PSY311 Midterm 2 Flashcards
What is anxiety?
“Anxiety is a negative mood (1) state characterized by bodily symptoms of physical tension (2) and apprehension about the future” (3).
'’perceived threat’’
describe the graph about anxiety, arousal and weakstrong and low/high arousal
optimal arousal and optimal performance = middle arousal. Moderate arousal for strong performance because some anxiety is good! = optimal
little or too high arousal does not work
Anxiety disorder all combined.
What is aoo?
Childhood and adulthood (like GAD)
Anxiety disorder, what is the biological contributions?
Inherit a tendency (anxious, tends…etc.)
Anxiety is associated with (dys)regulation of various hormones, neurotransmitters and circuits
What is the HPA axis?
hypothalamus, anterior pituitary
(very close to hypothalamus) and adrenal cortex → it is our primary response to stress. ACTH travels all the way to the adrenal gland(also called adrenal cortex) that are located above the kidneys and they secrete various thing like adrenaline and cortisol). the negative feedback loop is very important because it kinda ask: did you deal with the stressor or not? Ideally, you are not suppose to be always in the alarm state. once you deal with the stressor you are supposed to calm down. that’s why the negative feedback is important.
Is there a specific NT related to anxiety?
No! serotonin, gaba, norepinephrine and others
gaba levels is known to decrease serotonin level, increase norepinephrine level. there is a lot!
What is Gray’s motivation theory?
BAS/BIS/FFF
BAS: behavrioral activation system. it is saying something like, we are sensitive to reward (could be praise, validation, money etc.). = work more, try new things. more novelty seeking , extraverty. the NT Dopamine is very important+
BIS: behavioral inhibition system –> highly overactive. In case of anxiety, it works too much. high neuroticism, anxiety, high apprehension
Sensitive to punishment, to threat
Avoidance behavior: anxiety, tendency to apprehensively
evaluate the situation (potential threats)
Bidirectional activation: PFC (prefrontal cortex) ↔ limbic system
FFF: fight/flight/freeze
all related to the sympathetic nervous sustem: stress response: burns energy
What are some psychological contributions to anxiety disorders? + what are some important cues?
Classical conditioning (e.g. Little Albert) (ex. just seeing a dog…)
Sense of control: is develop quite early with parental aptitude, early-life foster a sense of foster (can either see a safe or uncontrollability work)
Anxiety sensitivity: can be predisposed, might also be fearful to anxiety symptoms. ‘’like being anxious to be anxious’’ ‘’fear to be overwhelmed with anxiety’’ (it is something that feeds the panic cycle in panic disorder - ex. you won’t need to see the dog, just thinking about it will trigger you, remembering how it felt).
Important cues
External cues: environment similar to where initial panic attack occurred
Internal cues: inner cognitive and physiological processes
associated with initial panic attack
What are some social contributions to anxiety disorders?
Exposure to stressful life events (e.g. death of a loved one, divorce, growing up in low socioeconomic environment, violence)
Lack of social support (it plays a lot, it worsen a lot the others one)- having a good social support can protect the person to develop mental disorder
Societal factors (e.g. media, societal values)
What is the anxiety disorders: biopsychological model
psychological (faulty cognition + maladaptive learning) + biological (evolutionary predispositions +geneticpredispositions + biochemical disturbances) + sociocultural (cultural pressures)
From Barlow, 2000. describe the anxiety disorders: triple vulnerability model
Generalized biological vulnerability: genetic, heritable, uptight, personality traits (neuroticism, stress response)
Generalized psychological vulnerability: across all anxiety symptoms
Specific psychological vulnerability: what might other think? creates apprehension. Ex. developing an apprehension of dog because you’re parents are scare of them, life experience too
–> it comes together, at least two, to develop an anxiety disorder
what is comorbidity in terms of anxiety disorder?
High comorbiidtybetween anxiety disorders and suicidal ideation & attempts
- common with anxiety and depression
Comorbidity between anxiety-related disorders
Anxiety disorder often occurs first (before physical disorders)
GAB: diagnostic criteria
Excessive anxiety and worry, occurring more days than not for at least 6 months
Finds it difficult to control the worry Anxiety or worry is associated with ≥3 of the following six symptoms: 1 Restlessness or “on edge” 2.Being easily fatigued 3.Difficulty concentrating (or “mind going blank”), scared of the future 4.Irritability 5.Muscle tension 6.Sleep disturbance
Symptoms cause clinically significant distress or impairment in social, occupational, or other areas of functioning
Disturbance is not due to substance abuse or medical condition
Disturbance is not better explained by another mental
disorder
GAB: statistics
What is the course? What is the age of onset? What is the sex ratio? What is the comorbidity? What about the elderly? and side effect of tranquilizer?
Course: Chronic
In individuals who face(d) stressful life event(s)
Onset ≈age 30 years
More insidious (gradual) development relative to other anxiety disorders, gradually getting more intense
Sex ratio: ≈2:1 in women (on the exam) twice then men
Comorbidity:
Women: greater comorbidity with mood and other anxiety disorders
Men: greater comorbidity with substance abuse
More prevalent in the elderly
More in age 45+ years (vs. young adults)
≤10% Often prescribed minor tranquilizers (valium, zanac), but side effects (small motor impairment- like muscle jammer, decrease of motor coordination-, memory impairment- important cuz there is a link with getting older and that (similar to amnesia but not that intense, irritable, sleep disturbance)
minotorize it
GAB: etiology
- genetic component
- Distinct cognitive characteristics (Dugas, Ladouceur et al., 1998)
- intolerance of uncertainty: worry about not being in control
- positive beliefs about worry: hold stronger that belief that worry is effective
- poor problem orientation: won’t face it ex. a friend of a friend told me that dogs bite, then I’ll avoid them altogether. Avoiding activities, people, places, addiction
- cognitive avoidance: trying to distract themselves in hopes to not think about what is stressing them
Borlow image on GAD
Generalized psycho + biological vulnerabiity – stress – anxious apprehension –> worry process (a loop of intense cognitive processinfm inadequate, avoidance of imagery, restricted autonomic response) = GAD
What are the treatment for GAD?
Pharmacological:
**Benzodiazepines (short-term) -tranquilizer. modest term effect.
** Antidepressants (SSRI= selective serotonin reuptake inhibitors- most common antidepressants) inhibit reuptake. can release a part of the anxiety system and will help reduce depression symptoms. It is often taken for a longer time than benzodiazepines would. side effect: sleep disturbances, nausea, sexual dysfunction
today we won’t rely only on drugs
Psychosocial:
Cognitive-behavioral therapy
Mindfulness meditation : increasing in popularity. detach observation, breathing, yoga, mindful eating, be in the present.no fixation on emotion
What is a panic disorder?
Panic attacks are periodic, short bouts of panic that occur suddenly, reach a peak, and pass
Those who suffer often fear they will die, go crazy, or lose control
Panic attacks typically happen in the absence of a real threat
it is difficult to pinpoint how many panic attack implies a panic disorder and are often accompanied with agoraphobia within the first year (they feel unsafe, unable to escape)
Name the panic disorder: diagnostic criteria
A. Recurrent unexpected panic attacks
B. At least one of the attacks has been followed by ≥1 month of one or both of the following:
I. Persistent concern or worry about additional panic attacks or their consequences
II. A significant maladaptive change in behavior related to the
attacks
C. Disturbance is not attributable to the physiological effects of a substance or another medical condition
D. Disturbance is not better explained by another mental disorder
Name some symptoms of Panic disorder including the main 4
AT LEAST 4 of them
Need at least 4 of them (often the first 4)
1. Palpitations, pounding heart or accelerated heart rate
2. Sweating
3. Trembling or shaking
4. Sensations of shortness of breath or smothering
- Feelings of choking
- Chest pain or discomfort
- Nausea or abdominal distress
- Feeling dizzy, unsteady, light-headed, or faint
- Chills or heat sensations
- Numbness or tingling sensation (i.e. Paresthesia)
- Derealization or depersonalization: detach from reality, dissociation
- Fear of losing control or “going crazy”
- Fear of dying
- Other symptoms (e.g., neck soreness, headache, uncontrollable screaming or crying) may be seen. Such symptoms should not count as one of the four required symptoms.
Panic disorder and agoraphobia (explain it)
Agoraphobia: marked fear or anxiety about two or more of the following five situations: Using public transport Being in open spaces Being in enclosed places Standing in line or being in a crowd. Being outside of the home alone
Explain the maladaptive side effect to the panic disorder
Agoraphobic avoidance: look at the escape place, avoided place where they don’t feel safe. it is difficult, if you’re a student and scare of places… you need to endure anxiety and keep going.
Enduring anxiety: need to travel for job but they are scared.
Interoceptive avoidance: avoidance of internal physical sensation. Ex. also doing exercise = heart rate increase =remind you of the feeling of getting a panic attack.
Substance (ab)use;
Panic disorder: statistic, sex ratio, onset, cultural differences
Sex ratio More common in women 3-4 women Agoraphobia (and avoidance) and women Alcohol and men AOO: ≈25-29 years Most 1st unexpected panic attacks occur at/post- puberty
Cultural differences
Susto in Latin America: sweating, heart rate, insomnia less worrying
Ataques de nérvios in Caribbean: bursting into tears
Kayak-angst in Inuit: intense fear of drowning and disorientation (fisher at sea)
Panic disorder: etiology
Inherited tendency to be overly reactive to daily stressful events
Misattribution of bodily responses as being catastrophic: ex being short of breath and automatically attributed that to a panic attack and they are aware of that so they trigger it.
Association between situation(s) and biological response are quick to form. where and what happens is associated very quickly. Ex: i should not be in this place, because thinking about it, triggers an alarm right away
Panic disorder: treatment
Pharmacological:
Selective Serotonin Reuptake Inhibitors (SSRIs)
Benzodiazepines
Psychosocial:
- **Cognitive restructuring: element of cognitive therapy. it is about challenging these maladaptive thoughts.
- *relation techniques: deep breath
- *interoceptive exposure: counteract the exposure. it is at first in a supervised environment. Trying to get a headache to trigger you, spinning on a chair. the point is to face those feeling and sensation and to see that there are not related to a panic attack
The three above are panic control treatment (PCT) → works best on the long run
Explain what it takes to have a specific phobia
A. Marked fear or anxiety about a specific object or situation
B.The phobic object or situation almost always provokes immediate fear or anxiety
C.The phobic object or situation is actively avoided or endured with intense fear or anxiety
D.The fear or anxiety is out of proportion to the actual danger posed by the specific object or situation and to the sociocultural context
E.The fear, anxiety, or avoidance is persistent, typically lasting for 6
months or more
F.The fear, anxiety, or avoidance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning
G.The disturbance is not better explained by the symptoms of another mental disorder
Explain different types of a specific phobia
Animals: around 7 years. Fears of spiders, snakes, dogs…
Natural environment: water, storm, height (tend to lcuster) 7 years old.
Blood-injection-injury:
**Physiological reactions: Strong vasovagal response
**Phobia develops over fear of fainting
**Autonomic system system is activated reacardio (causing the heart to drop, its an expression)
**it affects the nerve, the blood vessel (widen), legs arm (extremities) = blood pressure drop and it goes to your ed more and more = brian is very deprive with oxygen until fainting occurs
**fear of fainting - the panic cycle. very specific to a situation
AOO: ≈9 years
Situational: ex. dentist (agoraphobia) and closephoria
E.g. Fear of public transportation, fear of small spaces,
fear of flying, going to the doctor, work, etc.
AOO: ≈20-25 years
Specific phobia: statistics
Lifetime prevalence - not at the exam Women: 9.8% Men: 4.9% AOO average of all of them: ≈8 years Course: chronic People often don't seek treatment: prefer to adapt their lifestyle
Developmental awareness: need to consider what is appropriate for the age bracket (monster under the bed is not a phobia…!) it tends to develop as an anxiety disorder if it continues
Specific phobia: etiology
Biological vulnerability – Heritable tendencies
- Preparedness (evolutionary perspective of our fear and anxiety):
- Low threshold for defensive reactivity: would faint easier, like it takes much less then somebody else to react
Life circumstances as ways to develop a specific phobia: spook by something, certains phobia starts young
- direct experience and conditioning
- Indirect vicarious experience
- Informational transmission: rare. mostly for PTSD. you did not see it, you heard about it through a newspaper, someone,
Specific phobia: treatment
Consistent exposure-based exercises
Systematic desensitization (Joseph Wolpe)
Building the fear hierarchy
Gradually moving up and exposing individual to feared (can have loved one in the session with you)
think of spider
what is separation anxiety, diagnostic criteria and what are the treatment?
Originally viewed as “childhood anxiety” → can persist into adulthood (“adult disorder” as well)
Prevalence: 4.1% in youth(what is the age exactly? it is criticize); 6.6% in adults → you don’t start as an adult, it goes from youth to adult) As adults they might stay close to their caregivers, stay at their house/family house, or buy one close to theirs even how inconvenient it can be //not part of DSM5
Persistent and unrealistic worry that something will happen to the parents during one’s absence
Separation anxiety: diagnostic criteria
Etiology
Genetic component
Stressful life event
Parenting: let the child explore while being there
Social anxiety disorder (SAD) what is it?
A. Marked fear or anxiety about one or more social situations in which the individual is exposed to possible scrutiny by others.
B. The individual fears that he or she will act in a way or show anxiety symptoms that will be negatively evaluated
C. The social situations almost always provoke fear or anxiety
D. The social situations are avoided or endured with intense fear or anxiety
E. The fear or anxiety is out of proportion to the actual threat posed by the social situation and to the sociocultural context
F. The fear, anxiety, or avoidance is persistent, typically lasting
for 6 months or more
G. The fear, anxiety, or avoidance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning
H. The fear, anxiety, or avoidance is not attributable to the physiological effects of a substance (e.g., a drug of abuse, a medication) or another medical condition
I. The fear, anxiety, or avoidance is not better explained by the symptoms of another mental disorder, such as panic disorder, body dysmorphic disorder, or autism spectrum disorder
J. If another medical condition is present, the fear, anxiety, or avoidance is clearly unrelated or is excessive
Social anxiety disorder (SAD)stats?
Lifetime prevalence: 3.3%
Sex ratio: Only slightly more common in women (barely a difference)
Onset: Adolescence, peaking at age 15 years ( is there an influence of self-esteem? overweight is - judgment from others, make a conscious choice of clothing…)
Affected by cultural norms: more common in certain cultures
ocial anxiety disorder (SAD) etiology?
Biological Some people born with trait of inhibition: no symptom alone is sufficient for the SAd, they need to be together) Detect and react to angry faces quicker limbic system is activated not the prefrontal ↑ amygdala activation ↓ cortical activation
Environmental factors
Learnt from parents (or culture) to be concerned with opinion of others
Social evaluation is dangerous!
SAD and interpersonal cycle + treatment
people have biased social perceptions/expectations –> leads them to behave in maladaptive ways in social situations –> resulting social behavior elicits negative reaction
treatment : individual + group CT (group works best because of role-playing - creating desensitization, 40% work on the long run).
SAD no alarm, false alarm etc
no alarm: thinking about you having not so good speaking skill does not help. Low self esteem- emotion dysregulation, self-confiance .
direct experience: you did speak in front of people. you are the center of attention (always your perception of negative feedback). At the end it becomes a false alarm.
false alarm: you don’t need to be the center of attention, just the idea of it triggers you - negative evaluation is anchor in your head)
anxious apprehension
specific psychological vulnerability: cultural context is important too. you need ot be careful of what you say because certain people are there (a bit like my family) - today is it a anxiety disorder
PTSD: Criteiron
Exposure to actual or threatened death, serious injury, or sexual violence in ≥1of the following four ways:
(directly, witnessing, learning and experiencing epeated or extreme exposure to aversive details of the traumatic event(s) -very specific to ptsd. Think about the first responder, they see the aftermath of the scene, the after scene).
Presence of ≥1 of the following intrusion symptoms
(thoughts/memories, dissociative reactions, intense or prolonged psychological distress), reactions to inter and external cues that resemble an aspect of the traumatic events)
c. Persistent avoidance of stimuli associated with the traumatic event(s)
d. Negative alterations in mood and cognition associated with the traumatic event(s), beginning or worsening after the traumatic event(s) occurred, as evidenced by ≥2 of the following seven: (page 21)
e.Marked alterations in arousal and reactivity associated with the traumatic event(s), beginning or worsening after the traumatic event(s) occurred, as evidenced by ≥2 of the following
PTSD: Etiology
Social Cultural influences:
strong support group: if you don’t have one, the idea of not being able to rely and to trust someone increases.
PTSD: Key terms
Cognitive re-experiencing: Intrusive thoughts, nightmares, flashbacks
Avoidance: Of trauma-related stimuli; inability to recall trauma
Emotional numbing: Loss of interest, detachment, restricted affect, foreshortened future
Somatic hyperarousal: Sleep disturbance, irritability, difficulty concentrating, startled, hypervigilance
PTSD: Statistics
Lifetime prevalence: 8%
Higher rates among women than men
Higher rates among certain trauma victims
Combat veterans
Childhood trauma
Rape victims
Intensity/severity of trauma: very subjective
Family history
Little or no social support system
Hippocampal damage: stress and memory trouble
there is a true alarm
PTSD: treatment
SSRIs
Quick relief of anxiety and panic attacks
High risk of relapse
Beta blockers (blocking effects of adrenaline)
Effects on heart rate and blood pressure
Relieves negative reactivity related to traumatic event
MDMA (hallucinogenic and stimulant properties)
Pilot studies on efficacy and safety: wasn’t a large scale. The patient presents with MDMA- 3 doses- (low dose or full dose). Improvement in all the symptoms, the effectiveness was shown,the safety was shown and maintained up to a year in combination with psychotherapy.
it has chemical affinity with serotonin
How do sufferers shoukd face their trauma?
type of therapy: pet and CBT, EMDR
Prolonged exposure therapy (derived from CBT- which was developed for mood disorder) → it is about arranging the reexposure to the dramatic event but so it could be therapeutic rather than traumatic again. Unlike phobia, you cannot exactly recreate the same environment.
With PET, the therapist relies on the imaginal exposure. you help the victim to develop a narrative (known as constructionist narrative) → rebuilding the global picture of what happens that day and every session you add some details very gradually (again, similar to desentization) until it seems complete. The client can think and talk about the event without having the emotional distress/danger with it,
used in potential ptsd within clients. As a prevention.Dolson college shooting, a hospital develops a preventive approach to PTSD.
Cognitive therapy to correct negative assumptions (e.g. self-blaming and guilt). Essentially it is CBT but we focus on the cognitive part.
Can prevent PTSD if done early
focus on negative stigma
to diagnose a PTSD with all the symptoms, roughly three month after the event and sometimes years and years before enough symptoms appear and fulfill the criteria to be diagnosed.
Eye-movement desensitization and reprocessing (EMDR)
- role is to reduce vividness and emotionality
- it is controversial, both cognitive and eye movement have been found effective. Although, EMDR was found more effective in treating anxiety symptoms while cognitive therapy is found more effective for depressive symptoms.
what is acute stress disorder?
Experiencing, witnessing a traumatic event
Develops within 1 month following a traumatic event very important
Persists up to 1 month
Symptoms similar to PTSD → can turn into PTSD if not treated
what is adjustment Disorder (Stress Response Syndrome in DSM-5)?
- *short term condition: develop within 3 months following life stressor and persists up to 6 months
- *difficulting coping with a stressor
- *reason: anything. painful breakout, changing job (even for the better, upcoming marriage
- *Anxious or depressive reactions to life stress (develop symptoms of clinical depression but does not involve the physical symptom - change in appetite, weight ,etc.)
- *You can use ptsd treatment, beta blockers, antidepressant, cognitive therapy to alleviate symptoms and reduce the duration
what is attachment Disorder?
Disturbed and developmentally inappropriate behavior in children
Emerging before age 5 years
Unable to form normal attachment relationships
**Type 1: Reactive Attachment Disorder: disturb inappropriate way to relate socially→ failed to initiate social interaction or someone initiates it and you are paralyze from it and remove yourself. inhibition
- *Type 2: Disinhibited Social Engagement Disorder: inappropriate too. overly interesting, sitting on the lap of a stranger, doing anything to develop a relationship to be initiated.
cause: neglect, abuse etc. but it is quite rare.
what is OCD?
- Presence of obsessions, compulsions, or both.
–> obsession: Recurrent and persistent thoughts, urges, or images that are experienced. The individual attempts to ignore or suppress such thoughts, urges, or images, or to neutralize them with some other thought or action
–> compulsion: Repetitive behaviors or mental acts that the individual feels driven to perform in response to an obsession or according to rules that must be applied rigidly
The behaviors or mental acts are aimed at preventing or reducing anxiety or distress, or preventing some dreaded event or situation; however, these behaviors or mental acts are not connected in a realistic way with what they are designed to neutralize or prevent, or are clearly excessive
OCD: criteria
b. The obsessions or compulsions are time-consuming or cause clinically significant distress or impairment in social, occupational, or other important areas of functioning
C. The obsessive-compulsive symptoms are not attributable to the physiological effects of a substance or another medical condition
D. The disturbance is not better explained by the symptoms of another mental disorder
OCD: examples of obsession and compulsion
obession:
symmetry, cleaning/contamination, forbidden thoughts
Compulsions:
ordering/arranging, repetitive washing, checking avoiding
it is not clear why it is one form or the other, it is unclear obsessions vs compulsions a– b b→a
with DSM-5 the individual does not have to have both obsession and compulsions. they can have either or or. obsession without the compulsion and vs. BUT VERY RARE. usually the two are combined
OCD key terms
+ adulthood
aoo? course? substance use?
Obsessions OR Compulsions (trying to press your thoughts away = not always physical or observable)
Insight: recognizing obsessions (not clear; either early or not in life)/compulsions as excessive or unreasonable
Distress/impairment: time-consuming or cause marked distress or significant impairment: checking the lock over and over again
Obsession: not throw anything away because you were once living in poverty. That would be an example without having the compulsion as well..
ocd is more an adult conditioning
Sex ratio: equal
AOO: mid-20s
Course: chronic
substance use, eating disorder
OCD: Etiology
what is generalized Biological Vulnerability?
what is generalized Psychological Vulnerability?
what is Specific Psychological Vulnerability?
Generalized Biological Vulnerability
**Genetic influence: what is the family history? any anxiety related disorder?
**Dysfunctional orbitofrontal-caudate-thalamic pathway (prefrontal cortex, thalamic) → it all works together. various rejoins working together. impaired decision making, impair impulse control, emotion dysregulation,= use compulsion to alleviate stressing thoughts and increasing the risk display obsession and compulsion. not clear what is going on.
dysregulation in serotonin transport = a possibility but we don’t rely on this assumptions very much
40-60% treated sir SSRI do not show improvement. you can rely only on that.
Generalized Psychological Vulnerability
- *Sensitivity to anxiety: persistent thought
- *Things in life are uncontrollable
Specific Psychological Vulnerability
**Thought-action fusion: think that thinking about certain thoughts will increase the chance of it happening. Ex: thinking about cheating and now you think it is as bad as actually cheating- I’’should not think about it’’–> increase the stress even further.
OCD: treatment
Medication
**SSRIs: Beneficial, but slow effect and relapse
Psychological treatments
** CBT
Exposure and Response Prevention (ERP)–> not the
most popular
**Expose to whatever upsets them and, then, not allow to
perform their compulsion. block them from performing their ritual (ex. dust on a furniture, not let them clean).
Show them that thinking something ≠ it will happen.
not popular, not everyone wants to put themselves in that position and it can bring discomfort, very unpleasant
**Combo not more effective than therapy alone
what is compulsive? (think of the photo)
behavioral pattern, inability to disregard large quantities of objects.thy are aware but there is emotional attachement.
what is body dysmorphic disorder?
obsessive of some aspect of your body is severely flawed and it would take some exceptional measure to hide it/fix it. mostly imagined. if real it is exaggerated (ex. acne) 7 hours of the day and more. starts at adolescence. you create a routine to avoid certain aspects of it.
Body-Focused Repetitive Behaviors (BFRB)
BFRBs part of the obsessive-compulsive spectrum
chronic
start at adolescence
all high in anxiety
cognitive therapy and it is suggested that the clients keep a journal: what are your thoughts, feelings, etc.?
body focused repetitive behavior. maladaptive coping mechanism you need to unlearn that habit or replace it with a healthy pattern
what are the 4 types of behavior include in the body-focused repetitive behviors (BFRB)
Chronic skin picking: Excoriation disorder, ”
Chronic hair-pulling: Trichotillomania
Chronic nail biting: Onychophagia. very common.
Chronic cheek-biting: bite the imperfect area
what does mood spectrum include?
Depression and mania contribute independently
Mood disorders: characterized by severity and duration
Unipolar: major depresison and dysthymia
Bipolar disorder: Bipolar I & II, cyclothymia
Major depressive disorder (MDD)
what is it? what are the symptoms?
≥5 of the following symptoms have been present during the same 2-week period, most of the day and nearly every day, and represent a change from previous functioning; at least one of the symptoms is either (1) depressed mood or (2) anhedonia
1. Depressed mood most of the day, as indicated by either subjective report or observation made by others
2. Markedly diminished interest or pleasure in all, or almost all,
activities (anhedonia)
- *The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning
- *The episode is not attributable to the physiological effects of a substance or to another medical condition
- *The occurrence of the major depressive episode is not better explained by other mental disorder
- *There has never been a manic episode or a hypomanic episode
MDD statistics
Lifetime prevalence : 16% Sex ratio: 2:1 AOO: ≈25 years Adolescent onset also observed Greater chronicity Poor response to treatment Increased family inheritance Mean duration: 2-9 months Course: chronic
MDD statistics cntd.
**Specifier for depression
Recurrent: if two episodes occur at least two months apart
Chronic: if two episodes occur less than two months apart
**85% of individuals experience a second episode
Chronic because of the high risk of relapse
Persistent depressive disorder (Dysthymia) PDD
PDD vs MDD Statistics
Lifetime prevalence: ≈1.5%
PDD = MDD:
Both show greater chronicity if adolescent onset
PDD vs. MDD:
Fewer symptoms
More constant chronic course
Less responsive to treatment- cause it is more persistent
PDD: Diagnostic criteria
A. Depressed mood for most of the day, for more days than not, as indicated by either subjective account or observation by others, for at least 2 years
B. Presence, while depressed, of ≥2 of the following:
1. Poor appetite or overeating
2. Insomnia or hypersomnia
3. Fatigue
4. Low self-esteem
5. Poor concentration or difficulty making decisions
6. Feelings of hopelessness
C. During the 2-year period of the disturbance, the individual has
never been without the symptoms for more than 2 months at a time
D. Criteria for an MDD may be continuously present for 2 years
E. There has never been a manic episode or a hypomanic episode, and criteria have never been met for cyclothymic disorder
F. The disturbance is not better explained by a another mental disorder
G. The symptoms are not attributable to the physiological effects of a substance or another medical condition
H. The symptoms cause clinically significant distress or impairment in
social, occupational, or other important areas of functioning
unipolar depressive disorder there is not hypomanic episode
Premenstrual dysphoric disorder (PMDD)
Lifetime prevalence: ~2-5% of women Incapacitating emotional reactions during premenstrual period Controversial at first still a bit Includes: Physical symptoms Anxiety Severe mood swings as it goes, it takes over their life to (a week before and last a few days after the period)
Disruptive mood dysregulation disorder (DMDD)
**quite new
**Thought to account for youth with severe irritability, Bipolar I Not Otherwise Specified
**Childhood depressive disorder - there is a debate whether it would be bipolar type 1 for kids
AOO: 10 years
**Features for 3 times/day nearly every day for ≥12 months:
*Extreme irritability, anger
*Recurrent temper (verbal or physical) outbursts
NOS: not always specified. patient have symptoms but don’t fit in a bracket (like bipolar 1 or 2)- the psychiatrist might not know where to put up. SO now we need to reduce this category so DMDD was created.
What’s the treatment? therapy, stress management, anger management, group therapy (child, caregiver,family members etc)
Mixed episode
Meets criteria for major depressive episode and mania for ≥1 week nearly every day
Dysphoric mania: display all diagnose with manic episode and display some symptoms of dysphoria. don’t need to be diagnoses
Agitated depression
Frustrating, confusing and debilitating- interfere with there lives… so you can give mood stabilizer
Psychological dimension: depressive disorders
Seligman’s learned helplessness
People become depressed or anxious when they make an attribution that they have no control over the life stress
it is the repeated exposure to uncontrollable aversive environmental stimulate would lead gradually believe that harm is inescapable
it is suggested that Seligmen’s original theory had it almost backwards: brain default state is to assume no control is present. The presence of hopefulness is what is exactly learnt. and it is learned quite early with responsibilities as a child with parental attitude. it is limited but relevant still.
Depressive cognitive triad Negative cognitive belief system Self-blame schema These errors and schemas are automatic Supported by research
Psychological dimension: depressive disorders
What is beck interpretation?
Beck’s negative cognitive style
Depression may result from interpreting everyday life (self,
world, future) negatively
Cognitive errors
Beck became “father of cognitive therapy”
you ask the client to keep a journal, how did you feel about it and once in therapy you go and look at it in cognitive therapy. Being mindful of the event and how you react to it.
Psychological dimension: depressive disorders
What is Abramson’s concept of hopelesness?
Negative inferences or attributional styles
Internal: any harm done, failure ‘’it is my fault’’
Stable: my problems are always there
Global: it follows my in all the area of my life
Hopelessness (more related to anxiety overtime then depression)
Depressive disorders: medication
- Promising: ketamine: higher rate of clinical remission of depression
- glutamate is a NT, an excitatory. You can take that once a week. Don’t need this as much (very important)
- Common: antidepressants
- Tricyclic antidepressants (TCAs-SNRIs)
- Monoamine oxidase inhibitors (MAOIs): last resort. effective in atypical depression.
- Selective Serotonin Reuptake inhibitors (SSRIs): very common
- Increase amount of serotonin in the synaptic gap
Depressive disorders: medication (the common one = antidepressant)
pros and cons
Pros:
Better than placebo
Possibly better for severe episodes
highly effective with psychological treatment
Cons: Usually not an immediate benefit Physiological side effects → high dropouts possibly due to the side effects Sexual dysfunction is a big one ‘’won’t work anyway’’ kinda mentality SSRIs MAOIs side effect are now less major then before Not everyone responds to medication High relapse rate
Depressive disorders: ECT and TMS again combined with psychological treatment
Treatment-resistant and/or severe conditions
Electroconvulsive therapy
Electric shock administered to the brain for >1 sec
Side effects (e.g. confusion, trouble concentrating); follow-up needed
Transcranial magnetic stimulation
Magnetic fields stimulating the brain for ≈30 min
Effective yet temporary measure
Predominant: CBT
Cognitive component: Identification (monitoring) and re-evaluation (restructuring) of faulty thinking patterns (cognitive errors)
Behavioral component: Behavioral tasks: keeping a journal, hypothesis-testing, role-playing, taking a walk
Predominant: Interpersonal therapy
Involves resolving issues in existing relationships
Goals:
Deal life event with interpersonal conflict or adjust to loss of relationship
Acquire new relationships
Identify and correct social skills deficits
Helps with mood
CBT and this therapy are recommended
Also promising: Animal-assisted therapy Art therapy Music therapy (self-awareness, sublimation, not having to express yourself)
what about relapse with treatment for depressive disorders
lower rate for the combination of treatment
