Midterm Two Flashcards
What is obsessive compulsive disorder (OCD)?
Obsessions, with/without compulsions
Often associated with mental rituals, fluctuating insight, family involvement (often reinforcing the behaviour), avoidance, and reassurance seeking
What are obsessions?
Intrusive, unwanted, reoccurring, and foreign ideas that come in the forms of thoughts, images, impulses, and feelings
Often theme of contamination, aggression, violence, sexuality
What are compulsions?
Repetitive behaviour or mental act that you are driven to perform to neutralize the obsession, prevent feared event, and/or provide relief
Not always functionally related to the obsession
What is the comorbidity of OCD?
Mood and anxiety disorders are very common with OCD
80% of people with OCD also have depression
Biopsychosocial model of OCD: Etiology: Bio
Very biological
Moderately heritable
5-HT (SSRIs decrease emotional force)
Slight structural abnormalities in basal ganglia (motor control, learning, rewards)
Heightened thalamus (cleaning and checking)
Biopsychosocial model of OCD: Etiology: Psycho
Attention driven toward disturbing material related to obsession
Thought fusion: bad thought is same as doing the thing
Behavioural theory: conditioning
Initial fear is classically conditioned (something happened and now they must go together)
Compulsions negatively reinforced is operant conditioning
Biopsychosocial model of OCD: Etiology: Social
Behavioural theory: conditioning
Social reinforcement
Biopsychosocial model of OCD: Presentation: Bio
Compulsions correlated with increased brain activity
Basal ganglia
OFC
function: emotion in reward/punishment anticipation
increased activity preoccupation
Biopsychosocial model of OCD: Presentation: Psycho
Over importance of thoughts
Over estimation of threat
Intolerance of uncertainty
Cognitive distortions
Biopsychosocial model of OCD: Presentation: Social
Content of obsessions seems to be different from culture to culture
Cultures where OCD is not a problem and does not need to be treated
Biopsychosocial model of OCD: Treatment: Bio
Decreased activity in basal ganglia
Anti depressants (SSRIs)
Cingulotomy (disconnect part of the limbic system communication)
Biopsychosocial model of OCD: Treatment: Psycho
Behavioural: exposure and response prevention
Cognitive: challenge maladaptive thinking patterns
Biopsychosocial model of OCD: Treatment: Social
Family behavioural change
Increase social support
What are mood disorders?
Defining feature: extremes of emotion that cause a disruption in mood
Depression
Mania
What are the types of mood disorders (2)?
Unipolar: just one type of mood disorder (depressive episodes)
Bipolar: two types (depressive episodes and manic episodes)
What are the features of major depressive disorder (MDD)?
Sad, depressed mood
Anhedonia: loss of pleasure in things you used to enjoy (must have one of the first two)
Sleep difficulties
Agitation
Worthlessness
Recurrent thoughts of death or suicide
What is persistent depressive disorder (PDD)?
Chronic, lowgrade depression (>2 years)
Average duration 4-5 years
intermittent normal moods
Explain Beck’s cognitive theory
Main idea: negative interpretation of situation/events lead to feelings of depression which lead to more negative interpretations
Explain negative cognitive triad
negative views of individual from levels of the self (I am unloveable), world (no one loves me) and future (no one will ever love me)
All continually feed into each other
Explain helplessness theory
Learned helplessness from lack of perceived control over life events and pessimistic attribution style
Uncontrollable event → attributions → sense of helplessness → emerging depression
Explain hopelessness theory
Uncontrollable event → attribution or other cognitive factors → sense of
hopelessness → emerging depression
Helplessness vs hopelessness
Helplessness theory
Pessimistic attributional styles (diathesis)
+
Stressful life events (stressor)
Hopelessness theory
Pessimistic attribution styles (diathesis 1)
+
State of hopelessness (diathesis 2)
+
Stressful life event (stressor)
What are internal vs external attributions?
Internal (me): negative outcomes are one’s own fault
External (other): negative outcomes are the result of some uncontrollable factor
What are stable vs unstable attributions?
Stable (always): future negative outcomes will be one’s own fault
Unstable: can be changed
What are global vs specific attributions?
Global (everything): negative events disrupt many life activities
Specific: negative events are related to one particular activity
Biopsychosocial model of MDD: Etiology: Bio
Heritability ~35%
Lower 5-HT
Higher NE and DA leads to mania
Lower NE and DA leads to depression
Biopsychosocial model of MDD: Etiology: Psycho
Beck’s cognitive theory
Biopsychosocial model of MDD: Etiology: Social
Biopsychosocial model of MDD: Presentation: Bio
Lower left PFC
Higher Right PFC
Heightened amygdala
Biopsychosocial model of MDD: Presentation: Psycho
Beck’s cognitive theory
Negative cognitive triad
Helplessness and hopelessness theory
Rumination
Biopsychosocial model of MDD: Presentation: Social
Interpersonal theories
Genuine negative effect on others, alienation from social support
Insecure in relationships
Biopsychosocial model of MDD: Treatment: Bio
Pharmacology (help people see clearly)
SSRIs, MAOIs, SNRIs
Light therapy (seasonal depression)
Treatment resistance:
ECT (induce seizure using electric current)
TMA (magnetic stimulation in parts of brain)
Ketamine (NMDA receptors, may reduce inflammation)
Biopsychosocial model of MDD: Treatment: Psycho
Psychodynamic (importance of early loss, attachment styles)
CBT:
Cognitive (primary control: I can do something about it, secondary control: I can something about my attitude)
Behaviour (gold standard, get out of bed, increase mastery and experiences of pleasure)
Biopsychosocial model of MDD: Treatment: Social
Interpersonal therapy with relationships
Family and marital therapy
What is bipolar disorder?
Bipolar 1:
Manic episodes + depression
Problems
High risk of suicide, DV, divorce, truancy, substance abuse, episodic antisocial behaviour
Bipolar 2:
Hypomania (shorter period of time)
What are manic episodes?
Marked increase in activity level in a short period of time
Unusual talkativeness, rapid speech
Less that the needed amount of sleep
Inflated self esteem, believed have special talents, powers, and abilities
Excessive involvement in pleasurable activities there are likely to have undesirable consequences
Biopsychosocial model of Bipolar: Etiology: Bio
Super genetic (1st degree relatives at risk)
Identical twin 85%
Lower NE and DA lead to depression
Higher NE and DA lead to mani
Biopsychosocial model of Bipolar: Etiology: Psycho
Pessimistic attributional style
Personality: high neuroticism and high levels of achievement striving
Biopsychosocial model of Bipolar: Etiology: Social
Stressful life events often the stressor for an episode
Dependent (it was my fault)
More likely to get into an episode
Independent (that was not on me)
Less likely to be thrown into a mood episode
Low social support
Biopsychosocial model of Bipolar: Presentation: Bio
Biopsychosocial model of Bipolar: Presentation: Psycho
Biopsychosocial model of Bipolar: Presentation: Social
Biopsychosocial model of Bipolar: Treatment: Bio
Pharmacotherapy
Mood stabilizers:
Lithium, not very effective in the long haul
Antipsychotics
TMS
ECT
Biopsychosocial model of Bipolar: Treatment: Psycho
CBT
Cognitive restructuring of what went down during the episode, restricting attributions
Mindfulness based cognitive therapy
Acceptance of thoughts, emotions `
Biopsychosocial model of Bipolar: Treatment: Social
Interpersonal and social rhythm therapy
Biological system has different rhythms, goal is to be as consistent as possible
Family and marital therapy
What are the statistics for suicide?
> 10 per day
Base rate 11.9/100 000
2x higher in old age
For every completed, 20 attempt
How do sex differences relate to suicide?
Men 4x as likely to complete usually by gun or hanging
Women 3x as likely to attempt and survive by overdose
What is the comorbidity of suicide completions?
Bipolar
Conduct disorder (youth)
PTSD
Substance abuse
Panic disorder
What are some challenges when predicting suicide?
Low base rates
Hard to apply risk factors to individuals
Short vs long term risk
Interactions between risk factors
What are some protective factors for suicide?
Cognitive flexibility
Strong social support
Hope
Receiving treatment for psychiatric disorder
What are some myths about suicide?
People who talk about it won’t do it
People who are suicidal always want to die
Improved mood = less risk
Suicide ideation is rare
Asking about suicide might give them the idea
Why suicide?
A solution to problem of intense suffering
Goal is to stop the pain by ceasing consciousness
Solutions:
Reduce suffering
Help identify other options
Pull back from suicidal act
Explain Joiner’s theory
Desire for suicide:
Perception of self as burden
Perception of not belonging
Suicide attempt:
Desire for suicide + acquired capacity for suicide
Biopsychosocial model of Suicide: Etiology: Psycho
Impulsivity
Aggression
Pessimism
Family psychopathology or instability
Biopsychosocial model of Suicide: Etiology: Social
Divorce
Suicide of friend/family member
Substance use
Unemployment
Access to gun
Biopsychosocial model of Suicide: Treatment: Bio
Pharmacology
Antidepressants
Mood stabilizers
Biopsychosocial model of Suicide: Treatment: Psycho
CBT
DBT, acceptance
Biopsychosocial model of Suicide: Treatment: Social
Crisis intervention
Cope with immediate stress
Validate emotional pain
Clarify problems
Social support
What is non suicidal self injury (NSSI)?
Self inflicted damage to own tissue without the intent to die
Differs with suicide attempt based off of intent, not type of injury
What is the contagion effect?
When one person talks about it, it can implant the idea into someone else
More prevalent in the past 20 years
Reason why the media tries not to talk about it
What is the relationship of NSSI and suicide?
Approximately 1/2 of individuals who die by suicide have a history of NSSI
Less pain you feel the more likely to die by suicide
Can result in unintentional death
What is the 4 factor model (FFM)?
Reinforcement (positive or negative)
Target (automatic - intrapersonal or social)
Biopsychosocial model of NSSI: Treatment
Treat the function of the behaviour
Acceptance and commitment therapy
CBT
DBT:
Emotional regulation
Distress tolerance
Moment by moment analysis
What are the 3 most common eating disorders?
Binge eating disorder (BED)
Anorexia nervosa (AN)
Bulimia nervosa (BN)
What are the primary characteristics of binge eating disorder?
Frequent episodes of binge eating
Sense of a lack of control
No behaviours to prevent weight gain
What are associated behaviours of BED?
Eating for emotional comfort
Agitation during binge
Disassociation
Self disgust, guilt or depression after binge
Intense cravings for certain foods
What are the primary characteristics of anorexia nervosa?
Fear of gaining weight
Refusal to maintain a healthy weight
Distorted view of self/role of body in self worth
What are the two types of AN?
Restricting
Binge eating/purging
What are some associated behaviours with AN?
Dietary restrictions
Very rule based
Eating rituals
Hoarding, concealing, discarding food
Preoccupation with food
Efforts to conceal weight loss
What are medical complications related to AN?
Death, suicide, kidney damage, heart arrhythmia
What are the primary characteristics of bulimia nervosa?
Frequent episodes of binge eating
Lack of control over eating
Recurrent compensatory behaviour to prevent weight gain
Average weight (slightly overweight)
Distorted view of self/role of body in self worth
What are the two types of bulimia?
Purging
Non purging
What is the path of BN?
Restricted eating (goal to be thin)
Binging or eating restricted foods
Compensatory behaviour
What are associated behaviours with BN?
Preoccupation with food and/or weight
Severe self-criticism
Dietary restriction in public
Frequent washroom visits after meals
Impulsivity
What are the labels used to describe weight?
Severely underweight
Underweight
Normal weight
Overweight
Obese
Diagnostic crossover with eating disorders?
Anorexia (R) ↔ Anorexia (B-P)
Tends to stick with anorexia
Anorexia (B-P) → Bulimia
Less often going to see bulimia going to anorexia
Infrequently Bulimia → Anorexia (B-P)
Bulimia ↔ Binge Eating Disorder
Most often Binge Eating Disorder → Bulimia
What is comorbidity with eating disorders?
Depression
OCD
Substance abuse disorders
Personality disorders
Biopsychosocial model of Anorexia and Bulimia: Etiology: Bio
Hereditary
Brain abnormalities: frontal and temporal cortex
5-HT
Biopsychosocial model of Anorexia and Bulimia: Etiology: Psycho
Perfectionism
Excess self focus
Cognitive rigidity
Just self worth by body shape
Biopsychosocial model of Anorexia and Bulimia: Etiology: Social
Child sexual abuse (way of disassociating)
Family characteristics
Family systems theory
Sociocultural
Biopsychosocial model of Anorexia and Bulimia: Presentation: Psycho
Weight preoccupation
Mood dependent
Small weight gain leads to depression and irritability
Self image dependent
Slippery slope
Biopsychosocial model of Anorexia and Bulimia: Treatment: Bio
SSRIs
Appetite suppressants (BED)
Hospitalization to restore weight (AN)
Biopsychosocial model of Anorexia and Bulimia: Treatment: Psycho
CBT
IPT, mistakes are not catastrophes, desensitization
Shift need to control to other areas
Biopsychosocial model of Anorexia and Bulimia: Treatment: Social
Family lunch sessions to eat casually and redefining the eating problem as an interpersonal problem
