Midterm 2 Flashcards
What is suicidal ideation?
thoughts and intentions of killing oneself
What are sucide attempts?
Self-injury behaviors intended to cause death but that do not lead to death, all are important but they vary in seriousness
What are suicide gestures?
self-injury in which there is no intent to die
what is suicide?
Behaviors intended to cause death and death occurs.
What is subintentional death?
When individuals play indirect, hidden, partial, or unconscious roles in their own deaths, Shneidman classifies them in this category
Less then conscious drive to die
What are suicide warning signing?
Not everyone displays warning signs:
Giving away possessions
saying goodbye to friends or family
talking about death or suicide generally, or talking about plans
making threats of suicide
rehearsing a plan for suicide
What age group is the most likely to commit suicide?
In Western society, the elderly are more liekly to commit suicide than people in any other age group
There are many contirbutory factors:
Illness
Loss of close friends and relatives
What is unipolar depression?
Most people with a mood disorder experience only depression, called unipolar depression. Person has no history of mania, mood returns to normal when depression lifts
What is bipolar disorder?
Experiencing periods of mania that alternate with periods of depression
What is uniplora mania?
An uncommon pattern were people suffer from mainia only
What is the pattern for people with bipolar disorder?
Regardless of particular pattern, individuals with bipolar disorder tend to experience depression more than mania over the years. In most cases depressive episodes occur three times as often as manic ones, and last longer
What are the symptoms of mania?
Unlike those experiencing despression, people in a state of mania typically experience dramatic and inappropriate rises in mood.
Five main reas of functioning may be affected
1. Emotional symptoms: active, powerful emotions in search of outlet
2. motivational symptoms: need for constant excitement, involvement, companionship
3. behavioral symptoms: very active - move quickly; talk loudly or rapidly. Flamboyance is not uncommon
4. Cognitive symptoms: show poor judgement or planning; especially prone to poor or no planning
5. physical symptoms: high energy level - often in the presence of little or no rest
When is the onset of bipolar disorders?
onset usually occurs between 15 and 44 years of age. In most cases, the manic and depressive episodes eventually subside, only to recur at a later time.
How common is MDD and how long to they last, will they repeat and do they seek treatment?
LIfetime prevalence rates in the US; from 5.2% to 17.1%
About 80% of those with MDD experience another episode
13% of MDD cases lasts more than 2 years. May be explained by kindling hypothesis - once a depression has already been expeirences, it takesless stress to induce a subsequent recurrence
between 60% and 80% of univeristy students with a diagnosable depression do not seek or receive treatment
How does the neuroendocrine system effect bipolar disorder (biological theories)?
HPA axis may play a role in depression: higher levels of cortisol in depressed patients
Disorders of thyroid function are often seen in bipolar patients: thyroid hormones can induce mania
Right hemisphere dysfunction
Stressor -> hypothalamic activity: Hypothalamus releases corticotropin releasing factor (CRF) ->
Pituitary activity: pitutary release adrenocorticotropic hormone (ACTH) ->
Adrenal glands release cortisol
How is sleep different in depressed people?
REM starts sooner after falling asleep in depressed people
depressed experience more intense REM activity
Slow wave (deep) sleep occurs later
disturbed sleep
What are social factors to mood disorders?
Life events:
42-67% report a stressful life event in year prior to depression onset (e.g. romantic breakup, loss of job, death of loved one)
Lack of social support may be one reason a stressor triggers depression
Interpersonal difficulties:
High levels of expressed emotion (hostile and angry, criticism) by family member predicts relapse
marital conflict also predicts depression
Behavior of depressed people often leads to rejections by others:
excessive reassurance seeking
few positive facial expressions
negative self disclosures
slow speech and long silences
What are other theories of depression?
Psychodynamic: introjection of the lost object; anger turned inward; excessive severity of the superego; loss of self-esteem
Attachment:
insecure early attachments; distorted internal working models of self and others
Behavioral:
lack or loss of reinforcement or quality of reinforcement; deficits in skills needed to obtain reinforcement
Cognitive:
depressive mindset; distorted or maladaptive cognitive structures, processes, and products; negative view of self, world, and furutre; poor problem-solving ability; hopelessness
Self-control:
problems in organzing behavior toward long-term goals; deficits in self-monitoring, self-evaluation, and self-reinforcement
Interpersonal:
impaired interpersonal functioning related to grief over loss; role dispute and conflict, role transition, interpersonal deficit, single aprentings; social withdrawal; integration between mood and interpersonal events
Socioenviornmental:
stressful life circumstances and daily hassles as vulnerability factors; social support, coping, and appraisal as protective factors
Neurobiological:
Neurochemical and receptor abnormalitiies; neurophysioloigcal abnormailites; neuroendorial abnoramilites
What is interpersonal theory of depression?
sparse social networks that provide little support:
lowers an individual’s ability to handle negative life events
raises vulnerability to depression
Depressed people also elicit negative reactions from others and are low in social skills
they also constantly seek the reassurance of others
Depression wears out social networks
What is attachment theory of depression?
parental seeparation and interuption of an attachment bond are predisposing factors for depression
What is behavioral theory of depression?
emphasizes the importance of learning, environemntal consequences, and skills and deficits in the onset and maintenance of depression
depression is related to a lack of response-contingent postive reinforcement
There’s not enough fun, stimulation, rewarding activities
What are gender difference in depression?
MDD twice as common in women than men
Differences emerge in adolescence
Some biolgoical and psychological factors include:
Hormones
girls twice as liekly to experience sexual abuse
women more likely to experience chronic stressors
girls and women more likely to worry about body image
women may react more intensely to interpersonal loss
women spend more tiem ruminatng; mend tend to distract
ruminating may intensify and prolong sad moods
What is the integrative theory of mood disorders?
Depression, anxiety, mania caused by an interaction of
BIological vulnerability genetically determined
psychological vulnerability
stressful life events
hormonal imbalances and social causes
What brain structure causes bipolar disorders?
Brain imaging and psotmortem studies have identified a number of abnormal brain sturctures in people with bipolar disorder; in particular, the basal ganglia and cerebellum among others
it is not clear what role such structural abornalities play
What is cogntive therapy?
Can be used to treat unipolar depression
Beck’s Cognitive therapy - which includes a number of behavior techniques - is designed to help clients recognize and change their negative cognitive processes
this appraoch follows four phases and usually lasts fewer than 20 seasons
Phases:
1. Increasing activities and elevating mood
2. challening automaic thoughts
3. identitying negative thinking and biases
4. changing primary attitudes
What are the treatments for unipolar depression: psychological approaches?
Behavioral therapy
Cognitive therapy
Interpersonal psychotherapy
What are the treatments for unipolar depression: sociocultural approaches?
Interpersonal therapy
Couple therapy
How can interpersonal therapy treat unipolar depression?
This model holds that four interpersonal problems may lead to depression and must be addressed:
interpersonal loss
interpersonal role dispute
interpersonal role transistion
interpersonal deficits
studies suggest that IPT is as effective as cognitive therapy for treating depression
how can couple therapy treat unipolar depression?
The mian type of couple therapy is behavioral marital therapy (BMT)
focus is on developing specific communication and problem-solving skills
if marriage is conflictual, BMT is as effective as other terapies for reducing depression
How is electroconvulsive thepry used to treat unipolar depression?
The use of ECT was and is controverisal
it is now used frequently because it is an effective and fast-acting intervention
the procedure consists of targeted electrical stimulation to cause a brain seizure
the usual course of treatmnet is 6 to 12 sessions spaced over 2 to 4 weeks
treatment may be bilateral or unilateral
What are MAO inhibitors?
An antidepressant drug
They potentially pose a serious danger
blood pressure may rise to a potentially fatal level if one eats foods with tryamine (cheese, banadas, wine) while taking MAOIs
in recent years, a new MAO inhibitor in the form of a skin patch has become available
dangerous food interactions to not appear to be as common a problm with this kind of MAO inhibitor
What are the three basic types of antidepressant medication used?
Tricyclics
MAOIs
Second-generation antidepressant drugs
What the the effectiveness and effects of second-generation antidepressant drugs
The effectiveness and speed of action of these drugs is on par with the tricyclics yet their sales have skyrocketed
Clinicians often prefer these drugs because it is harder to overdose on them than other kinds of antidepressants
there are no dietary restricitons like there are with MAO inhibitors
they have fewer side effects than the tricyclics
These drugs may cause some undesired effect of their own, including reduction in sex drive
How is bipolar disorder treated?
Psychotherapy alone is rarely helpful for persons with bipolar disorder
mood stabilizing drugs alone are also not always sufficient
30% or more of patients don’t repsond, may not receive the correct dose,a nd/or may relapse while taking it
as a result, clinicians often use psychotherpay as an adjunct to lithium (or other mediciation-based) therapy
What are substance-related disorders?
substances may cause temporary changes in behavior, emotion, or thought
may result in substance intoxication (literally poisoning), a temporary state of poor jdugement, mood changes, irritability, slurred speech, and poor coordination
some substances such as LSD may produce a particular form of intoxication, sometimes called hallucinosis, which consists of perceptual distorition and hallucinations
What is intoxication?
experience of significant maladaptive behavioral and psychological symptoms due to the effect of a substance on the central nervous system
what is withdrawal?
experience of clinical significant distress in social, occupational, or other areas of funcitoning due to the cessation or reduction of substance use
what is tolerance?
with repeated use of a susbtance more of it is required to obtain the same effect
What is substance abuse?
a pattern of behavior in which a person relies on a drug excessively and chronically, damaging relationships, affecting work funcitoning, and/or putting self or others in danger
what is substance dependence?
a more advanced pattern of use in which a person abuses a drug and centers his or her life around it
also called addiction
may included tolerance and withdrawal
How is alcohol as a drug?
it is a depressant
Though legal, alcohol is one of the most dangerous recreational drugs
its effect can extend across the life span
alcohol use is a major problem in high school, college, and adulthood
What are the 6 neurotransmitters, alcohols effects on them, and the psycholgoical and behavioral effects?
Dopamine:
Alcohol increased DA secretion at the nucleus accumbens, a system implicated in reward.
Increases pleasurable sensations; system may in implicated in alcohol’s addictive properties
Norephinephrine/ noradrenaline:
Alcohol incrases the release of NE.
Produces enlivening/activiting sensations
Gamma-aminobutric acid:
Alcohol stiulates GABA activity, an inhibitory neurotransmitter.
Reduciton is stress and anxiety; sedation; memory disturbanses; coordination problems, such as slurred speech and stumbling
Endogenous opioids:
Alcohol increases the release of opioids. Increases pleasurable sensations; reduces stress; numbing effects
Glutamate:
Alcohol blocks the excitatory NMDA receptor which, in turn, inhibits gluatmate, an excitatory neurotransmitter.
Causes memory problems and general cerebral depressant effects (slower reaction time, poor concentration)
Serotonin:
Alcohol stimulates 5-HT, an excitatory neurotransmitter.
Associated with pleasurable effects and nausea
What is fetal alcohol syndrome?
Leading cause of intellecutal disability - heavy alcohol consumption during pregnacy
growth of the fetus is slowed
cranial, facial, and limb anomalies are produced
known as fetal alcohol syndrome
see also partial fetal alcohol syndrome and alcohol-related neurodevelopmental disorder (ARND)
What are delirium tremens? (DTs)
frightening hallucinations and body tremors, especially in withdrawals
What are stimulants?
Most widely consumed drug in Canada and the US
such drugs increase alertness and increase energy
examples include amphetamines, cocaine, nicotine, and caffeine
What are opioids?
Opiate: natural chemicals in opium poppy having a narcotic effect
Sleep-inducing, pain-relieving (analgesic)
canada in grip of opioid crisis: prescription and illegal; high in First Nations adults
withdrawal is unpleasant
intravenously taken: risks of HIV
high mortality rates
How can narcotics be taken and what are the effects?
Narcotics are smoked inhaled, injected by needle just under the skin (skin popped) or injected directly into the bloodstream (mainlined)
injection seems to be the most common method of use, although other techniques have been increasing in recent yeras
an injection quickly brings a rush: a spasm of warmth and ecstasy that is sometimes compared with orgasm
this spasm is followed by several hours of pleasurable feelings (caled a high or nod)
What are biological factors to substance-related disorders?
Theorists suspect that people who abuse substances suffer from a reward-deficiency syndrome. Their reward center is not readily activated by “normal” life events so they turn to drugs to stimualte this pleasure pathway, particulary in times of stress. Defects in D2 receptors have been cited as a possible cause
What are the cognitive-behavioral views of substance-related disorders?
According to behaviorists, operant conditioning may play a key role in the development and maintenace of substance abuse
they argue that the temporary reduction of tension produced by a drug has a rewarding effect, thus increasing the likelihood that the user will seek this reaction again. similarly, the rewarding effects may also lead users to try higher doses or more powerful methods of ingestion
Cognitive theroists further argue that such rewards eventually produce an expectancy taht substances will be rewarding, and this expecatation is sufficient to motivate individuals to increase drug use at times of tension
What causes substance related disorders?
Clinical theorists have developed sociocultural, psychological, and biological explanations for substance abuse and dependence. No single explanation has gained broad support. best explanation is a combination of factors
What is the common liabilities model?
It explains how neurological, psychological, and social factors create a vulnerability to problematic behaviors. including substance abuse and dependence
one common liability may be a problem with impulsivity
common liabilities may account for the high comorbidity between substance use disorders and impulse-control disorders
What is motivational enchacement therapy? (MET)
BEcuase substance abusers arrive at treatment at different stages to change substance use behavior, MET increases motivation to change behavior
What are antagonist drugs?
A biological treatment. an aid to resist falling back into a pattern of substance abuse or dependence, antagonist drugs block or change the effects of the addictive substance
Example: disulfiram (Antabuse) for alcohol
Example: naltrezone for narcotics, alcohol
What is detoxification?
Detoxification programs seem to help motivate people withdraw from drugs
for people who fail to receive psychotherapy after withdrawal, however, relapse rates tend to be high
What is gambling disorder?
Lifetime estimate of approzimately 2% Americans
Job loss, bankruptcy, arrests
similar to substance use disorders
tolerance and withdrawal
people with gambling disorder: indenial, impulsive, continually optimisic
internet gambling disorder
What is forensic psychology?
the intersection between the mental health field and the legal and judical systems are collectively referred to as “forensic psychology”
Who is dangerous?
Historically, people with mental illnesses were less likely than others to commit violent or dangerous acts because of mass hospitalization
since deinstitutionalization, however, this is no longer true
finding do not suggest that people with mental disorders are generally dangerous but studies now suggest at least a small relationship between severe metnal disorders and violent behavior
What are the trends in civil commitment?
the Supreme Court ruled that imprisoning people hwo suffered from drug addictions might violate the Constitution’s ban on curel and unusual punishment
as the public became aware of these issues, states passed stricter standards for commitment
today, fewer people are institutionalized through civil commitment proceedings than in the past
How is psychology used in jury selection?
During the past 25 years, more and more lawyers have turend to clinicians for advice in conducting trials
a new breed of clinical specialist - “jury specialists” - has evolved
they advise lawyers about which jury candidates are likely to favor their side and which strategies are likely to win jurors’ support during trials
How has psychological research impacted legal topics?
In criminal cases testimony by eyewitnesses is extremely influential. reserach indicates that eyewitness testimoney can be highly unreliable. the events are usually unexpected and fleeting. Laboratory subjects can be fooled into misremembering information. Research has also found that accuracy in dientifying perpetrators is influenced by the method used in investigation
When can confidentially be violated?
A patient gives the clincian permission to violate confidentiality
a clincian has reasonable cause to suspect child abuse, elder abuse, or abuse of the disabled
a clinican has reasonable cause to suspect that the patient is a threat to himsef or herself (suicidal)
a clinican has reasonable cause to suspect that the patient is a threat to others (homicidal)
What is premenstrual dysphoric disorder?
Clinicians identified a small group of women, from 2 to 5 percent, who experienced severe and sometimes incapacitating emotional reactions during the premenstrual time.
A combination of physical symptoms, severe mood swings, and anxiety is associated with incapacitation during this time.
What is disruptive mood dysregulation disorder
Severe recurrent temper outburst manifested verbally (e.g., verbal rages) and/or behaviorally (e.g., physical aggression toward people or property) that are grossly out of proportion in intensity or duration to the situation or provocation. After 6 years old and before 18.
What is cyclothymic disorder?
Cyclothymic disorder is a chronic alternation of mood elevation and depression that does not reach the severity of manic or major depressive episodes
What is bipolar I
They experience major depressive episodes that alternate with hypomanic episoders, which are less severe.
What is the learned helplessness theory of depression?
The idea that people become anxious and depressed when they make an attribution that they have no control over the stress in their lives
What is transcranial magnetic stimulation (TMS)?
another method for altering electrical activity in the brain by setting up a strong magnetic field. It shows promise in treating depression although ECT may be more effective.
What is venlafaxine and nefazodone?
venlafaxine a newer antidepressant that is closey related to tricyclic but reduce some of associated side effects
nefazodone is closely related to SSRIS but seems to improve sleep efficency instead of disrupting sleep
What are the 4 types of suicide?
altruistic suicide: individuals who brought dishonor to themselves or families
Egoistic suicide: loss of social support
Anomic suicides: marked disruptions
fatalistic suicides: loss of contorl over our own destiny
What is intermittent explosive disorder?
People who have episodes in which they act on aggressive impulses that result in serious assaults or destruction of property
What is kleptomania?
a recurrent failure to resist urges to steal things taht are not needed for personal use or their monetary value
What is pyromania?
an inpulse-control disorder that involvecs having an irresisitible urge to set fires
