Midterm 2 Flashcards
What is obsessive compulsive disorder (OCD)?
Obsessions, with/without compulsions
Often associated with mental rituals, fluctuating insight, family involvement (often reinforcing the behaviour), avoidance, and reassurance seeking
What are obsessions?
Intrusive, unwanted, reoccurring, and foreign ideas that come in the forms of thoughts, images, impulses, and feelings
Often theme of contamination, aggression, violence, sexuality
What are compulsions?
Repetitive behaviour or mental act that you are driven to perform to neutralize the obsession, prevent feared event, and/or provide relief
Not always functionally related to the obsession
What is the comorbidity of OCD?
Mood and anxiety disorders are very common with OCD
80% of people with OCD also have depression
Biopsychosocial model of OCD: Etiology: Bio
Very biological
Moderately heritable
5-HT (SSRIs decrease emotional force)
Slight structural abnormalities in basal ganglia (motor control, learning, rewards)
Heightened thalamus (cleaning and checking)
Biopsychosocial model of OCD: Etiology: Psycho
Attention driven toward disturbing material related to obsession
Thought fusion: bad thought is same as doing the thing
Behavioural theory: conditioning
Initial fear is classically conditioned (something happened and now they must go together)
Compulsions negatively reinforced is operant conditioning
Biopsychosocial model of OCD: Etiology: Social
Behavioural theory: conditioning
Social reinforcement
Biopsychosocial model of OCD: Presentation: Bio
Compulsions correlated with increased brain activity
Basal ganglia
OFC
function: emotion in reward/punishment anticipation
increased activity preoccupation
Biopsychosocial model of OCD: Presentation: Psycho
Over importance of thoughts
Over estimation of threat
Intolerance of uncertainty
Cognitive distortions
Biopsychosocial model of OCD: Presentation: Social
Content of obsessions seems to be different from culture to culture
Cultures where OCD is not a problem and does not need to be treated
Biopsychosocial model of OCD: Treatment: Bio
Decreased activity in basal ganglia
Anti depressants (SSRIs)
Cingulotomy (disconnect part of the limbic system communication)
Biopsychosocial model of OCD: Treatment: Psycho
Behavioural: exposure and response prevention
Cognitive: challenge maladaptive thinking patterns
Biopsychosocial model of OCD: Treatment: Social
Family behavioural change
Increase social support
What are mood disorders?
Defining feature: extremes of emotion that cause a disruption in mood
Depression
Mania
What are the types of mood disorders (2)?
Unipolar: just one type of mood disorder (depressive episodes)
Bipolar: two types (depressive episodes and manic episodes)
What are the features of major depressive disorder (MDD)?
Sad, depressed mood
Anhedonia: loss of pleasure in things you used to enjoy (must have one of the first two)
Sleep difficulties
Agitation
Worthlessness
Recurrent thoughts of death or suicide
What is persistent depressive disorder (PDD)?
Chronic, lowgrade depression (>2 years)
Average duration 4-5 years
intermittent normal moods
Explain Beck’s cognitive theory
Main idea: negative interpretation of situation/events lead to feelings of depression which lead to more negative interpretations
Explain negative cognitive triad
negative views of individual from levels of the self (I am unloveable), world (no one loves me) and future (no one will ever love me)
All continually feed into each other
Explain helplessness theory
Learned helplessness from lack of perceived control over life events and pessimistic attribution style
Uncontrollable event → attributions → sense of helplessness → emerging depression
Explain hopelessness theory
Uncontrollable event → attribution or other cognitive factors → sense of
hopelessness → emerging depression
Helplessness vs hopelessness
Helplessness theory
Pessimistic attributional styles (diathesis)
+
Stressful life events (stressor)
Hopelessness theory
Pessimistic attribution styles (diathesis 1)
+
State of hopelessness (diathesis 2)
+
Stressful life event (stressor)
What are internal vs external attributions?
Internal (me): negative outcomes are one’s own fault
External (other): negative outcomes are the result of some uncontrollable factor
What are stable vs unstable attributions?
Stable (always): future negative outcomes will be one’s own fault
Unstable: can be changed
What are global vs specific attributions?
Global (everything): negative events disrupt many life activities
Specific: negative events are related to one particular activity
Biopsychosocial model of MDD: Etiology: Bio
Heritability ~35%
Lower 5-HT
Higher NE and DA leads to mania
Lower NE and DA leads to depression
Biopsychosocial model of MDD: Etiology: Psycho
Beck’s cognitive theory
Biopsychosocial model of MDD: Etiology: Social
Biopsychosocial model of MDD: Presentation: Bio
Lower left PFC
Higher Right PFC
Heightened amygdala
Biopsychosocial model of MDD: Presentation: Psycho
Beck’s cognitive theory
Negative cognitive triad
Helplessness and hopelessness theory
Rumination
Biopsychosocial model of MDD: Presentation: Social
Interpersonal theories
Genuine negative effect on others, alienation from social support
Insecure in relationships
Biopsychosocial model of MDD: Treatment: Bio
Pharmacology (help people see clearly)
SSRIs, MAOIs, SNRIs
Light therapy (seasonal depression)
Treatment resistance:
ECT (induce seizure using electric current)
TMA (magnetic stimulation in parts of brain)
Ketamine (NMDA receptors, may reduce inflammation)
Biopsychosocial model of MDD: Treatment: Psycho
Psychodynamic (importance of early loss, attachment styles)
CBT:
Cognitive (primary control: I can do something about it, secondary control: I can something about my attitude)
Behaviour (gold standard, get out of bed, increase mastery and experiences of pleasure)