Midterm #2 Flashcards

1
Q

DSM 5 criterion for Major Depressive Disorder?

A

DSM criterion shown to be consistent across cultures in first, second and third world countries

1) At least two weeks of depressed mood and/or the loss of interest or pleasure in most activities.

Plus 4 additional symptoms from:
Changes in appetite or weight (Increase or decrease in weight, normally due to increase or decrease in appetite), Sleep disturbances (change in normal sleep pattern), agitation, decreased energy, feelings of worthlessness or guilt, difficulty concentrating or making decisions, recurrent thoughts of death, or suicidal ideation.

Most common additional symptoms:
Changes in appetite: Appetite may increase or decrease
Changes in weight: Increase or decrease in weight
Sleep disturbances: Normal pattern changes. May sleep more, or may sleep less. May awake frequently, ie every night at 2am
Agitation: Some people may become jittery and anxious, while others become lethargic and cant get out of bed

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2
Q

Social Phobia

A

When someone has a marked or persistent fear of social or performance situations in which embarrassment may occur.
*Social phobia is common

It has higher rates in western cultures, primarily North America. Also some Asian countries, but primarily a western phenomenon

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3
Q

Psychoses?

A

Loss of contact with reality

This is why schizophrenia is considered a psychotic disorder, because they have hallucinations and delusions that prevent them from seeing the world as it actually is

*Depressed people typically see the world more accurately. the opposite of psychoses

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4
Q

Prevalence of Major Depressive Disorder?

A

2X as common in women

approximately 4.7% of Canadians

2-9% of depressed patients commit suicide

**Only chronic for a minority of people. Depression normally remits within 6 months for most people.

*Highest % in young people and *lowest in older people

Prevalence is increasing steadily year by year. This may be because we are becoming more able/willing to assess/diagnose

**Although depression rates are increasing, suicide rates are not. Suicide rates have not gone up in 20 years. May be because we now have more supports for suicide.

**As rates of depression go up, rates of schizophrenia are going down.

With every episode of depression that you have, your risk of relapse increases. This is the case with all mental health disorders.
.

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5
Q

Differences in stated depressive symptoms in western vs nonwestern countries?

A

DSM 5 criterion are applicable across all cultures

Westerners focus on mental symptoms “depression”

Non-Westerners focus on physiological symptoms, lethargy etc.

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6
Q

What two conditions are highly comorbid in depression?

A

1) Anxiety

2) Substance abuse

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7
Q

What are the four types of antidepressants?

A

1) SSRIs
2) Dopamine agonists
3) Epinephrine reuptake inhibitors
4) Reversible MOAI

*All these drugs increase either epinephrine, serotonin, or dopamine in the brain.

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8
Q

What psychiatric condition has the highest rate of mortality?

A

1) is Anorexia

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9
Q

What four mental disorders have the highest rates of suicide?

A

1) Depression
2) Schizophrenia
3) Bipolar
4) Substance abuse

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10
Q

Suicide differences between men and women

A
  • Across all cultures *Women have a higher rate of attempting suicide, but *men have a higher rate of successfully committing suicide.
  • Men choose more lethal methods, such as guns
  • Women tend to choose pills, which are slower, more chance of recue etc.
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11
Q

What mental disorder has the strongest association with suicide?

A

Depression

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12
Q

marriage and depression?

A

Marriage is a risk factor for females

Marriage is a protective factor for males

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13
Q

Why do females have twice the rate of depression compared to males?

A

2: 1 ratio
* This is across all cultures, even present in “progressive” cultures, like Sweden
* rates are the same between career vs housewives

For this class: Women are more likely to continually ruminate on their problems.

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14
Q

Neurobiology of depression

A

Underactivity of the PFC- not the cause of depression, but it coincides with depression
- Administering drugs that suppress activity of the PFC will result in depression

You can rectify depression by stimulating the PFC:

1) Artificial stimulation: via antidepressants, ECT, TMS (transcranial magnetic stimulation)
2) Psychologically: Use of CBT or insight therapy
* PFC will become more active as you become better

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15
Q

What causes underactivity of the PFC during depression?

A

*Prolonged Stress, *Stress hormone Cortisol: *biological cause for changes in the depressed brain.

Other reasons: Diet, lack of exercise, hormonal changes etc. *There are many routes that can result in depression.

Sometimes there is a single important factor, but many time it is a combination of factors

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16
Q

Effective treatments for depression?

A

Psychotherapy: Especially CBT- changing thought processes

Drugs: SSRIs, NRIs, Dopamine Agonists, Reversal MAOI

Hormones: Thyroxin,Testosterone, Estrogen+Progesterone

Underactive thyroid: may cause depression, treated with the hormone “Thyroxin”.

Low testosterone: Testosterone supplemented (indirectly stimulates dopamine), improve mood, energy etc.

Estrogen+ Progesterone: Variations in these hormones are associated with mood. Can be helpful in regulating mood in women

**Antiglucocorticoid: *Upstream approach to stress induced depression: This hormone Decreases cortisol levels. This in turn elevates dopamine, serotonin, and epinephrine.

Sleep deprivation: Temporary mood improvement. Fast effective relief. Only lasts a day or two.
*Everyone with depression has some form of sleep disorder

Exercise: As effective as medication+therapy for minor and moderate depression.

  • decreases cortisol
  • increases exercise flow to the brain, increases endorphins and keflins

Light

Diet

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17
Q

Problems with lithium

A
  • Only 50% of bipolar patients respond
  • Does not treat the depressive phase of depression, it only modulates the manic phase
  • Can cause temours and memory problems
  • Longterm risk of tardive dyskinesia: permanent uncontrollable tics
  • Has a narrow range of safety between therapeutic levels and toxicity
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18
Q

6 Treatments for Bipolar disorder

A

1) Lithium: Mood stabilizer *Most common for conventional bipolar
2) Carbamazepine(Tegretol): Anticonvulsant
3) Valproic acid: Anticonvulsant
4) Antipsychotics: Given in the the ER to quickly control the manic episode.
5) EMPower
6) ECT

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19
Q

ECT + Bipolar

A

ECT works for both depressive and manic states

Only used under three conditions:

1) When you don’t respond to medications
2) When you are pregnant and don’t want to damage the fetus
3) When an immediate response is necessary

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20
Q

Mania

A

Often contains: State of Euphoria

  • Grandous delusions
  • Excitation
  • “Push of speech”- cant interrupt them
  • Persistently elevated or irritated mood
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21
Q

What is the most dangerous treatment for bipolar and why?

A

Lithium, because blood levels must be monitored constantly to avoid toxicity

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22
Q

What environmental manipulations work for bipolar?

A

Having a strict routine and sleep schedule

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23
Q

What causes bipolar?

A

Bipolar is mostly a genetic brain disorder, where the brain was built improperly

75% heritable

Similar neurobiological mechanisms to depression

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24
Q

What anticonvulsants are used to treat bipolar?

A

Valproic Acid

Carbamazepine

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25
Q

How many people have another manic episode after having experienced one?

A

90%

The frequency increases with every subsequent episode

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26
Q

What are the 6 subtypes of bipolar?

A

1) Mixed/Rapid cycling- Fast cycling between depression and manic phases
2) Anxious- includes high state of anxiety
3) Psychotic- includes prominent delusions
4) Seasonal- Summer triggers mania (increased light), winter triggers depression (decreased light)
5) Post partum: Fluctuations in hormones causes mood changes
6) Cyclothymia- Chronic. Constains less severe forms of depression, and hypomania instead of mania. May experience clearer thoughts during hypomania, improved cognition etc.

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27
Q

Diet and depression

A

Depressed people have different dietary profiles, minerals, vitamins etc.

Small levels of lithium can be obtained from foods, and from water

Promising studies for zinc, vitamin D, and folate

Omega 3 fatty acids- low levels are associated with many MH issues.

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28
Q

ECT + Depression

A

Artificially induced seizure

Last resort

*Most effective treatment for severe depression
80% success vs 2/3 for other therapies

Problem: Causes minor brain damage, can result in memory loss/memory problems

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29
Q

Exercise+Depression

A

As effective as medication or psychotherapy for minor to moderate depression. Not as effective for severe depression.

Physical action releases build-up of stress hormones, like cortisol

Increases oxygen flow to the brain

Increases endorphins and keflins + increases dopamine indirectly

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30
Q

Transcranial magnetic stimulation TMS

A

Uses powerful magnets to stimulate PFC

No known side effects

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31
Q

4 Hormone treatments for depression

A

1) Thyroxin: Stimulates thyroid = more energy
2) Testosterone: Indirectly improves reward/motivation and mood.
3) Estrogen+Progesterone: Associated with mood regulation, , especially in women
4) Antiglucorticoid: Cutting edge hormone that reduces cortisol. Upstream approach

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32
Q

Sleep deprivation

A

Temporary, fast mood elevation

Not a longterm solution, but can provide effective fast improvement in mood

*All depressed people also have some form of sleep disorder. Maybe insomnia, wierd awakening, too much sleeping etc.

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33
Q

Causes of depression?

A

50% genetic

Also includes environment and psychological/behaviour patterns

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34
Q

List 7 environmental factors that contribute to depression

A

1) Stressors: Divorce, loss of a loved one, poverty etc.
2) Traumatic events
3) Lack of social support
4) Psychological coping skills: How you deal with upset and aggression
5) Culture is very achievement oriented, competitive society:
6) Loss of religion as a society: Loss of social support systems, sense of purpose in life

7) Personality: Some people are chronically pessimistic and neurotic
- Permanent optimists are better innoculated against depression

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35
Q

Aboriginals and suicide

A

Worldwide aboriginal people have higher rates of suicide.

*More trauma and substance abuse in these sections. + disadvantageous social conditions. These result in hopelessness, no sense of a possible future.

Reserves with good economies and living conditions have much lower suicide rates

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36
Q

Frequencies about bipolar

A

1.5% of the Canadian population

Any age, equally as common in men and women

Peak mania occurs in summer

6-70% of the time mania is preceded or followed by a depression episode

90% relapse rate, interval between episodes decreases with each episode

Rates of suicide are 2-4%

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37
Q

Somatic Symptom Disorder

A

One or more bodily symptoms causing persistent (>6months) distress
*Excessive thoughts, feelings, and/or behaviours related to these bodily symptoms. (preoccupation, anxiety , excessive time and energy devoted to these symptoms)

  • Chronic, but fluctuating
  • EXCESSIVE medical consultation and intervention, without effect
  • Can and does occur alongside real physical problems
  • Inability to realize that your concern is out of proportion
  • Resistant to psychological referral

Appraise their symptoms as unduly threatening, despite reassurance

High comorbidity with depression and anxiety

Physical symptoms associated with significant psychological stress or impairment

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38
Q

Generalized Anxiety Disorder

A

Worried, always nervous about everything
Nonspecific anxiety
self conscious- need excessive reassurance

Psychosomatic complaints: Upset stomach etc.

(Heightened anxiety produces more stress hormones that affect the body)

**Chronic, does not necessarily go away with time or treatment

*Highly genetic

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39
Q

Trichotillomania

A

Compulsive pulling out of hair, strand by strand
*No associated thought, which is where it differs from OCD

In OCD behaviours are often done to counteract the obsessive thought

40
Q

3 characteristic syndromes of PTSD

A

1) Intrusive recollections
2) avoidance behaviour
3) Always jumpy, on edge

41
Q

One-year prevalence of mental disorders

A

OCD-1-1.5%

42
Q

What pattern occurs in OCD

A

Obsessions cause anxiety, and compulsions are done to reduce the anxiety

43
Q

Trichotillomania

A

Compulsie hair pulling, strand by strand

**Differs from OCD, because there is no associated obsessive thought

**No cognitive component, so medication is more likely to be used

44
Q

Medication for OCD

A

Clomipramine- SSRI

45
Q

Cingulotomy

A

Surgical treatment for OCD, cuts connections between emotional parts of the brain

20-25% success for OCD

46
Q

Best treatment for BDD?

A

CBT- challenge incorrect thoughts surroudning bodypart

47
Q

Best treatment for BDD?

A

CBT- challenge irrational thoughts by introducing rational beliefs surrounding bodyparty
I.e. “Nose is too big” -> “Nose is fine and no bigger than anyone elses”

SSRI- Sometimes helpful

Cosmetic surgery- Not helpful

48
Q

Hoarding

A

Persistent difficulty parting with or discarding possessions, regardless of value.

Exists on a spectrum from collecting to hoarding

*Chronic

Excessive acquisition (SHopping addiction)- Also present 80-90% of the time.

49
Q

Disorder that mostly occurs in older people

A

Hoarding disorder

50
Q

Prevalence of anorexia

A
  • *Specific to western countries
  • Found in high socioeconomic groups, typically caucasian

0.4%- young females. lower for older females and males

90% of affected are females. 10% males, 1/2 of these are gay males

10-15% mortality (highest of all mental disorders)

Highly comorbid with depression and perfectionism

51
Q

Mortality of mental disorders

A

1) Anorexia
2) Depression
3) Schizophrenia
4) Bipolar

52
Q

*Extreme perfectionism

A

Sometimes called “Obsessive-compulsive personality:. Includes extreme neat freaks etc.

53
Q

Treatment of anorexia

A
  • Highest rates of relapse. Majority will relapse.

* VERY chronic

54
Q

Causes of anorexia?

A

*highly genetic

Evolution: Food restriction+ Unlimited exercise causes anorexia in rats. They starve to death

***** For most of our history we were hunter gatherers when one food source is used up, we would migrate to the next. As soon as food starts decreasing, you should start “exercising more” to move and find a new food source, this can spiral out of control if a new plentiful food source is not found.
Rats could be saved from starvation by introducing a plentiful food source. It would break the cycle
*When anorexic women restrict their food intake and their start exercising, it triggers all of these evolutionary mechanisms. *Triggering the anorexic cycle

55
Q

Neurobiology anorexia

A

Lower levels of endorphins , keflins, and serotonin

*Low levels of zinc: Dont know if this is cause or consequence

56
Q

Why is anorexia uncommon in males?

A

Compared to females 1) Males are less concerned with their own looks and 2) Males believe that they are better looking than they actually are

*Females will see a greater mismatch between their own bodyshape and their professed ideal bodyshape than isaccurate

Men believe they are closer to their ideal body shape, Women believe that they are further than their ideal bodyshape

57
Q

Environmental Factors in Anorexia

A

*Leaving home for the first time is a comon trigger

More common in some professions: Dancing, acting etc

*High prevalence of perfectionism and obsessiveness in anorexics.

58
Q

Treatment of Annorexia

A
  • ***Psychotherapy DOES NOT WORK
  • **Medication DOES NOT WORK

Hospitalization until reaching 85% bodyweight

**Anorexia is a delusional disorder, so rational interventions do not work very well.

  • Family therapy can work- involves reigning in the mother and forcing her to acknowledge her role in this
  • Zinc supplementation has been found to be useful
59
Q

Bulimia

A

**Involves binge eating. Binge eating occurs sometimes in anorexia, but almost always in bulimia

Self-Evaluation is unduly influenced by body size and shape

Binge eating is followed by compensatory periods, normally vomiting, but could also be excessive exercise.

60
Q

3 differences between bulimia and annorexia

A

Bulimia has better insights, no delusions. Anorexia is more delusional

*Bulimia doesn’t have the excessive increase in exercise that is seen in anorexia

Bulimia(1-2%) is more common than anorexia(0.4%) of adolescent + young adult females

Bulimia isn’t associated with perfectionism

  • Stomach acid from vomiting can cause enamel loss in bulimics
  • Bulimia is intermittently chronic. They will remis for a short period of time and then start again
  • No known evolutionary cause for bulimia, unlike anorexia
  • More neural correlates for bulimia

** Both are genetic, but anorexia runs in families, while bulimia shows up in families with other mood disorders depression, substance abuse, obesity, and bulimia

61
Q

Environment and Bulimia

A

High rates of sexual abuse in bulimics

Seasonal bulimia: Triggered by winter. caused by low light. Treated by light therapy.

Evo: Linked to feeding for hibernation

62
Q

Treatments for bulimia

A
  • *Best one is desensitization with response prevention:
  • Having high caloric food around, but unable to eat it. Ie in the therapists office

Behavioural contracting: Reward the person for not throwing up

Lifestyle changes: Structured meal times and places, diet and exercise routine

SSRIs are effective but may cause weight gain
**Wellbutrin is a better alternative since it is associated with weight loss

*Fairly treatable, significant reduction 66% of the time

63
Q

Development of Paraphilias

A

Evo: Adaptive for men to have as many sexual partners as possible, their brain is less sexually discriminate. Coded for sexual promiscuity.
Sexual promiscuity is not adaptive for women
*High evolutionary cost for females to be promiscious
No evolutionary cost for promiscuity in males

Early sexual experience often involves paraphilia -> **Reinforced through associative learning: Masturbation in presence of the stimulus

*This is easily done through the male brain, not easy in the female brain

64
Q

Treatments for paraphilia

A

Anti-androgens: Basically a chemical castration

Organismic Reorientation: Trying to redirect sexual arousal towards

Aversion therapy: Positive punishment when arousal occured to paraphillic stimulus. Trying to punish the arousal.

*Psychotherapy DOES NOT WORK FOR PARAPHILIAS

65
Q

Types of paraphilias

A

Frotteurism- Rubbing up against someone
Zoophilia: Sexual arousal/attraction towards animals
Fetishes: Arousal involves the use of an object, ie shoes, panties etc.

66
Q

Paraphilia

A

Unusual imagery and acts required for peak sexual arousal

67
Q

Causes of Gender Dysphoria

A
  • Primarily genetic and biological in origin
  • Not much impact from raising environment etc

Genetic: Runs in families

  • The chance of having gender dysphoria increases as a function of the number of older brothers you have
  • Significant number of people with GD have chromonsal abnormalities

Neurobiological: Brains resemble those of the gender that they identify with, espeically

-Mechanism? Sexual inversion*- Mother releases testosterone at a specific time during gestation to cause male-characteristics in the embryo. Stressing the mother can disrupt this process, ie starvation etc, and the testosterone is not released at the proper time.

Environment: Not much evidence that environment is important
*Unusual number of absent fathers for children with GD

68
Q

gender dysphoria

A

Strong and persistent discomfort with being your perceived gender+ strong persistent identification with the opposite gender

69
Q

Prevalence of gender dysphoria

A

0.01%- very uncommon

Gender identity at age 3- cannot be changed

If it is present in adolescence it is permanent

2-5 TIMES more common in males

Female to male: attracted to FEMALES (Almost like they want to be hetero)
Male to female: 50% like males, 50% like females

70
Q

Causes of Somatic Symptom Disorder

A
Highly genetic
Stress
Lack of insight
Stress+lack of insight = concurrent + physical
Secondary reward
Concurrent illness
71
Q

Treatment for Somatic Symptom Disorder

A

*Difficult to treat

CBT- Can work for willing clients
Combination of antidepressants + Anxiety medication

72
Q

Illness Anxiety Disorder

A

Preoccupation with having or acquiring a serious illness
- Hypersensitive to latest illness
- Worried about getting ill when they have no symptoms
-

Physical symptoms are mild or not present

Fear persists despite medical reassurance

73
Q

Conversion Disorder(psychosomatic)

A

Physical ailment caused by psychological factors
*not under voluntary control

features weakness, paralysis, body tremours, altered skin sensation, vision or hearing, speech absence or difficulties

  • Symptoms dont make physiological sense
  • Client often acts unbothered by strange symptoms
  • Physical, because it causes increase in immune cell response
74
Q

Prevalence of conversion disorder

A

Transient CD is common, but persistent is not

More common in children( due to lack of insight)

2-3X more common in middle-age FEMALES + lower soceioeconomic status, in cultures where emotional expressions of emotional distress are inhibited

75
Q

Treatment for conversion disorder

A

Reducing stress

*CBT is best if there is an irrational thought (But doesnt cure)

Hypnosis

Removal of original noxious situation(What is being avoided) or secondary reward (reward behaviour)

76
Q

What can cause conversion disorder

A

Stressful life events

repression or lack of insight ( in this case, recognition will absolve symptoms)

*Symptoms always have to do with client avoidance/what they don’t want

77
Q

Mass conversion disorder

A

When a group of people develop the same psychosomatic symptoms

Symptoms have changed historically, reflecting societal beliefs and concerns

Seizures and paralysis were common historically, but rare today. Ie 1980s- many people reported permanent hypnotic state, as interest in hypnosis was peaking

78
Q

Phobias

A

Unreasonable fear of a specific object or situation. Which is excessive and interferes with every day life.

79
Q

5 most common phobias

A

1) Spider 2) Snakes 3) public speaking ( evo: Isolated, outsider to group, threat of attack) 4) insects/bugs 5) bubonic plague

80
Q

Prevalence of phobias

A

7-9% prevalence
2X more common in females
*Usual onset is in childhood
Some fears are more common than others

81
Q

Causes

A

1) genetic
Evo: Selection pressures -> phobia developed for survival-> genes passed on

2) environmental

classical conditioning: Adverse experiences preceptitates event

observational learning: Seeing fear in others and acquiring it yourself

82
Q

Treatment for phobia

A
  • People rarely seek treatment, because it is too anxiety provoking and difficult to own
    1) Desensitization: (Flooding technique)
    2) Counterconditioning ( Systematic Desensitization)
    3) Modelling
83
Q

Social Phobia

A

*Most important of all phobias
Also known as social anxiety, avoidant personality

Marked and persistent fear of social or performance situations in which emberrassment may occur

  • May result in avoidance of social situations
  • May result in underachievement at work, school or socially
84
Q

What can cause social phobia?

A

Genetics: Extroversion and Introversion are highly heritable

Environmental
* Overprotective parents

Stress- flustered- so less likely to socialize

Close knit families : Cn result in belief that the outside world is dangerous

85
Q

Treatment for social phobia

A

CBT- Especially effective for combating irrational negative thoughts in teens that can lead to SP.

Exposure: Can be done with increasing frequency+amount of exposure. Put yourself out there as much as possible and realize it “isn’t that bad”.

Social skills training - Learn how to small talk and interact socially, some people have not picked this up and must learn it.

Relaxation training- Deep breathing+ tensing muscles then releasing tension

Yoga: Physical exercise + Mind slows

Medication: Benzodiazepenes*, SSRI

86
Q

Prevalence of social phobia

A
  • Repeated avoidance of social encounters
  • Highest in North America, very low in the rest of the world

% decreases with age

Lessens with time, but not radically different.

Comorbid with depression, poor self-esteem, poor self-concept.

87
Q

Panic attacks + Agoraphobia

A

Recurrent unexpected periods of intense fear or panic

Symptoms: Pounding heart, sweating, trembling, shortness of breath, chest pain etc.

88
Q

What can cause agoraphobia+panic attacks?

A

1) Genetics
2) Stress prior to onset
3) Fear of arousal ( fear of having a panic attack now becomes the precipitator)

89
Q

Treatment for panic attacks+agoraphobia

A

1) Desensitization + relaxation training is the most effective
2) Antidepressants+ benzos works in short term

90
Q

Generalized Anxiety

A
  • Always Chronic
  • Chronic excessive general anxiety
  • Worries about everything (vs phobis which are specific)
  • Excessive worry about past and future events
  • Excessive need for reassurance
  • Marked-self conscious
91
Q

Treatment for Generalized Anxiety

A
  • CHRONIC does not go away forever, even with treatment
    1) Meditation:1) Here+ now focus 2) slows down mind ( no peripheral thoughts)
    2) Medication : Buspirone (No withdrawl/Dependence)
    3) Sometimes antihistamines
    4) CBT+ Relaxation training Exercise
    5) Easily aroused, sensitive limbic system. “Sensitive brain”.
92
Q

Causes for GAD

A

1) Genetics
2) Easily aroused, sensitive limbic system. “Sensitive brain”.
3) Closeknit family

93
Q

Cause of PTSD

A

***Major stress + **Personal vulnerability

*Event + No stressful reaction = No PTSD. **Some people are more resilient

Backout memory is attempted through substance abuse, namely alcohol

94
Q

PTSD

A
Syndrome experienced by some people following a traumatic event
Includes:
1) Intrusive thoughts
2) Persistent arousal/agitation
3) Avoidance behaviours

Common among emergency personel

3-4% prevalence

95
Q

Treatment for PTSD

A

**People who need treatment are those with no improvement after 3 months. 50% resolve after 3 month

NOT EFFECTIVE : Critical incident stress debriefing *However can be used to identify people who need the most help

Effective:
EMDR(Eye movement desensitzation reprocessing)
+or Desensitization
- person must commit
-helps to address actualy issue
-effective for nightmares especially
*Reinvoking thoughts/sounds to relive the event

Benzos: 1-2 weeks
*can cure completely in short term PTSD
Helps to prevent alcohol dependence

96
Q

Somatic symptom disorders

A

inability to realize that your concern is out of proportion

**Excessive thoughts, feelings and behaviours relating to the physical symptoms. This is what distinguishes it, rather than the physical problems, it is the thoughts feelings and behaviours