Midterm #2 PSYC 3604 A Flashcards
1
Q
What is a stressor?
A
Any event that triggers coping adjustment
2
Q
What is strain?
A
The physical and emotional wear and tear reaction of a person attempting to cope with a stressor
3
Q
What is stress?
A
The process by which we perceive and respond to events (stress)
4
Q
Three Research Focuses
A
- The environment
- Reaction to stress
- Stress as a process that includes stressors and strains, but includes relationship between person and the environment (coping)
5
Q
The environment:
A
Stress as a stimulus (stressors)
6
Q
Reaction to stress:
A
Stress as a response (distress)
7
Q
When we sense danger, what is there an increase in?
A
Adrenaline, heart rate, breathing, blood pressure, cortisol, etc
8
Q
When we sense danger, what is there a decrease in?
A
Reduced blood flow to the kidneys, skin and gut that are not immediately needed
9
Q
What is the role of the endocrine system during stress?
A
The hypothalamus orders the pituitary to secrete adrenocorticotrophic hormone (ACTH) which is taken up by the adrenal glands
10
Q
What do the adrenal glands do?
A
Mediates most of our physiological responses to stress. Also releases cortisol, epinephrine and norepinephrine
11
Q
What are the two parts of the Adrenal Glands?
A
- Adrenal Medulla
- Adrenal Cortex
12
Q
What does the adrenal medulla do?
A
Fast acting, secretes epinephrine, and norepinephrine
13
Q
What does the adrenal cortex do?
A
Delayed response that restores body to homeostasis
14
Q
What does cortisol influence?
A
Immune function, metabolism, heart rate, blood to muscles, memory
15
Q
Sympathetic Nervous System (adrenal medulla) increases
A
Heart rate, respiration, perspiration, blood to muscles, metabolism, mental activity
16
Q
Explain General Adaptation Syndrome
A
Perceived stressor –> Alarm Reaction (fight or flight) –> Resistance (arousal high as the body tries to defend and adapt) –> Exhaustion (limited physical resources; resistance decreases; death)
17
Q
What are the 5 biological theories of psychophysiological disorders?
A
- Somatic-Weakness Theory
- Specific-Reaction Theory
- Prolonged Exposure to Stress Hormones
- Stress and the Immune System
- Stress as a transaction
18
Q
Somatic weakness theory
A
Weakness in a specific body organ (ex. congenitally weak respiratory system might predispose the individual to asthma)
19
Q
Specific reaction theory
A
Individual response to stress is idiosyncratic
20
Q
Prolonged Exposure to Stress Hormones
A
Activation of CNS and HPA axis
20
Q
Stress and the Immune System
A
Stress impacts the ANS, hormone levels, and brain activity
20
Q
Stress as a transaction
A
The circumstance in which transactions lead a person to perceive a discrepancy between the physical or psychological demands of a situation and the resources of his or her biological, psychological, or social systems
21
Q
Explain the transactional model?
A
First, encounter a potentially stressful event or situation. Followed by two cognitive appraisals (primary & secondary).
21
Q
What is the primary appraisal?
A
Is this event positive, neutral or negative: and if negative, how bad?
22
What is the secondary appraisal?
Do I have resources or skills to handle the event/demand?
If yes... Problem focused coping: Moderate stress.
If no... Emotion focused coping: High stress.
23
What are the psychological aspects of stress?
Stress can affect our cognitive performances (vicious cycle of rumination and worrying) as well as our emotions (fear and anxiety)
24
What is cognitive vulnerability?
A person's perception of himself as subject to internal or external dangers over which his control is lacking or is insufficient to afford him a sense of safety.
*In clinical syndromes, the sense of vulnerability is magnified by certain dysfunctional cognitive processes
25
Stress arises or is augmented by faulty or irrational ways of thinking. What are 3 dysfunctional cognitive processes?
Catastrophizing, Overgeneralizing, and Selective abstraction
26
Give an example of catastrophizing
"It is the end of the world if I get turned down when I ask for a date"
27
Give an example of overgeneralizing
"I didn't get a good grade on this test, I can't get anything right"
28
What is selective abstraction?
Only seeing specific details of the situation (e.g., seeing the negatives but missing the positive details).
29
How do we measure stress physiologically?
Galvanic Skin Response: measure of the skins resistance to electricity
30
Glass and Singer / Driskel et al.
Social facilitation (good stress)
31
What is social facilitation?
Any increment of individual activity resulting from the presence of another individual
32
What is the social readjustment rating scale?
Life's most stressful events in one chart. 100 = most stressful
33
What are the top 5 most stressful life events?
1. Death of a spouse
2. Divorce
3. Marital separation
4. Jail term
5. Death of close family member
34
What is acute stress? + an example
Sudden, typically short-lived threatening event (e.g., robbery, giving a speech)
35
What is chronic stress? + an example
Ongoing, environmental demand (e.g., marital conflict, work stress)
36
What are daily hassles? Add some examples
Experiences and conditions of daily living that have been appraised as salient and harmful or threatening. Ex. concerns about weight, home maintenance, too many things to do, etc
37
What are daily uplifts? Add some examples
Experiences and conditions of daily living that have been appraised as salient and positive or favorable. Ex.completing a task, feeling healthy, relating well to friends
38
What are the 3 types of job stress?
1. Work overload
2. Role overload
3. Burnout
39
What is work overload?
Work too long and too hard
40
What is role overload?
Balance several different jobs at once
41
What is burnout?
Physical and psychological exhaustion
42
Types of environmental stress?
Natural disasters, accidents, terrorism, and war
43
How does stress affect health?
Physiological Effects, Unhealthy Habits and Poor Coping, Health Behavior
44
What are the physiological effects of stress?
Hormones, decreased immunity, and increased blood pressure
45
What are unhealthy habits and poor coping from stress?
Increased smoking, drugs, alcohol and decreased sleep and nutrition
46
What is the health behavior effect from stress?
Decreased compliance, delay in care seeking
47
How many people die from heart disease in Canada?
Heart disease is the second leading cause of death in Canada, accounting for 1 in 5 deaths
48
What is essential hypertension?
Hypertension without identified biological cause
49
What else is essential hypertension known by?
Primary hypertension or the silent killer (as it may go undetected for years)
50
What is coronary heart disease (CHD)?
The narrowing of blood vessels supplying O2 and blood to heart
51
What are the two diseases involving heart and blood circulation system that are adversely affected by stress?
1. BP (high blood pressure)
2. CHD (coronary heart disease)
52
How do genetics relate to BP?
Little success in identifying specific genes
53
How does biology relate to BP?
Heightened cardiovascular reactivity in response to exposure to stressors
54
How does psychology relate to BP?
Acute stress such as anger episodes and physical exertion can trigger myocardial infarction
55
How does chronic stress affect BP?
Activates immune system and contributes to inflammation, which, in turn, produces coronary heart disease
56
Risk Factors for BP
Excessive weight
Central obesity
Lack of regular physical activity
Heavy alcohol use
Inadequate diet
Poor coping response to chronic stress
Low socio-economic status
Low birth weight
etc
57
Risk Factors for CHD
Age
Sex (males at greater risk)
Smoking
Elevated BP
Elevated serum cholesterol
Increased size of left ventricle
Obesity
etc
58
What are the two psychological diatheses (predispositions)?
Type A behavior pattern and type D (distressed) personality
59
Explain Type A behavior pattern
An intense and competitive drive for achievement and advancement, exaggerated sense of urgency, aggressiveness and hostility toward others
59
Explain type D (distressed) personality
Negative affectivity + social inhibition, including the inhibition of anger, anxiety, and depression
59
What are 4 therapies for psychophysiological disorders?
Treating hypertension through decreasing CHD risk factors, drugs can be used to decrease cholesterol levels, biofeedback, and cardiac rehabilitation.
59
Effectiveness of biofeedback?
Only modest empirical support
60
What is cardiac rehabilitation?
Support and counseling aimed at decreasing stress.
61
What are the concerns about barriers to access programs for Cardiac Rehabilitation?
Lack of physician referral, long travel time and distance to available rehab
62
What are 3 trauma and sterssor-related disorders?
Adjustment disorder, acute stress disorder, posttraumatic stress disorder
63
Diagnostic Criteria of Adjustment Disorder
A. The development of emotional or behavioral symptoms in response to an identifiable stressor(s) occurring within 3 months of the onset of the stressor
B. These symptoms or behaviors are clinically significant, as evidenced by one or both of the following:
1. marked distress that is out of proportion to the severity or intensity of the stressor, taking into account the external context and the cultural factors that might influence symptoms severity and presentation
2. Significant impairment in social, occupational, or other important areas of functioning
C. The stress-related disturbance does not meet criteria for another mental disorder and is not merely an exacerbation of a preexisting mental disorder
D. The symptoms do not represent normal bereavement
E. Once the stressor or its consequences have terminated, the symptoms do not persist for more than an additional 6 months
64
Diagnostic Criteria of Acute Stress Disorder
A. Exposure to actual or threatened death, serious injury, or sexual violation in one (or more) of the following ways:
1. Directly experiencing the traumatic event
2. Witnessing, in person, the event as it occurred to others
3. Learning that the event occurred to a close family member or friend (violent or accidental)
4. Experiencing repeated or extreme exposure to aversive details of the traumatic event (not through media unless work related)
B. Presence of nine or more symptoms from any of the five categories: intrusion, negative mood, dissociation, avoidance, and arousal, beginning or worsening after the traumatic event occurred
C. Duration of the disturbance is 3 days to 1 month after trauma exposure (typically begin immediately after the trauma)
D. The disturbance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning
E. The disturbance is not attributable to the physiological effects of a substance, or another medical condition and is not better explained by brief psychotic disorder
65
Intrusion Symptoms:
1. Recurrent, involuntary, and intrusive distressing memories of the traumatic event (in children - repetitive play with themes of event)
2. Recurrent distressing dreams in which the content/affect of the dream are related to the event (children - frightening dreams without recognizable content)
3. Dissociative reactions (e.g., flashbacks) in which the individual feels or acts as if the event was recurring (occur on a continuum)
4. Intense of prolonged psychological distress or marked physiological reactions in response to internal or external cues that symbolize or resemble an aspect of the traumatic events
66
Negative Mood:
Persistent inability to experience positive emotions
67
Dissociative Symptoms:
6. An altered sense of the reality of one's surroundings or oneself
7. Inability to remember an important aspect of the traumatic events (typically due to dissociative amnesia and not other factors)
68
Avoidance Symptoms:
8. Efforts to avoid distressing memories, thoughts, or feelings about or closely associated with the traumatic event
9. Efforts to avoid external reminders (people, places, activites, etc) that arouse distressing memories, thoughts, or feelings about closely associated with the traumatic events
69
Arousal Symptoms:
10. Sleep disturbance
11. Irritable behavior and angry outbursts (with little or no provocation), typically expressed as verbal or physical aggression toward people or objects
12. Hypervigilance
13. Problems with concentration
14. Exaggerated startle response
70
Diagnostic Criteria of Posttraumatic Stress Disorder
A. Exposure to actual or threatened death, serious injury, or sexual violation in one (or more) of the following ways:
1. Directly experiencing the traumatic event
2. Witnessing, in person, the event as it occurred to others
3. Learning that the event occurred to a close family member or friend (violent or accidental)
4. Experiencing repeated or extreme exposure to aversive details of the traumatic event (not through media unless work related)
B. Presence of one or more intrusion symptoms
C. Persistent avoidance of stimuli associated with the traumatic event beginning after the traumatic event occurred
D. Negative alterations in cognitions and mood associated with the traumatic event, beginning or worsening after the traumatic event occurred
E. Marked alterations in arousal and reactivity associated with the traumatic event, beginning or worsening after the traumatic event occurred
F. Duration of disturbance is more than 1 month
G. The disturbance causes clinically significant distress or impairment in social, occupational or other important areas of functioning
H. Disturbance is not attributable to the physiological effects of substance or other medical disorder
71
Negative alterations in cognitions evidenced by two or more of the following:
1. Inability to remember an important aspect of the event
2. Persistent and exaggerated negative beliefs or expectations about oneself, others or the world (e.g., "No one can be trusted", "I am bad"
3. Persistent, distorted cognitions about the cause or consequences of the traumatic event that lead the individual to blame them self or others
4. Persistent negative emotional state
5. Markedly diminished interest or participation in significant activities
6. Feelings of detachment or estrangement from others
7. Persistent inability to experience positive emotions
72
PTSD specify if...
With dissociative symptoms or with delayed expression
73
PTSD with dissociative symptoms:
1. Depersonalization: persistent or recurrent experiences of feeling detached from and as if one were an outside observer of, one's mental processes or body
2. Derealization: persistent or recurrent experiences of unreality of surroundings
74
PTSD with delayed expression:
If the full diagnostic criteria are not met until at least 6 months after the event (although the onset and expression of some symptoms may be immediate)
75
Risk Factors of PTSD
Exposure to trauma
Severity of trauma
Gender (more females)
Perceived threat to life
Family history of psychiatric disorders
Pre-existing psychiatric disorders
Early separation from parents
Previous exposure to traumas
Dissociative symptoms at time of trauma
Trying to push memories of trauma out of one's mind
Tendency to take personal responsibility for failures
Coping with stress by focusing on emotions ("I wish I could change how I feel")
Attachment style (insecure attachment style)
76
Psychological theories of PTSD
PTSD arises from a classical conditioning of fear avoidances being built up, and they are negatively reinforced by the reduction of fear that comes from not being in the presence of the CS
77
Cognitive theories of PTSD
Hallmark feature being constant involuntary recollection of the traumatic event. There is a robust association between PTSD and memory impairment and this tendency is stronger for verbal memory than visual memory
78
Biological theories of PTSD - MZ co-twin control design... Abnormalities common to both twins:
Smaller hippocampal volume, large cavum septum pellucidum, more neurological soft signs, lower general intellectual ability, and poorer performance in the specific cognitive abilities of executive function, attention, declarative memory, and processing of contextual cues
79
Biological theories of PTSD - MZ co-twin control design... Abnormalities in twin with PTSD that are not present in identical co-twin:
Psychophysiological responding, higher resting anterior cingulate metabolism, event- related potential abnormalities associated with attentional processes, recall intrusions, and possibly some types of chronic pain
80
Lifetime prevalence of AN
Women: 0.9%
Men: 0.3%
81
Lifetime prevalence of BN
Women: 1.5%
Men: 0.5%
82
Lifetime prevalence of BED
Women: 3.5%
Men: 2.0%
83
BED vs BN prevalence
Similar in terms of age of onset (late teen years to early 20s) but it was slightly earlier for those with BN. BN also distinguished by having a longer persistence (6.5 years vs 4.3 years)
84
Stats Canada Facts Eating Disorders
0.5% of Canadians 15 years or older reported an eating disorder in the preceding 12 months
Women more likely than men to report an eating disorder
1.5% of women aged 15 to 24 reported they had an eating disorder
1.7% of Canadians met 12 month criteria for an eating attitude problem
Hospitalization rates are highest among young women in the 15 to 24 age range. However rates are high among those aged to 10 to 14
85
EDs during COVID-19
Diagnostic incidence was 15.3% higher in 2020 with a steady increase solely in females between 10-19 years old. Primarily anorexia nervosa
86
Pathways through which COVID increased ED risk & symptoms
Increased risk (media exposure, social isolation, negative affect, disruption to daily activities) and Lower protective capacity and access to care (social support, emotional regulation, access to treatment and care)
87
When did EDs first appear in the DSM
1980
88
What were the categories in ED in DSM-IV?
AN and BN formed distinct categories
Eating Disorder - Not Otherwise Specified (EDNOS)
89
How are ED portrayed in DSM-5?
BED is distinct category.
Removed EDNOS and replaced it with more specific categories
90
Unspecified Feeding Or Eating Disorder
Can be used for any condition that causes clinically significant distress or impairment but does not meet diagnostic thresholds
Can be used when there is insufficient information (ex. hospital emergency room situations)
91
Other specified feeding or eating disorder
Applies to atypical, mixed, or subthreshold conditions
92
What is night eating syndrome?
A repetitive tendency to wake up and eat during the night and then get quite upset about it
93
What is purging disorder?
Form of bulimia that involves self induced vomiting or laxative use at least once a week for a minimum of six months in the absence of binge eating
94
Why is the term Anorexia Nervosa a misnomer?
Because most patients do not lose their appetite or interest in food - they become preoccupied with food
95
Essential features of Anorexia Nervosa:
Individual refuses to maintain a minimally normal body weight, is intensely afraid of gaining weight, and exhibits a significant disturbance in the perception of the shape or size of their body
96
Diagnostic Criteria of AN:
A. Restriction of energy intake relative to requirements, leading to significantly low body weight (less than minimally normal than that minimally expected)
B. Intense fear of gaining weight or of becoming fat, or persistent behavior that interferes with weight gain, even though at a significantly low weight
C. DIsturbance in the way in which one's body weight or shape is experienced, undie influence of body on self evaluation, or persistent lack of recognition of the seriousness of the current low body weight
97
Which code depends on the subtype of AN?
Code IDC-10-CM
98
Specify whether (for AN)...
Restricting type: weight loss is accomplished primarily through dieting, fasting, and/or excessive exercise
Binge-eating/Purging type: during the last 3 months, the individual has engaged in recurrent episodes of binge eating or purging behavior
99
Thinness and Self Esteem in AN:
The self esteem of people with AN is closely linked to maintaining thinness - known as evaluation of appearance
100
When does the development of AN typically occur?
Typically begins in the early to middle teenage years, often after an episode of dieting and exposure to life stress
101
What is the comorbidity like with AN?
Comorbidity is high. Also prone to depression, panic disorder and social phobia
102
Women with AN are substantially greater at risk for:
Mania, agoraphobia and substance dependence
103
Explain AN and Death Rates
10x greater than general population. 2x greater than patients with other psychological disorders
Mortality rate is 5x higher than for general population
104
T/F: There is no other disorder that matches the mortality risk inherent in AN
True
105
What is Bulimia Nervosa?
Involves episodes of rapid consumption of a large amount of food (binge) accompanied by a lack of self control. Followed by compensatory behaviors (purging). Typically occur in secret.
106
What is a purge?
Vomiting, fasting, or excessive exercise
107
Diagnostic Criteria of Bulimia Nervosa
A. Recurrent episodes of binge eating (eating within any 2 hour period an amount of food definitely larger than normal accompanied by a lack of self control)
B. Recurrent inappropriate compensatory behaviors n order to prevent weight gain
C. Binge eating and compensatory behaviors both occur, on average, at least once a week for 3 months
D. Self evaluation is unduly influenced by body shape and weight
E. The disturbance does not occur exclusively during episodes of anorexia nervosa
108
Characteristics of Binge Eating:
Binge episodes tend to be preceded by poorer than average social experiences, self concepts, and moods
Stressors that involve negative social interactions may be particularly potent elicitors of binges
People with BN have high levels of interpersonal sensitivity (reflected in large increases in self criticism following negative social interactions)
Continues until person is uncomfortably full
109
T/F : People with BN report that they lose control during a binge, even to the point of experiencing something akin to a dissociative state, perhaps losing awareness of what they are doing or feeling that it is not really they who are binging
True
110
T/F : Foods that can be rapidly consumed, especially sweets such as ice cream or cake, are usually part of a binge
True
111
T/F: Binges are not always as large as the DSM implies and there may be wide variation in the caloric content consumed by individuals with BN during binges
True
112
What is fat talk?
The focus on fear of becoming fat and negative appraisals of the self for being fat. Refers to the tendency for friends (particularly female) to take turns disparaging their bodies to each other
113
When were average weight and overweight people seen as more likeable?
If they were depicted engaging in fat talk
114
What does fat talk reflect?
A highly defensive and negative sense of self
115
What is fat talk associated with among university women?
Body dissatisfaction, negative affect, disordered eating, and more frequent checking of one's body
116
When does development of BN typically occur?
Typically begins in late adolescence or early adulthood
Many people with BN are somewhat overweight before the onset of the disorder and the binge eating often starts during a dieting episode
117
How many deaths per 1000 person years for AN?
5.1
118
How many deaths per 1000 person years for EDNOS?
3.0
119
How many deaths per 1000 person years for BN?
.7
120
What are predictors of death for EDs?
Lower BMI and older age at first presentation for treatment and alcohol misuse
121
What does death from ED most often result from?
Physical complications of the illness or suicide
122
AN is associated with a ___ year reduction in life expectancy
25
123
T/F: Suicide rates are not elevated in BN like they are in AN
True
124
T/F: 1 in 5 deaths attributed to AN involved suicide
True
125
What clinical features do AN and BN share?
Intense fear of being overweight and self evaluation is unduly influenced by body shape or weight
126
What is the diagnostic crossover with EDs?
More than 18% with AN eventually develop BN, while approximately 7% of those with BN eventually develop AN
127
What is BED linked with?
Impaired work and social functioning, depression, low self esteem, substance abuse, and dissatisfaction with body shape
128
What are some risk factors of developing BED?
Childhood obesity
Critical comments regarding being overweight
Low self concept
Depression
Childhood physical or sexual abuse
129
Diagnostic Criteria of BED
A. Recurrent episodes of binge eating
B. Episodes are associated with three or more of the following:
1. Eating much more rapidly than normal
2. Eating until feeling uncomfortably full
3. Eating large amounts of food when not feeling physically hungry
4. Eating alone because of feeling embarrassed by how much one is eating
5. Feeling disgusted with oneself, depressed, or very guilty afterward
C. Marked distress regarding binge eating is present
D. The binge eating occurs, on average, at least once a week for 3 months
E. Binge eating is not associated with the recurrent us of inappropriate compensatory behavior as in bulimia nervosa and does not occur exclusively during the course of bulimia nervosa or anorexia nervosa
130
How do genetic factors affect EDs?
Little research
AN and BN run in families
Overvaluation of appearance and body dissatisfaction appear to be heritable
131
How does the brain (hypothalamus) affect EDs?
Hypothalamus regulates hunger and eating. Lesions in animals show that they lose weight and have no appetite. Hormone abnormalities may result from starvation and return to normal with weight gain
132
What are endogenous opioids?
Substances produced by the body that reduce pain sensations, enhance mood, and suppress appetite, at least among those with low body weight
133
How can endogenous opioids affect EDs?
Starvation may increase the levels of endogenous opioids, resulting in a positively reinforcing euphoric state
Excessive exercise would increase opioids and thus be reinforcing
134
What did Hardy and Waller hypothesize?
They hypothesized that bulimia is mediated by low levels of endogenous opioids, which are thought to promote craving; a euphoric state is then produced by the ingestion of food, thus reinforcing binging
135
How has the prevalence of overweight people increased?
Prevalence of obesity has doubled since 1900; currently 20 to 30% of North Americans are overweight and there are continuing references to an obesity epidemic
136
What do Pinel, Assandand, and Lehman attribute the increasing prevalence of obesity to?
An evolutionary tendency for humans to eat to excess to store energy in their bodies for a time when food may be less plentiful
137
How does the media promote stereotypes regarding obesity?
Having excessive body fat has negative connotations such as being unsuccessful and having little self control. Also viewed as less smart and lazy.
138
Who endorses stereotypes about obesity?
Even the most obese people tend to endorse these views; however, the bias seems more automatic among thinner people
139
What did the content analysis of 18 primetime television situation comedies find?
Females with below average weights were overrepresented in these shows
The heavier the female character, the more likely she was to have negative comments directed toward her
These negative comments were especially likely to be reinforced by audience laughter
140
What is the pro ana lifestyle/website?
A website promoting eating disorders and thinness. Gives fasting tips and "Ana's Creed" speaks of being worthless and believing in calorie counting and weight being an indicator of success etc. Way to have "ana buddies" to feed off each others EDs. Includes goals etc
141
Where are eating disorders more common/evident?
Western cultures. More common in industrialized societies such as US, Canada, Europe, etc
However, it is generally concluded that the gap is closing
142
T/F: Young women who immigrate to industrialized Western cultures may be especially prone to developing eating disorders owing to the experience of rapid cultural changes and pressures
True
143
What are the effects on cognition when exposed to media?
The medias portrayal of thinness as an ideal, being overweight, and a tendency to compare oneself with especially attractive others all contribute to dissatisfaction with one's body
Even brief exposure to pictures of fashion models can instill negative moods in young women and women who are dissatisfied with their bodies seem especially vulnerable when exposed to these images
Exception: thinspiration effect
144
What is the thinspiration effect?
Chronic dieters actually feel thinner after looking at idealized images of the thin body and this motivates them to diet
This can begin a process of dieting that can ultimately lead to distress among dieters unable to attain unrealistic body image standards
145
What are the psychodynamic views of EDs?
Propose the core cause lies in disturbed parent-child relationship
Core personality traits, such as low self esteem and perfectionism are found amongst people with EDs
146
What do psychodynamic theories propose about EDs?
That the symptoms of an eating disorder fulfill some need
147
How does childhood sexual abuse related to EDs?
Childhood sexual abuse experiences higher amongst people with EDs (especially BN).
25% of women with ED reported previous sexual abuse.
148
T/F: Having at least three times of abuse, relative to one or two types, amplified the risk of having an eating disorder (physical and sexual)
True
149
What 6 personality factors were linked consistently with EDs?
Avoidance motivation, lower extraversion, self directedness, neuroticism, perfectionism, and sensitivity to social rewards
150
T/F: People with AN and BN are high in neuroticism and anxiety and low in self esteem
True
151
People with AN and BN score high on a measure of traditionalism, which indicates what?
This indicates a strong endorsement of family and social standards
152
What does Hewitt and Flett's multidimensional perfectionism scale assess?
Self oriented perfectionism (setting high standards for oneself)
Other oriented perfectionism (setting high standards for others)
Socially prescribed perfectionism (the perception that high standards are imposed to the self by others)
153
Why is it difficult to get a person with a eating disorder into treatment?
Because the person typically denies that he or she has a problem
154
How many people are in treatment?
Up to 90% are not in treatment and those who are in treatment are often resentful
155
How can dentists detect bulimia?
The erosion of teeth enamel as a result of the stomach acid coming into contact with the teeth during vomiting
156
Why is hospitalization required frequently to treat people with anorexia?
So that their ingestion of food can be gradually increased and carefully monitored
157
What is the immediate primary goal in the treatment of anorexia?
Weight restoration
158
T/F: Weight loss can be so severe that intravenous feeding is necessary to save the person's life
True
159
What is the best validated and current standard for the treatment of bulimia?
The cognitive behavioral therapy (CBT) approach of Fairburn
160
What is the client encouraged to question in Fairburn's therapy?
Question society's standards for physical attractiveness
161
List some aspects of Fairburns therapy?
See that normal body weight can be maintained without severe dieting
Taught that all is not lost with just one bite of high calorie food?
Altering all or nothing thinking can help patients begin to eat more moderately
Etc
162
How many people relapse after treatment of CBT?
Half the clients relapse after four months
163
T/F: No other treatment has greater efficacy than CBT
True
164
What are predictors of relapse for EDs after CBT?
Less initial motivation for change and higher initial levels of food and eating preoccupation
165
Which works quicker? CBT or IPT?
CBT
166
How many clients with EDs treated in some CBT controlled studies do not recover? Why not?
At least half
May be that they have psychological disorders in addition to eating disorders, such as borderline personality disorder, depression, anxiety, and marital distress
Individuals who begin with negative self-efficacy judgments about their ability to recover are more treatment resistant and take longer to recover
167
How many people relapse with EDs?
High rate of relapse. 41% of patients relapsed during the one year follow up period
168
Carter et al. found that rekapse was more likely for clients who:
Binge purge anorexia subtype
Had more OCD-like checking behaviors
Lower motivation to receiver predicted subsequent relapse
169
Types of Psychotic Disorders
Schizotypal personality disorder, delusional disorder, brief psychotic disorder, schizophreniform disorder, schizophrenia, substance/medication induced psychotic disorder, schizoaffective disorder, psychotic disorder due to another medical condition, catatonia, etc
170
Who formulated the concept of Schizophrenia
Emil Kraepelin and Eugen Bleuler
171
What is dementia praecox
Early term for schizophrenia presented by Kraepelin
172
What were the two groups of endogenous psychoses Kraepelin differentiated?
Manic depressive illness and dementia praecox
173
What common core did Kraepelin believe his two groups shared?
An early onset (praecox) and a deteriorating course marked by a progressive intellectual deterioration (dementia)
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What are the subtypes of dementia praecox?
Dementia paranoides, catatonia, and hebephrenia
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What were the three types of schizophrenic disorders that were included in DSM-IV-TR?
1. Disorganized (hebephrenic)
2. Catatonic
3. Paranoid
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What changed in DSM-5 regarding schizophrenia?
DSM-5 discontinued all of the "classic" subtypes of schizophrenia and rejected alternatives to take their place. DSM-5 includes a dimensional rating of symptoms that enables clinicians to consider the heterogeneity in symptom expression
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Schizophrenia and Schizophreniform Disorder
Lifetime prevalence about 0.3% to 0.7%
Two or more of the following for at least 1 month: hallucinations, delusions, disorganized speech, grossly disorganized or catatonic behavior, negative symptoms
Impairment in one or more areas of functioning (social, occupational, educational self care) for a significant period of time since the onset of the illness
Continuous signs of the illness for at least 6 months (this can include prodromal or residual symptoms, which are attenuated forms of the symptoms described above)
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Schizoaffective Disorder
Lifetime prevalence about 0.3%
A period of illness where the person has both the psychotic symptoms necessary to meet criteria for schizophrenia and either a major depression or manic episode
The person experiences either delusions or hallucinations for at least 2 weeks when they are not having a depressive or manic episode
The symptoms that meet criteria for depressive or manic episodes are present for over half of the illness duration
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Delusional Disorder
Lifetime prevalence about 0.2%
The presence of at least one delusion for at least a month
The person has never met criteria for schizophrenia
The person's function is not impaired outside the specific impact of the delusion
The duration of any depressive or manic episodes have been brief relative to the duration of the delusions
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Brief Psychotic Disorder
One or more of the following symptoms present for at least 1 day but less than 1 month: delusions, hallucinations, disorganized speech, grossly disordered or catatonic behavior
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Attenuated Psychotic Disorder
Lifetime presence unlear
One or more of the following symptoms in an "attenuated" form: delusions, hallucinations, or disorganized speech
The symptoms must have occurred at least once a week for the past month and must have started or gotten worse in the past year
The symptoms must be severe enough to distress or disable the individual or to suggest to others that the person needs clinical help
The person has never met the diagnostic criteria for a psychotic disorder, and the symptoms are not better attributed to another disorder, to substance use, or to a medical condition
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Rate these psychotic disorders from less severe to more severe
Delusional --> brief psychotic --> schizophreniform --> schizophrenia --> schizoaffective
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What are positive symptoms that define psychotic disorders?
Positive symptoms appear to reflect an excess or distortion of normal functions
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What do positive symptoms include?
Distortions in thought content (delusions), perception (hallucinations), language and thought processes (disorganized speech), and self monitoring of behavior (grossly disorganized or catatonic behavior)
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What are the two dimensions of positive symptoms?
1. "Psychotic dimension": includes delusions and hallucinations
2. "Disorganized dimension": includes disorganized speech and behavior
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What are negative symptoms of psychotic disorders?
Appear to reflect a diminution or loss of normal functions
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What are delusions?
Erroneous beliefs that usually involve a misrepresentation of perceptions or experience, and are resistant to change even in the face of conflicting evidence
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What are the two types of delusions?
1. Bizzare: clearly implausible, do not derive from ordinary experience, and are not understandable to peers (e.g., belief that an outside force has removed my internal organs and replaced them with someone else's without leaving scars)
2. Non-Bizarre: belief that i am being watched by the police or government
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What are persecutory delusions?
Most common - the person believes they are being tormented, followed, tricked, spied on, or ridiculed
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What are referential delusions?
Believes that certain gestures, comments, passages from books/newspapers, song lyrics (etc) are directed at them
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What are grandiose delusions?
Believes they have exceptional abilities, wealth, or fame
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What are erotomanic delusions?
Believes that another person is in love with him/her
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What are nihilistic delusions?
Believes that a major catastrophe will occur
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What are somatic delusions?
Believes that health or organ function is at risk
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What are hallucinations?
Perception-like experiences that occur without an external stimulus. Vivid and clear. Not under voluntary control. Can occur in any sensory modality (auditory, visual, olfactory, gustatory, tactile)
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What kind of hallucinations are most common?
Auditory (usually experienced as voices that are perceived as distinct from the person's own thoughts)
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Grossly Disorganized behavior
May manifest in a variety of ways, including childlike silliness to unpredictable agitation (may involve difficulties in performing goal directed behaviors)
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Disorganized Thinking (speech)
(formally "thought disorder")
Emphasis here is on disorganized speech:
- Derailment or loose associations
- Tangentiality
- Incoherence or "word salad"
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Catatonia (Catatonic Motor Behaviors)
Include a marked decrease in reactivity to the environment
-negativism
-catatonic mutism and stupor
-catatonic rigidity
-catatonic posturing
-catatonic excitement
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What is negativism?
resistance to instructions
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What is catatonic mutism and stupor?
complete unawareness
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What is catatonic rigidity?
rigid posture
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What is catatonic posturing?
assuming bizarre postures
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What is catatonic excitement
purposeless excessive motor activity
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Types of negative symptoms
Flat affect
Avolition
Alogia
Anhedonia
Asociality
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Flat Affect
Diminished emotional expression
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Avolition
Lack of energy
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Alogia
Poverty of speech, amount of speech, poverty of content of speech etc
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Anhedonia
Lack of interest in recreational activities, relationships with others, and sex
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Asociality
Few friends, poor social skills, and little interest in being with others
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What is inappropriate affect?
Emotional responses which are out of context
Ex. Client may laugh on hearing that his or her mother just died, rapid shifts from one emotional state to another for no discernible reason
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How often is inappropriate affect present?
This symptom is quite rare, but its appearance is of considerable diagnostic importance because it is relatively specific to schizophrenia
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What is the impact of symptoms of schizophrenia on life?
Delusions and hallucinations may cause considerable distress, compounded by the fact that hopes and dreams have been shattered
Cognitive impairments and evolution make stable employment difficult, with impoverishment and often homelessness the result
Strange behavior and social skills deficits lead to loss of friends and a solitary existence
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What is the strongest predictor og social disability?
Chronic cognitive impairment
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What do high substance abuse rates reflect in schizophrenia?
An attempt to achieve relief from negative emotions
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Genetics of Schizophrenia
Genetic influences act together with environmental factors (diathesis-stress model)
Involves multiple genes, rather than a single gene
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What genes are affected in Schizophrenia?
The Serotonin Type 2s receptor gene (5-HT2s)
The Dopamine (D3) receptor gene
Several chromosomal regions (regions on chromosomes 6, 8, 13, and 22)
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What are sporadic cases?
People who developed schizophrenia without a family history of the disorder
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How do sporadic cases occur?
Schizophrenia seems to reflect relatively rare protein-altering gene mutations that have implicated up to 40 genes, including a disruption in DCGR2. This gene is found in the 22q11.2.
Many of these gene mutations may have taken place in early development
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What is the dopamine hypothesis?
Schizophrenia: biochemical disorder involving excess dopamine activity
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Evidence for dopamine hypothesis
Drugs effective in treating schizophrenia decrease dopamine activity.
Also produce side effects similar to Parkinson's disease which is caused in part by low dopamine
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Clues provided by amphetamine psychosis
Closely resembles paranoid schizophrenia and can exacerbate symptoms of schizophrenia
Amphetamines cause release of norepinephrine and dopamine
Dopamine thought to be the culprit of the symptoms
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What other neurotransmitters are involved in schizophrenia?
Serotonin and Glutamate
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How is serotonin affected in schizophrenia?
Serotonin neurons regulate dopamine neurons in the mesolimbic pathway.
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How does glutamate affect schizophrenia?
Low levels of glutamate have been found in cerebrospinal fluid of people with schizophrenia, and post-mortem studies have revealed low levels of the enzyme needed to produce glutamate
Administration of NMDA receptor antagonists (blocking the effects of Glutamate on the NMDA receptors) produce Schizophrenia symptoms in normal patients
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What role does dopamine play in schizophrenia?
Drugs that reduce dopamine activity also diminish psychotic symptoms
Drugs that heighten dopamine activity exacerbate or trigger psychotic episodes
Antipsychotic drugs block dopamine receptors (the D2 subtype) - the newer "atypical" antipsychotic drugs have the same effect but cause fewer side effects
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Which receptor is crucial for Glutamate?
The NMDA receptor
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Explain enlarged ventricles and schizophrenia
Enlarged ventricles which implies a loss of subcortical brain cells
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Explain structural problems in the brain and schizophrenia
Structural problems in the hippocampus, the basal ganglia, and in the prefrontal and temporal cortex
Reduction in cortical grey matter in both the temporal and frontal regions and reduced volume in basal ganglia (e.g., caudate nucleus) and limbic structures
Correlated with impaired performance on neuropsychological tests, poor adjustment prior to the onset of the disorder, and poor response to drug treatment
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Which gender are Schizophrenia brain structure and function issues most common in?
Males
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T/F: A possible interpretation of Schizophrenia brain abnormalities is that they are the consequence of damage during gestation or birth?
True
Craniofacial/midline anomalies and/or early functional impairments
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What are the prenatal risk factors for Schizophrenia?
Maternal Infection
Risk rate is elevated for individuals born shortly after a flu epidemic
Stressful events during pregnancy
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What is "season of birth" effect on Schizophrenia?
A disproportionate number of patients with schizophrenia are born during the winter months - possibly reflecting a seasonal exposure to viral infections during the second trimester (an important time for brain development)
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Children whose mothers have chronic schizophrenia are at...
High risk
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What was negative symptom Schizophrenia preceded by?
A history of pregnancy and birth complications and by a failure to show electrodermal responses to simple stimuli
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What was positive symptom Schizophrenia preceded by?
A history of family instability, such as separation from parents and placements in foster homes or institutions
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How does psychological stress affect Schizophrenia?
Stressful life events can worsen the course of Schizophrenia
Stress exposure can also contribute to the onset of symptoms in vulnerable individuals
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When are offspring of parents with Schizophrenia more at risk?
Significantly greater increases in behavioral problems if they are exposed to abuse/neglect
More likely to develop Schizophrenia if they are raised in an institutional setting rather than by family
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What is the role of impaired insight?
Many clients lack insight into their impaired condition and refuse any treatment.
Especially true of people with paranoid schizophrenia, who may regard any therapy as a threatening intrusion by hostile outside forces
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What are the different multi-point therapies known to improve functional outcome in Schizophrenia?
Selection and application of antipsychotic medication to control acute psychotic symptoms, including strategies for maintaining adherence
Identification and treatment of comorbid disorders, including substance use and depressive disorders
Use of psychosocial treatment approaches with demonstrated effectiveness in improving symptoms and ability to function socially and vocationally
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What are modern day biological treatment of Schizophrenia?
Repetitive transcranial magnetic stimulation
First generation antipsychotic drugs
Second generation antipsychotic drugs
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What is wrong with first generation antipsychotic drugs?
About 30-50% do not respond favorably. Can reduce some positive symptoms but are not a cure. There has been success in treating psychosis. Half of people quit to side effects
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What is the difference between first and second generation antipsychotic drugs?
Second generation less likely to cause side effects
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What are the two forms of psychological treatments for Schizophrenia?
1. Psychosocial treatments
2. Cognitive behavioral interventions
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What are positive aspects of psychosocial treatments?
Play an important role in increasing the effectiveness of medication treatment and decreasing the relapse rate
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What are the three key elements of social skills training in Schizophrenia?
1. Receiving skills
2. Processing skills
3. Behavioral responses in social interaction
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What are the features of family therapy in Schizophrenia?
They educate clients and families about the biological vulnerability that predisposes people to schizophrenia, cognitive problems inherent to Schizophrenia, the symptoms of the disorder, and signs of impending relapse
They provide information about and advice on monitoring the effects of antipsychotic medication
They encourage family members to blame neither themselves nor the client for the disorder and for the difficulties all are having in coping with it
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How is Schizophrenia treated with Cognitive Behavioral Therapy?
Helps patients deal directly with their symptoms. Can be effective at reducing hallucinations and delusions.
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