Lecture 5 - Stress and Psychological Outcomes II Flashcards
What is PTSD?
Posttraumatic stress disorder is when…
1) intrusions (memories and dreams) and avoidance (thoughts and reminders)
2) cognition and mood changes (negative beliefs and mood)
3) increased arousal and reactivity (hypervigilance, irritability)
occur after a traumatic event.
PTSD can happen from a personal experience, or hearing about/witnessing someone close experience a horrible event.
What is PTSD often confused with?
Depression, because PTSD often presents like depression
What are some consistent thought patterns related to PTSD?
Negative beliefs concerning self, others and the world
Describe negative beliefs about the self in relation to PTSD, and give some examples
Self-blame, despite the blame not being valid. e.g. “I’m to blame”, “I deserve it”
Describe negative beliefs about others in relatoin to PTSD, and give some examples
Negative beliefs about others. In cases of child abuse, there can be negative beliefs surrounding authority figures. e.g. “others can’t be trusted”, “people are bad”
Describe negative beliefs about the world in relation to PTSD, and give some examples
Negative beliefs that are not directed at the self and others. e.g. “the world is a bad place”
What is a common approach to PTSD treatment?
Negative beliefs about self, others and the world are identified and addressed. There is usually a primary one, followed by less stringent negative beliefs.
Does everyone that experiences a traumatic event develop PTSD?
No, most people process and recover from a trauma over time.
When is PTSD after a traumatic event most likely to happen?
When avoidance happens, because this prevents processing of the event and the individual becomes “stuck” in a posttraumatic state.
What is the prevalence of PTSD?
7%
What is a theory of PTSD?
Diatheses-stress model: an individual with a vulnerability to PTSD (genetic, personality, etc.) develops PTSD when exposed to a stressor.
What type of a disorder is PTSD?
It’s a disorder of non-recovery. It is a normal stress reaction that fails to correct over time.
Why does anger occur?
It is a response to perceived injustice, dominance frustration, etc.
What is the physiological circuitry behind anger?
It activates the HPA and SAM systems
What are the negative physiological outcomes of anger?
Anger produces wear and tear on your body, and it is similar to the physiological difficulties produced by chronic stress. e.g. hypertension, headaches, diabetes, cardiovascular disease
What are primary and secondary emotions?
Primary emotions occur in direct response to a situation, whereas secondary emotions occur in response to another emotion and are often used as a way of coping or avoidance.
Give two examples of how anger can be a secondary emotion.
If a person has anxiety as a primary emotion but is unable to manage or cope with this emotion, this may result in anger.
If a person has pain as a primary emotion but has no way of managing or coping with this pain, this may result in anger.
Why is anger as a secondary emotion problematic?
It can be hard for the other person to interpret, and it is an ineffective coping mechanism. For example, my Mom asks about my thesis so I snap at her. This is hard for her to interpret, and it’s not an effective coping mechanism.
What is a disorder related to anger?
Intermittent explosive disorder. This is a disorder where there are verbal or physical angry outbursts, and it can involve destruction or assault. It is more severe than ‘regular’ anger. However, a diagnosis is not needed to treat anger issues.
What is the difference between affect and emotion?
There is no difference, and these words can be used interchangeably
What is the difference between affect/emotion and mood?
Affect/emotion is temporary and fleeting, while mood is long-lasting and stable (sad for two weeks, or two months). An analogy is daily weather vs climate.
What is major depressive disorder?
It is a persistent depressed mood or loss of interest and pleasure in activities (anhedonia) that often starts after a stressor. Each episode increases the risk of another episode.
What is the prevalence of major depressive disorder?
12%, it is one of the most common mental disorders
What is the difference between depression and dysthymia?
Dysthymia is longer lasting, it has to have lasted at least two years to be diagnosed, whereas depression has to have lasted for two weeks. Dysthymia also has less severity in symptoms than depression.
Dysthymia is the colloquial term, what is the DSM classified disorder called?
Persistent depressive disorder
What is double depression?
It is when dysthymia and depression coincide.
If someone starts off depressed, then has dysthymia, it would likely be depression that is not fully recovered. It wouldn’t be double depression, then dysthymia.
If someone has depression, then dysthymia, then depression, the first incident would likely be only depression, followed by an incomplete recovery to dysthymia, then the second depressive episode would then be double depression.
What are some symptoms of depression?
sleep disturbances, changes in weight or appetite, hopelessness, depressed mood, anhedonia (loss of interest in activities), suicidal thoughts
What are the theories for major depressive disorder?
1) Chemical Imbalance
2) Learned Helplessness
3) Low Positive Reinforcement
4) Negative beliefs
5) Diathesis-stress model
What is the chemical imbalance theory on depression?
There is an imbalance in monoamine neurotransmitters (serotonin, norepinephrine and dopamine).
What is the learned helplessness theory on depression?
It’s the perception that nothing you do works. Studies on dogs and electric shocks found that at first, dogs shocked in cages try to escape, but eventually give up.
What is the low positive reinforcement theory on depression?
This theory states that apathy about life causes depression. If someone has no joy in life, they don’t engage in the world around them, and this leads to more severe depression. This theory suggests treatments such as walking around the block everyday to help increase engagement.
What is the negative beliefs theory on depression?
Negative beliefs about self, others and the world result in maladaptive thinking errors such as black or white thinking, or catastrophizing that lead to depression.
What is the diathesis-stress model on depression?
It states that having a short serotonin transporter genotype increases your risk of depression.
Describe the study supporting the diathesis-stress model on depression
This study found a dose-dependent effect of the short serotonin transporter allele. The probability of developing major depressive disorder was 40% for those with a short/short genotype, 30% for a short/long genotype, and only 20% for those with a long/long genotype.
Furthermore, those with a short/short genotype had a greater and more sustained cortisol release in response to stress.
What is bipolar disorder?
It is the cycling between manic or hypomanic and depressive episodes.
What is the difference between mania and hypomania?
Mania is defined as expansive mood and heightened energy to the point where there is functional impairment.
Hypomania is very similar to mania, but there is no impairment in functioning.
What is the prevalence of bipolar disorder?
Less than 1%
What is the time course of manic/hypomanic episodes in comparison to depressive episodes?
Manic and hypomanic episodes usually last for a few weeks, but can range from days to a couple months. Depressive episodes are usually longer and more impairing and can last from days to months.
What happens to the frequency of mood episodes as age increases?
The frequency of mood episodes increases with age. They go from being per year to every couple of months.
Is bipolar II less severe than bipolar I?
No, because there are more depressive episodes which tend to be very functionally impairing. There are also more frequent mood episodes associated with bipolar II, as well as more mixed features.
What are mixed features in bipolar disorder?
Mixed features are a mixture of both depressive and hypomanic symptoms that occur at the same time. For example, when someone is feeling sad but can’t sleep. Mixed features are very rare.
What are the theories of bipolar disorder?
1) hypersensitive behavioural activation system
2) social zeitgeber theory
What is the hypersensitive behavioural activation system theory of bipolar disorder?
The BAS (behavioural activation system activates or deactivates in response to stress. e.g. I want ice cream (BAS activation) or I don’t want ice cream (BAS deactivation)
activation: goal attainment/striving/reward, anger inducing
deactivation: definite failure, irreconcilable loss
In vulnerable individuals with high BAS sensitivity, there is excessive activation or deactivation which lead to hypomanic/manic symptoms (excessive activation) or depressive symptoms (excessive deactivation).
What is the social zeitgeber theory of bipolar disorder?
This theory postulates that…
stressful life events (e.g. getting fired)
-> disruptions in social routines (life changes)
-> disruptions in circadian rhythm (physiological changes e.g. sleep disturbances)
-> disruptions in mood (mood changes)
This theory also postulates that routines decrease mood episodes. Furthermore the stressful life events don’t have to be major because bipolar individuals are extra sensitive to these changes.
What is the neuroanatomy/biology behind mood and anxiety disorders?
Hypoactive prefrontal cortex and hyperactive amygdala (emotion dysregulation).
Dysregulated serotonin and dopamine systems.
There is low disorder specificity.
What is the neuroanatomy/biology behind bipolar disorder?
smaller anterior cingulate cortex and hippocampus
What are the different types of eating disorders?
- Anorexia nervosa -> two subtypes binge/purging and restrictive
- Bulimia nervosa
- Binge-eating disorder
What is anorexia nervosa?
It is when you have a fear of gaining weight and becoming fat, so you restrict your calorie intake and resultingly have very low body weight. There are two subtypes; binge/purging and restrictive.
What is bulimia nervosa?
Recurrent bingeing, which is defined as consuming excessive calories coupled with low self-control, and compensatory behaviours such as purging, fasting and excessive exercise.
What is binge-eating disorder?
Recurrent bingeing without compensatory behaviour
How do you tell apart anorexia with a bingeing/purging subtype from bulimia?
anorexia: low body weight/BMI
bulimia: normal body weight or overweight
How do you tell apart binge-eating disorder from normative bingeing from coping/stress release?
binge-eating disorder: frequent bingeing, low self control, shame
normative bingeing: infrequent, less or no shame
coping/stress release: bingeing linked to stress, feel better afterwards
How is the media related to eating disorders?
1) it puts a social value on thinness
2) 50% of women, and 30% of men are not satisfied with their appearance
3) beauty standards are unattainable -> low mood, body dissatisfaction binges
Although social pressures exacerbate biological and psychological vulnerabilities, they do not cause eating disorders in and of themselves.
Describe the brain imaging study on anorexia
Patients with anorexia nervosa had less activation in the insula, which is involved in perception of self, than healthy controls. Meaning people with anorexia don’t have the same recognition and processing of the self.
Describe the study on binge eating disorder, cortisol, and cravings
participants: obese BED patients, obese non-BED, and normal weight controls
measured: cortisol response to stressor, and binge/sweet cravings in response to stressor
results:
1) Obese BED patients had a blunted cortisol response
- > theory is that because ppl with BED and other anxiety disorders have so much activation of fear response, fight/flight, HPA/SAM axis, the cortisol response wears down over time so it can’t engage properly when it needs to
2) Obese BED patients had greater desire to binge and greater cravings with greater stress.
What are substance use disorders?
Continued substance use despite cognitive, behavioural, and physiological issues that it causes or exacerbates. They are divided into ten categories.
What are some problems with diagnosing substance use disorders?
Only 2 of 11 possible symptoms are needed for diagnosis, so contextual factors also need to be taken into consideration.
What are the theories on substance use disorders?
1) neurobiological changes (e.g. sensitive reward system)
2) coping -> common with other disorders -> e.g. social anxiety disorder, cope with drinks
3) social pressures e.g. frosh week drinking, MDMA at music festivals
4) impulsivity -> some people have less control
5) mood enhancement -> getting buzzed
6) genetics
Why is it hard to diagnose substance use disorders when there are other comorbid disorders?
If substances are used to cope with other disorders such as anxiety or depression, the behaviour or symptom could be related to the anxiety or depression instead of being its own disorder.
Describe the study on substance withdrawal and CRF
This study measured corticotrophin-releasing factor (CRF; measures stress, related to HPA axis) during alcohol withdrawal in rats in an area of the brain related to anxiety.
treatments:
1) alcohol-infused diet that was stopped
2) alcohol-infused diet stopped then reintroduced
3) control diet
Once the alcohol was taken away, both groups on the alcohol-infused diet had a spike in CRF that continued to rise during alcohol withdrawal when the control diet was given. In the group that had alcohol reintroduced, CRF decreased upon reintroduction.
Describe the study on cannabis, emotion regulation and coping.
Highly anxious cannabis users often use cannabis to cope with distressing situations and emotions. This study measured the interaction between difficulty quitting cannabis and emotional regulation (being able to control emotions).
results: Found that quitting difficulty was related to emotion regulation and habitual coping using cannabis. Severe anxiety increased withdrawal symptoms and decreased the ability to resist using cannabis in distressing situations.
- > inability to regulate emotions increased both anxiety and withdrawal symptoms
What is the front line medication for both anxiety and depression, and what do they do?
SSRIs (selective serotonin reuptake inhibitors) increase serotonin levels
How long does it take for antidepressants to take effect?
About one month
What are some common side-effects of SSRIs?
weight gain, sleep disturbance, sexual dysfunction
What percentage of antidepressant effects are due to placebo effects?
60%
What are SSRIs used for?
Both anxiety and depression
What are anxiolytics and what do they do?
They are benzodiazepines that increase GABA activity, and they are used as anti-anxiety medication.
Explain how anxiolytics work
GABA suppresses brain activity, so increasing GABA activity suppresses arousal
What are the pros and cons of benzodiazepines?
+: they work immediately
-: they are addictive
What are some side effects of benzodiazepines?
drowsiness, dizziness, cognitive impairment with long-term use, chronic use has long-lasting effects
What are benzodiazepines used for and what type of drug are they?
They are used as anti-anxiety medications and they are an anxiolytic.
What type of drugs are used for bipolar disorder?
Mood stabilizers such as lithium carbonate, valproate, and lamictal, as well as antivconvulsants that were originally developed for epilepsy.
What are the effects of bipolar disorder medications?
The effects are unclear, especially for lithium carbonate, but they target several neurotransmitters, sodium, and glutamate.
What do antipsychotic medications do?
They primarily decrease dopamine
What disorders are antipsychotic medications used for?
Psychosis, schizophrenia, etc.
What are some side-effects of antipsychotic medications?
weight gain, dry mouth, and neurological issues such as tardive dyskinesia
