressful or disruptive
  3. Symptoms are not explained by another disorder (e.g., preoccupation with weight as in eating disorders)
55
Q

Explain the recurrent obsessions and/or compulsions of OCD

A

Obsessions: unwanted recurrent thoughts, urges or images that increase distress

Compulsions: Repetitive behaviors/mental acts that are performed to decrease distress

56
Q

Describe the etiology of OCD

A
  • Strong genetic component
  • Patients appear to be inheriting a brain with functional and chemical abnormalities
  • Overactivity of specific brain curcuitry(a loop that includes the frontal lobe and motor networks)
  • Serotonin deficiency
57
Q

What does it mean when an individual has OCD with absent insight

A

(I.e. delusional beliefs)

-Individual is completely convinced that OCD beliefs are true

58
Q

How is OCD treated psychologically?

A
  • Behavioral therapy: Exposure and response prevention
    1. Expose to feared situation
    2. Avoid engaging in compulsion
  • Practiced in therapy and at home
  • Good results after 2-3 weeks
  • Considered at least “as effective “ and longer lasting than medications
59
Q

How is OCD treated medically?

A

Pharmological: All SSRIs and 1 TCA(Anafranil) are approved for OCD

Psychosurgery: two brain parts are intentionally lesioned to disrupt the overactive circuitry in severe and treatment-resistant OCD

  1. Anterior cingulate gyrus (cingulotomy)
  2. Internal capsule (capsulotomy)
    The gamma knife(radiation) procedure is replacing surgical lesioning

DBS

60
Q

Describe Deep brain Stimulation as a treatment for OCD

A
  • Brain electrode with external pacemaker
  • Electrical pulses are delivered to neural circuitry implicated into OCD
  • FDA-approved as a “Humanitarian Device” for severe and treatment-resistant OCD
61
Q

What is the Yale-Brown Obsessive Compulsive Scale(Y-BOCS)?

A

An objective scale used to qualify and quantify the symptoms and severity of OCD.

-Useful to monitor symptom changes over time

62
Q

What is the treatment of OCD related disorders?

A

All are usually treated with behavioral therapy (first choice); SSRIs can also be used

63
Q

What is the essential feature of Trichotillomania?

A

Compulsive hair pulling

*pukling not accounted for by another disorder

64
Q

What is the essential features of Excoriation?

A

Compulsive picking, not accounted for by another illness

65
Q

What is the essential feature of Body Dysmorphic Disorder(BDD)?

A

O-C behavior about perceived defect in appearance

66
Q

What is the essential feature hoarding?

A

O-C behavior resulting in the excessive accumulation of possessions, hoarding nit explained by other illnesses

67
Q

What are the diagnostic criteria of Body Dysmorphic Disorder?

A
  • Preoccupation with a perceived flaw in physical appearance(flaw is minimal/non-observable)
  • repetitive behaviors or mental acts are performed in response to the appearance concerns
  • The preoccupation is not better accounted for by an eating disorder
  • The preoccupation in BDD must cause functional impairment (e.g., sequestering oneself)-otherwise, the preoccupation May be considered normal vanity

The belief can be of delusional intensity(100% certainty)

Add specifier: BDD “with absent insight(delusional beliefs)”

68
Q

What is hoarding disorder?

A

An OCD-related disorder that caused accumulation of possessions in living areas that compromises their intended use

69
Q

What is Excoriation disorder?

A

An OCD related disorder which causes recurrent unwanted skin picking causing lesions

70
Q

What is Trichotillomania?

A

An OCD related disorder which causes recurrent unwanted pulling out of one’s hair

71
Q

What are the additional requirements of OCD-related disorders?

A

Additional Diagnostic requirements

- Behaviors cause distress/impairment 
- Behaviors are not better explained by another disorder

      (E.g. Excoriation to remove a perceived flaw in BDD would not be excoriation disorder)

psycopathology (23 decks)

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