Lecture 4 - Stress and Psychological Outcomes I Flashcards
What is psychopathology?
Psychopathology is a clinically significant disturbance in thoughts, emotions, or behaviours that cause significant distress or functional impairment.
What factors play a role in diagnosis?
1) DSM symptoms/criteria
2) functional impairment
3) high distress
What are the pros and cons of a diagnosis?
Pros:
- differential diagnosis
- informs treatment
- insurance categories
- prognosis may provide relief to patient
Cons:
- there is stigma associated with a mental illness diagnosis
- probability of misdiagnosis
How is culture relevant to diagnosis?
Culture can mediate the symptoms and criteria of a mental illness and influence its diagnosis.
What are some differences in how depression presents itself in different cultures?
Western cultures tend to exhibit more psychological cultures, whereas Asian cultures, such as China and India, exhibit more physical symptoms.
Some examples of physical symptoms of depression are feeling sick, having low energy, and inability to sleep.
How is culture relevant to psychopathology?
Some, particularly Eastern, cultures have hesitation, shame, and embarrassment in sharing psychological issues. Therefore, culture can mediate the symptoms and criteria of mental illnesses and influence their diagnosis.
Describe Slotkin’s (1954) anecdotes about culture and psychopathology.
1) A Menomini (Native American) was diagnosed with a snake phobia before the psychiatrist knew that Menomini’s believe all but one species of snake are evil spirits who come out at night.
2) A social worker was disturbed upon finding a bloody bedsheet hanging on the family clothesline the day after their daughter had been married. She hadn’t known that Balkans do this so neighbors can see the bloody sheet as proof of a daughter’s virginity.
What is the difference between fear, anxiety and worry?
Fear is in the moment, and associated with the HPA and SAM axes. Fear is associated with imminent threat, sympathetic arousal, and escape.
Anxiety/worry are interchangeable. Anxiety is more chronic, and it is associated with future threat, muscle tension, and avoidance.
What is the difference between normal and pathological anxiety?
Pathological anxiety is at an intensity level higher than normal.
- high sensitivity to perceived threat
- high stress reactivity
- attentional bias to threats -> the brain looks for anxious stimuli, and is wired for negative stimuli, this leads to a vicious cycle
What are the main types of anxiety disorders?
- specific phobias
- panic disorder
- agoraphobia
- social anxiety disorder
- generalized anxiety disorder
- obsessive-compulsive disorder
- post-traumatic stress disorder
What are the different types of phobias?
Animal: snakes, spiders
Environment (natural): storms, heights, water
Blood, injection, injury
Situational: driving, flying
What is the prevalence of phobias?
11%
What is the average number of fears people with specific phobias have?
3, however not all of these phobias have to trigger an equal level of fear
Which type of phobia has the worst treatment outcomes?
Blood, injection and injury because the symptoms tend to be faiting and disgust, which are very hard to treat and suppress.
What is panic disorder?
It is a disorder where the person experiences recurrent and unexpected panic attacks, so they worry about having more panic attacks, and the consequences of having these panic attacks.
What is the prevalence of panic disorder?
5%
If a person has a panic attack every time they have to give a presentation, what disorder are they likely to have?
Social anxiety disorder with a panic attack specifier
What is the difference between having panic disorder and having a panic attack specifier?
Panic attacks in panic disorder are unexpected, whereas panic attacks in a panic attack specifier would be expected, since they are triggered by certain situations.
What is the cycle for panic attacks for people who have panic disorder?
Trigger (internal/external) > perceived threat > apprehension > body sensations > interpretations of sensations as catastrophic
This all happens REALLY fast, in a matter of seconds to minutes.
What is agoraphobia?
Excessive fear or anxiety about multiple situations where escaping or getting help is difficult.
It’s rare to have agoraphobia without panic disorder. There is a large overlap. However, you can have panic disorder without agoraphobia.
What is SAD?
Social Anxiety Disorder is an excessive fear or anxiety about social situations, particularly about judgement or embarrassment.
The judgement or embarrassment surrounds:
i) social competence -> being funny, having interesting conversation topics
ii) physical appearance
iii) anxiety signs -> concerned people will notice flushed skin, sweating, stuttering
What is the prevalence of social anxiety disorder?
13% It is the most common anxiety disorder.
Why is social anxiety disorder so prevalent?
Likely because we’re evolutionarily wired to be social
What is performance only social anxiety disorder?
It is a type of SAD where the person is only anxious in performance situations such as lectures, interviews, or presentations.
What is having SAD like?
If you have anxiety before the situation, during the situation, and after the situation (rumination)
What is GAD?
People with Generalized Anxiety Disorder have excessive and difficult to control worry about several major and minor things. “worry wart” personality.
What are associated symptoms of GAD?
restlessness, muscle tension, irritability
What is the prevalence of GAD?
6%
What is “excessive” worry?
catastrophization, level of worry higher than average, length of worry longer than average, worry that isn’t realistic and normal
Why is worrying reinforcing for anxiety?
Worrying reduces anxiety by creating a perception of management of the anxiety or issue. Sometimes people use worry as a coping mechanism. e.g. creating a study plan instead of studying.
How is procrastination related to anxiety?
Worrying can cause procrastination. Also, people who are big worriers tend to have a hard time making decisions.
What is OCD?
Obsessive-compulsive disorder consists of obsessions, which are intrusive thoughts and urges, and compulsions, which are repetitive thoughts and actions done to reduce anxiety.
What are the categories of OCD?
- contamination
- checking
- symmetry
- sexual/aggressive
- perfectionism
Describe the OCD cycle
Obsession/situation = increased anxiety > compulsion > decreased anxiety
Why are obsessions so problematic to people with OCD?
Obsessions are ego-dystonic (conflicts with self-image), so they are distressing. They are never about happy things.
In OCD, what is a normal vs abnormal obsession?
Abnormal obsessions are more frequent, distressing and hard to ignore
Why are people with OCD compelled to act out their compulsions?
Though-action fusion. They believe that their thoughts directly predict an action or outcome. e.g. in-class activity
What is the prevalence of OCD?
1-2%
Why can OCD be difficult to identify?
Compulsions can be mental, so they can be difficult to tease apart from obsessions
What is the biggest factor in developing, maintaining and reinforcing anxiety behaviours?
Safety behaviours
What are safety behaviours?
They are a mental or physical action done to avoid anxiety, a situation or an object
What is the general cycle for a safety behaviour?
anxiety/trigger > avoidance > temporary reduction in anxiety
The anxiety is maintained and the safety behaviour is reinforced
Give an example of a safety behaviour for a specific phobia
trigger: seeing dog > avoidance: avoid parks > temporary reduction in anxiety
Give an example of a safety behaviour for panic disorder
trigger: increased heart rate > avoidance: avoid exercise > temporary reduction in anxiety
Give an example of a safety behaviour for agoraphobia
trigger: malls > avoidance: only shop online > temporary reduction in anxiety
Give an example of a safety behaviour for social anxiety disorder
trigger: planning a date > avoidance: don’t go on dates > temporary reduction in anxiety
Give an example of a safety behaviour for generalized anxiety disorder
trigger: planning a trip > avoidance: excessive worrying > temporary reduction in anxiety
Planning trips requires prediction and lots of thought. This may result in overplanning/overthinking
Give an example of a safety behaviour for obsessive compulsive disorder
trigger: touch doorknob > compulsion: wash hands x5 > temporary reduction in anxiety
McKnight et al. (2016) study
- reading on anxiety and functional impairment
- correlation between anxiety/functional impairment < depression/functional impairment
- however, you can’t say that anxiety is less severe or less impairing than depression
- anxiety is domain-specific, whereas depression is more global
- so functional impairment in anxiety disorders can be avoided through safety behaviours, but that’s still debilitating
Anxiety and stress response, CBT study
Wichmann et al., 2017
- measured stress response over course of therapy
- patients with panic disorder had lower cortisol response compared to control
- people with a higher mobility inventory (more agoraphobic symptoms) had lower cortisol concentration
Anxiety and stress response, genetics study
Koszycki et al., 2019
- healthy children of low risk vs high risk (anxiety disorder) parents
- measured cortisol response and heart rate variability (how fast you can bring your heart rate back down after stressor)
- higher heart rate variability in low risk children -> good/expected
- blunted cortisol response in high risk kids -> opposite what you’d expect
Why do people with anxiety disorders have blunted cortisol response?
People with anxiety disorders don’t necessarily have a higher level of cortisol. They have dysregulated cortisol response -> HPA/SAM. There’s a weaker ability to respond to stress in a beneficial way, and they are unable to adapt to stress properly.
Healthy people have a spike in cortisol in response to stress, but people with anxiety disorders don’t seem to have this. What we know has come from research on healthy people.
What is the key area involved in negative emotions?
The amygdala
Which areas of the brain modulate anxiety?
the medial prefrontal cortex (mPFC) and the anterior cingulate cortex (ACC)
-> these areas tell the brain not to be overactive with anxiety by decreasing the activity of the amygdala
What is the supervisor analogy for the brain of an anxious person?
In an anxious person, the “supervisors” (mPFC & ACC) are not there so the “naughty child” (amygdala), runs wild.
