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Psychological disorders > Test 2 in depth > Flashcards

Test 2 in depth Flashcards

1
Q

Core Symptoms of Depression

Must be : 2
Severe: 3, Include diagnosis:
Children: 1
Misdiagnosis: 1
Early symptoms: 3
Symptoms begin:13

A
  1. Must be present for at least two weeks, almost all day, almost every day.
  2. Must eliminate bereavement, other medical conditions, or medications as the cause.
  3. The more severe the depression, the more likely it is to reoccur.
  4. The more severe it is, the more likely it is to be continuous (chronic).
  5. In severe cases of depression, there may be psychotic features, such as having non-bizarre delusions (diagnosed as depression with psychotic features).
  6. In young children, the disturbed mood is usually manifested as irritability or hostility.
  7. Irritability may be initially misdiagnosed as an anxiety disorder.
  8. Affects sleep (hypersomnia or insomnia), appetite & libido (these are often some of the earliest symptoms).
  9. Produces feelings of guilt, sadness, irritability, hopelessness, worthlessness, and helplessness.
  10. Weight loss or gain
  11. Individuals sometimes experience physical aches and pains.
  12. Difficulty concentrating or making decisions.
  13. Recurring thoughts of death (passive or active suicidal ideation).
  14. Decreased self-esteem.
  15. Anhedonia (inability to enjoy that which was previously enjoyable to them).
  16. Fatigue or loss of energy
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2
Q

Depression is:

A

Depression is a mood disorder that has persistent sad or low mood which is severe enough to impair a person’s interest in, or ability to engage in normal enjoyable activities.

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3
Q

Mild-moderate Depression can sometimes remit:

A

after 7-9 months .

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4
Q

Mood disorders include:

A
  1. Depression
  2. Cyclothymia
  3. Persistent Depression
  4. Bipolar disorder
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5
Q

Depression

Typical age of onset:

Prevalence rate:

Gender ratio:
Comorbidity:

A

Typical age of onset: Late 20’s. Over the last 10 years, there’s been a spike in adolescent depression.

Prevalence rate: 8%

Gender ratio: women to men = 2:1

Commodity:

1.One of the anxiety disorders
2. Substance abuse disorder (drugs or alcohol)
3. impulse control disorder
4. Eating disorders.

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6
Q

Depression Specifiers include:

3 points

A
  1. Depression with Peri-Partum/Post partum
  2. Depression with Seasonal pattern
  3. Depression with Psychotic Features
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7
Q

Depression with Peri-Partum/Post Partum Onset:

A

Onset: Depression that comes on during pregnancy or shortly after childbirth (almost always after birth)

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8
Q

Depression with Post-Partum facts:

4 points

A
  1. Increased risk for developing depression after childbirth if you’ve been depressed in the past and in particular if you’ve had it during the post-partum period in the past.
  2. Don’t confuse this with Baby/Maternity Blues which is not considered a disorder and affects 80% of women
  3. Milder depressive symptoms
  4. Usually lasts a few days to two weeks and spontaneously remits.
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9
Q

Depression with seasonal pattern:

Remission:

3 points

A
  1. Repeated relationship between onset of symptoms and the seasons
  2. Fall & winter; less sunlight
  3. Remission during spring and summer
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10
Q

Depression with Psychotic Features:

2 points

A
  1. With hallucinations and or delusions
  2. Typically these are non-bizarre in nature.
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11
Q

Depression in Children:

5 points

1 Young children
2: Symptoms (6)
3. Gender ratio
4. When it starts
5. 3 Misdiagnosis

A
  1. Young children lack the vocabulary and insight to describe depressed mood
  2. Often have headaches, stomach aches, irritability, hostility, decline in schoolwork and relationships, may become reckless and impulsive.
  3. Throughout early childhood the gender ratio is the same, then in teen years, 2:1 girls to boys.
  4. The earlier in life they develop depression, the more serious the disorder will be for them and the more likely it will be a life-long struggle.
  5. Sometimes depression is misdiagnosed as ADHD, anxiety, or a behavioral disorder due to irritability and concentration issues.
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12
Q

Persistent Depressive Disorder:

5 Points

A
  1. Milder form of depression (fulfils fewer DSM-5 criteria than depression)
  2. Not episodic as depression is.
  3. Typically lasts a minimum of two years without relief.
  4. Most people suffer for years and don’t present themselves for treatment, they think this is how everyone feels, so never get diagnosed.
  5. Higher risk for depression.
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13
Q

Theories of the Etiology/Causes of Depression

Biological causes:

A
  1. Estimates are that about 40% of the cause of depression is due to genetic factors, the other 60% is the environment.
  2. The earlier the age of onset and the more recurrent it is, usually, the higher the genetic loading.
  3. When we talk about the levels of your neurotransmitters not being where they should be, that’s a genetic/inherited predisposition to develop a mood disorder.
  4. Neurotransmitters involved in depression: Serotonin & Norepinephrine, either levels too low or not being optimally utilized by the post-synaptic neuron.
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14
Q

Common environmental factors that can be the trigger for those predisposed to depression:

6 points

Not like suicide

A
  1. Prolonged stress
  2. Loss
  3. Grief
  4. Threats to relationships
  5. Health diffculties
  6. Occupational difficulties
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15
Q

Depression

Psychological Perspective:

Name the theories and their founders

A
  1. Psychodynamic Theory: Sigmund Freud
  2. Attachment Theory: John Bowlby (1907-1990)
  3. Behavioral Theory: B.F. Skinner (1904-1990)
  4. Learned Helplessness: Martin Seligman (1942- )
  5. Cognitive Theory: Aaron Beck
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16
Q

Depression

Psychological Perspective: Psychodynamic Theory

1. What he believes
2. How did he figure it out (4 symp)
3. Conclusion

A
  1. Anger turned inward after experiencing loss, either real loss (death) or perceived loss (parent emotionally unavailable).
  2. Freud looked at the behaviors of those who were depressed and thought they were similar to those who were grieving. Behaviors and feelings such as decreased self-esteem, inability to enjoy themselves, guilt, anger.
  3. He concluded that those who were depressed had experienced a loss, either a concrete or perceived loss that they hadn’t emotionally acknowledged.
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17
Q

Depression

Psychological Perspective: Attachment Theory

2 points

A
  1. Looked at the various types and stages of attachment between child and parent.
  2. If something goes wrong along the attachment process when the child is very young, Bowlby saw this as leaving someone vulnerable to depression, anxiety, and attachment issues as adults.
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18
Q

Depression

Psychological Perspective: Behavioral Theory

A
  1. As children they may get too many punishments, too few rewards for their behaviors.
  2. As adults they duplicate that situation for themselves (surround themselves with people who put them down and don’t appreciate their strengths).
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19
Q

Depression

Psychological Perspective: Learned Helplessness

3 points

1. Type of experiement
2. Observations
3. Conclusion

A
  1. Conducted experiment with dogs in 1975.
  2. Looked at how people stop trying after repeated failures or abuse.
  3. Repeated failures leads to feelings of helplessness and hopelessness, which leads to depression.
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20
Q

Depression

Psychological Perspective: Cognitive Theory

1. What does he think?
2. What do they do ?
3. Conclusion

A
  1. Believed depressed people have distorted and irrational thinking, all, or nothing (black & white) thinking, over-generalizing, catastrophizing, personalizing.
  2. They develop a habit of thinking this way.
  3. Negative thoughts cause us to have negative feelings, which cause us to behave in a negative way.
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21
Q

Treatment of Depression facts:

2:%
4: Medication
1: Important
1 Policy issue
1: Social

9 Points

A
  1. It’s estimated that only 50% of those depressed reach out for professional help.
  2. 59% of U.S. mental health drug prescriptions are written by family doctors (PCP), not psychiatrists. PCPs have very little training in mental health (4-8 weeks, depending upon the medical school).
  3. Some people are hesitant to admit that they’re depressed (stigma) or don’t know enough about depression to recognize it.
  4. Some are hesitant to take medication.
  5. Parents hesitant to treat teens with medication. Parents often believe that medication will always be part of the treatment when it may only be psychotherapy their child needs.
  6. Psychotherapy may involve insurance coverage disparities.
  7. If depression is mild to moderate, best practice suggests trying Cognitive Behavior Therapy (CBT) or Dialectical Behavior Therapy (DBT) first, then add medication if psychotherapy & lifestyle change is not providing enough relief.
  8. For more severe depression, especially if there’s suicidal ideation, medication will probably be part of the treatment plan from the beginning, along with psychotherapy & lifestyle change.
  9. Lifestyle change is crucial, and most often overlooked.
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22
Q

Specific Types of Treatment for Depression:

4 points

A
  1. Psychotherapy
  2. Psychotropic Medication
  3. TMS
  4. ECT
23
Q

Treatment of Depression:
Mild to moderate:
Severe:

2 points

A
  1. Mild to moderate: CBT or DBT
  2. Severe: Medication & CBT or DBT
24
Q

Depression

Facts about psychotherapy:

1. What is it?
2. Who gives it?
3. When?
4. How? (4)

A
  1. Psychotherapy is an umbrella term that refers to any type of talk therapy.
  2. Generally delivered by psychologist, or LCSW, and rarely, by a psychiatrist (they’ve become more diagnosis/medication oriented).
  3. Often meet weekly.
  4. Work on more effective ways to deal with environmental factors, lifestyle change, developing awareness of the effect their thoughts, feelings and behavior are having on themselves and others, improve social skills deficits and lifestyle that contribute to depression.
25
Q

Depression

Types of Psychotherapy for depression include:

2 points

A
  1. Cognitive-Behavioral Therapy (CBT)
  2. Dialectical Behavior Therapy (DBT)
26
Q

Cognitive-Behavioral Therapy (CBT) approach to depression:

How ? 9
What changes? 1

10 points

A
  1. Client becomes aware of how they think.
  2. Learn how to think differently.
  3. Challenge hypothesis of your worse-case scenario.
  4. Identify situations that trigger depressive thoughts and feelings, modify thoughts surrounding them or change situation if possible
  5. This type of therapy focuses on the here and now, not the past
  6. Client asked to identify a couple of specific problems they want to work on
  7. Behavioral portion focuses on increasing chances for rewards and avoiding punishing situations.
  8. Therapist gives homework (read a book on CBT, keep a journal, modify behavior, etc.)
  9. Activity Scheduling
  10. Time-limited (specific number of sessions)
27
Q

Dialectical Behavior Therapy (DBT) approach to depression:

A

DBT is a type of therapy that combines cognitive-behavioral techniques foremotional regulation with the following 4 skills

a. Mindfulness Training Skills: Bringing one’s attention to the present moment, both internally and externally.

b. Distress Tolerance Skills: Learn to bear pain skillfully, acceptance of reality doesn’t mean approval of reality.

c. Interpersonal Effectiveness Skills: Assertiveness training. Most people are either too passive or too aggressive.

d. Emotional Regulation Skills: Learn techniques to regulate emotionality.

28
Q

Depression (Biological Therapy: Psychotropic Medication)

Two major types of antidepressants for depression include:

A
  1. Selective Serotonin Reuptake Inhibitors (SSRI’s):
  2. Serotonin Norepinephrine Reuptake Inhibitors (SNRI’s)
29
Q

What does Selective Serotonin Reuptake Inhibitors (SSRI’s) do ?

2 points

A
  1. Inhibits the reuptake or reabsorption of serotonin at the presynaptic neuron making more of the serotonin available to be absorbed by the postsynaptic neuron.
  2. Most commonly used antidepressants.
30
Q

Examples of SSRI’s:

A
  1. Prozac
  2. Lexapro
  3. Celexa
  4. Zoloft
  5. Luvox
31
Q

What does Serotonin Norepinephrine Reuptake Inhibitors (SNRI’s) do ?

Include example of symptoms

2 points

A
  1. Inhibits the reuptake or reabsorption of serotonin & norepinephrine at the presynaptic neuron making more of it available to be absorbed by the postsynaptic neuron.
  2. SNRI’s also help with the physical symptoms of depression some individuals experience (aches and pains).
32
Q

Examples of SNRI:

A
  1. Cymbalta
  2. Effexor
33
Q

Both SSRI’s and SNRI’s

4 points

A
  1. Take about 4-6 weeks to work.
  2. Side effects: possible weight gain, decreases libido.
  3. Never stop medications abruptly, severe anxiety if not weaned off slowly.
  4. If given to children and teens, small increased risk of suicide, important to be monitored very carefully, especially during the first month.
34
Q

Alternative Treatments For Treatment Resistant Depression Often With Suicidality:

A
  1. ECT: Electro-Convulsive Therapy
  2. Transcranial Magnetic Stimulation (TMS)
35
Q

ECT: Electro-Convulsive Therapy

5 points

A

Only for individuals who fulfill the following three specific criteria:

  1. Severely depressed
  2. Actively suicidal
  3. Various medications and psychotherapy haven’t worked.
  4. Shock to brain
  5. Done as in-patient
36
Q

Transcranial Magnetic Stimulation (TMS)

5 points

A
  1. This is a noninvasive procedure that uses magnetic fields to stimulate nerve cells in the brain to improve symptoms of depression.
  2. This treatment for depression involves delivering repetitive magnetic pulses.
  3. TMS is typically only used for treatment resistant depression with suicidality.
  4. Magnetic paddles on head daily for several weeks
  5. Out-patient
37
Q

Suicide statistics:

3 points

2: Stats
1: Fact

A
  1. 10th leading cause of death in US
  2. 2nd leading cause for 10-24 year-olds (accidents is #1)
  3. Unsure of actual rates due to possible misclassification of accidental deaths.
38
Q

Suicidal ideation: It’s a continuum of a feeling ranging from:

A
  1. Passive suicidal ideation: thinking about suicide or wanting to be dead, or more often wanting the pain to stop, but no plan.
  2. Active suicidal ideation; includes plan as to where, how, and sometimes when.
39
Q

Suicidal Gestures:

Start with what is it .

5 points

  1. Fact
  2. %
  3. Statement
  4. Statement
A
  1. A term that refers to attempts at suicide that others mistakenly believe are not serious, such as wrist slashing, over-dosing.
  2. Some refer to these individuals as not really wanting to die, just crying for help, but they are suicidal and should be taken seriously.
  3. 40% of those who commit suicide, made previous attempts.
  4. All attempts should be taken seriously and require immediate attention.
  5. They ARE suicidal
40
Q

Covert Suicides:
Example:

1. Definition
2. Children:
3. Adults:

A
  1. Refers to the Method of suicide used that makes it difficult to know if it was a suicide or an accident.
  2. Children: walk in traffic, fall out of windows.
  3. Adults: mix drugs and alcohol drive into embankment on dark rainy night
41
Q

Gender ratio of suicide:
Methods:

2: ratio
2: methods

4 points

A
  1. Women 3X more likely to attempt suicide.
  2. Men 3X more likely to complete the act.
  3. Women use: wrist slashing, overdoses
  4. Men use: lethal means such as hanging and fire arms
42
Q

Suicide

Telling others:

4 points

A
  1. Most people who are suicidal tell at least one other person.
  2. Often the person doesn’t take them seriously, or refuses to get involved, or tells them they’ll feel better in the morning, etc.
  3. The person being told about it should respond by erroring on the safe side.
  4. Never leave an actively suicidal person alone (if they have a plan).
43
Q

Risk factors for suicide:

6 points

3 factors
1 (include symptoms)
2 stats

A
  1. Previous attempts
  2. Existence of mood disorders such as (depression, bipolar, substance abuse, conduct disorder)
  3. Availability of firearms!!!!
  4. Family history of suicide. Family history contributes to both genetic and environmental factors (learned behavior).
  5. Severe depression: 90% of those who attempt suicide are severely depressed.
  6. Bipolar Disorder: 50% of those with bipolar disorder attempt suicide.
44
Q

Creative population:

A

They have higher rates of all mood disorders.

45
Q

Immediate events that typically precipitate suicide attempts in those with serious mental health diagnoses:

3 points

A
  1. Relationship break-ups
  2. Interpersonal problems
  3. Financial difficulties
46
Q

Suicide

Ethnicity:

2 rates

A
  1. Higher rates for Whites and Native Americans.
  2. Blacks and Hispanics lower.
47
Q

Biological influences on suicide:

1 points

A
  1. Low levels of serotonin (as in depression), but not this alone, must be coupled with impulsivity and aggressive tendencies, even if aggression is towards the self, not others.
48
Q

Prevention of Suicide includes:

5 points

A
  1. Crises intervention
  2. Concentration on high-risk groups
  3. Preventing Suicidal Contagion
  4. Contract for Safety
  5. Treatment after attempts
49
Q

Suicide

Crises intervention:

2 points

A

1.Suicide hotlines
2. Hospital emergency rooms

50
Q

Suicide

Concentration on high-risk groups:

6 points

A
  1. Those who have just experienced sudden untimely death of someone close to them
  2. Those with previous attempts
  3. Children of parents who committed suicide
  4. Those struggling with substance abuse
  5. In schools, train all staff to recognize depression
  6. Train students to report suicidal ideation of classmates.
51
Q

Preventing Suicidal Contagion (copy-cat suicides):

5 Points

1 what
2 do
2 don’t

A

What : When the media or schools portray the person who committed suicide as a martyr, or a perfect person, or that the suicide came out of the blue, it can cause copy-cat behavior for those already suicidal.

  1. Don’t plant trees, don’t buy benches
  2. Don’t encourage school-based memorials
  3. Do reach out to those who were close to the person
  4. Do offer treatment for those identified as at-risk
52
Q

Suicide

Contract for Safety:

Definiton

A

A short-term promise the patient/client makes to the therapist not to harm themselves.

53
Q

Suicide

Treatment after attempts:

3 points

A
  1. The person is usually hospitalized until they’re no longer a threat to themselves.
  2. Should be gradually transitioned back to school or work, with built-in support system. This rarely happens.
  3. Found that those released from in-patient care often are at high risk for another attempt upon returning home

Psychological disorders (6 decks)

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