Unit 2 Flashcards
anxiety
emotional/ cognitive symptoms (worry, dread) and physical symptoms ( arousal and tension)
anxiety disorder
most common mental disorder
- 1/3 develop at some point
- only 1/5 seek treatment
- women are 2x as likely as men
anx disorder comorbidities
tend to be high with other disorders- depression, asthma, chronic pain, hypertension, IBS
ADs are distinguished by
1) type of objects that are feared
2) content of associated thoughts and beliefs
panic attack
particular type of fear response and common symptom in many anx disorders
unexpected panic attack
no evident trigger- evident of panic disorder
expected panic attack
known trigger= situationally bound and predisposed
phobia
more intense persistent fear (distress) and a greater desire to avoid the feared object or situation
- associated dysfunction
- specific item of fear
phobia diagnostic criteria
1) fear of situation or object
2) immediate anxiety response
3) go to extremes to avoid the situation
4) fear is disproportionate to accompanying danger
5) may have panic attacks associated with phobia
6) must cause clinically significant distress/ social impairment (dysfunction)
7) persistent fear- symptoms must be present for at least 6 months
phobias stats
9% of US have symptoms
many suffer from more than one
women 2x men
vast majority don’t seek treatment
general subtypes
1) animals
2) natural environment
3) situations
4) medical
treatment (phobia)
- exposure therapy
- systematic desensitization (in vivo= place in the feared environment; covert= imagined)
- best= actual contact with feared object
social anxiety disorder
anxiety about being watched by others and fear of being embarrassed or judged negatively
-signif distress or impairment and avoidance
subtypes of SAD
performance- may be narrowly affected by oral presentation, etc
general subtype- broadly affected by social
-in both, people rate themselves as doing more poorly than they are
SAD stats
12% lifetime prevalence
onset= teen years- may follow humiliation
duration is usually life long, but may decrease in adulthood
-comorbidity and self medicating are common
SAD treatment
behavior and cognitive techniques
- group therapy can be helpful
- antidepressants, beta blockers, benzos
antidepressants (SSRIs)
most often prescribed -prozac, celexa, lexapro, Zoloft -taken daily for long term use not addictive appropriate for regular feelings of anxiety
Beta blockers
can help with physical symptoms of social anx
- safe for most patients, few side effects, not habit forming
- propranolol (infernal)-can lower BP
benzodiazepines
found to be effective (1950s) in decreasing anx
- valium, Xanax, Ativan, klonopin
- agonist for GABA
- negative= tolerance builds up and drowsiness (should be tapered off to stop)
panic disorder diagnostic criteria
1)person experiences recurrent panic attacks
AND 2) person is apprehensive about having it for at least one month
OR 3)person develops behaviors designated to avoid PAs
-high comorbidity rate (83% have 1+)
-3-4% of pop (1/4 pop has panic ATTACK at some point)
bio perspective-panic disorder
1) genetic
2) increased amygdala activity (heightened startle reactions and abnormally sensitive neural networks)
3) biochem abnormalities
SSRI
can decrease PAs (1960)
increase serotonin and decrease norepinephrine activity
-bring improvement to at lead 80% of panic disorder patients
agoraphobia
fear of being in public places/ situations where escape may be difficult should they panic or be incapacitated
- typically develops in 20s and 30s
- go to great lengths for avoidance
- must have symptoms for at least 6 months
- create “safe zones” which they do not leave
agoraphobia treatment
- skype/ home therapy (difficult)
- variety of exposure therapy
- support group
- home based self help
- medications to decrease anxiety (+psychotherapy)
generalized anxiety disorder (GAD)
1) excessive/ unreasonable anxiety and worry under most circumstances- free floating anxiety
2) person finds it hard to control the anxiety-“anxious apprehension”= hallmark- frequently checking and diff with decisions
3) physical symptoms (restlessness, fatigue, muscle tension, sleep probs)
4) distress or dysfunction
5) not due to meds or stimulants
6) symptoms must last at least 6 months
GAD stats
6% prevalence in US
appears in adolescence
more common in women (2:1)
shows up in care settings for physical symptoms
disorder worsens during stressful periods
GAD therapies
1) changing maladaptive assumptions (rational emotive therapy)
2) breakdown the worrying (increase self awareness)
3) barbiturates (50s)- addictive and dangerous
- benzodiazepines (60s)- work quickly and addictive
- antidepressants (SSRIS take 2 weeks to work) and azapirones work on serotonin
OCD
recurrent obsessions and or recurrent compulsions (only need one to be diagnosed)
diagnosis:
1)causes great distress or
2)takes up time (>1hr/day)
OR 3) interferes with daily function
-can be paired with trichotillmania, body dimorphic disorder, hoarding, and excoriation
OCD stats
1-2% US in given year (3% prev. over lifetime)
equally common between sexes
40% seek treatment
common obsessions
- contamination
- doubts
- need for order/ symmetry
- aggressive/ horrific impulses
- unpleasant/ unwanted sexual imagery
common compulsions
- cleaning/ washing
- checking
- demanding assurances
- organizing
- counting**
- repeated touching
OCD therapy
- psychoeducation
- SSRIs(prozac)
stress disorder
exposure to traumatic event/ stressor is explicitly listed as diagnostic criterion
symptoms= anxiety, depression (comorbid), dissociation, anhedonia, aggression
stress response
influenced by how we see the event and how we judge our capacity to react to the event effectively
sympathetic NS
hypothalamus excited SNS which stimulates key organs
hypothalamic pituitary adrenal (HPA) axis
hypothalamus signals the pituitary gland which stimulates the adrenal cortex to release corticosteroids into the bloodstream
adjustment disorder
psych response within 3 months of exposure to common identifiable stressor- resulting in emotional/ behavioral symptoms
- stressors may be single or repeated exposures
- distress and dysfunction
- very common- therapy aiming at increasing coping ability
acute stress disorder
symptoms (same as PTSD) begin within 4 weeks of trauma and last 3-30 days
PTSD
symptoms may begin shortly or after period of time from trauma and last over 1month**
symptoms= exposure to trauma, intrusive/ reliving trauma (nightmares/ flashbacks), avoidance of trauma linked stimuli, changes in cognition or mood, changes in reactivity (hyperarousal)
PTSD triggers
- disasters= 10x more common than combat- natural or accidental- 1st responders are more likely than civilian
- combat= increased deployment leads to increased risk
- victimization/ abuse= 1/3 victims of physical or sexual abuse develop due to human caused trauma nature (destroys societal/ human trust)
- terrorist/ torture
PTSD risks
1) pre existing factors (attitudes, hormones, prior trauma)
2) nature of trauma
3) support after trauma (or lack thereof)
uncovering
reliving trauma in safe environment; such as prolonged exposure (high dropout rate)
covering
supportive therapy and stress management to seal over pain
-CBT= most effective for PTSD
dissociation
affects memory, personal identity, and consciousness of time and environment
-can be defense against trauma; may become pattern if trauma is repeated= disorder
dissociative identity disorder
person must have 2+ distinct identity or personality states, which may alternate within the individual’s conscious awareness
DID diagnostic criteria
1- disruption of identity with 2+ distinct personalities
2-memory gaps in events
3- not due to substance abuse
host personality
primary- usually takes birth name, appears most often, tends to be passive and dependent
alters
each with unique set of memories, behaviors, thoughts and emotions; may have different abilities
mutually amnesic
relationships in which sub personalities have no awareness of one another
mutually congnizant
patterns in which each sub personality is aware of the others
one-way amnesic
most common relationship/ pattern- some personalities are aware of the others, but each pattern isn’t mutual
reintegration
of various sub personalities into host is the goal goal of therapy
depersonalization/ derealization disorder
characterized by persistent/ recurrent experiences of depersonalization OR derealization OR both
depersonalization
experiences of unreality, detachment, or being an outside observer with respect to oneself
derealization
experiences of unreality/ detachment with respect to one’s surroundings
psychogenic amnesia
amnesia with a psychological cause- affects episodic memory
1- cannot recall autobiographical info (usually trauma)
2- distress/ dysfunction
3- not due to substance abuse or neuro condition
dissociative amnesia diagnostic criteria
1- cannot recall autobiographical info
2- distress/ dysnfunction
3- not due to substance abuse or a neuro/ medical
localized amnesia`
most common. amnesia of memories during period of stress/ trauma- clear cut time period
selective amnesia
loss of some memories during a period of time, but not all memories
generalized amnesia
begins with a particular event and extends back in time - tends to have sudden onset and wandering
dissociative fugue
subtype of dissociative amnesia= extensive loss of episodic memory and unexpected travel from home region
major depressive episode
5 different types of symptoms:
- emotional
- physical
- cognitive
- motivational
- behavioral
major depressive disorder
experienced major depressive episode and never had manic or hyperactive episode
monoamine hypothesis
depression is caused by depletion in the levels of NTs (serotonin, NE, DA)… clear problems with this hypothesis developed in the 1980s= clinical effects take time to be visible and only a minority of patients have low 5HT levels
reactive (exogenous) depression
follows clear-cut stressors/ events
endogenous depression
caused by internal/ bio factors
Beck- cognitive theory on depression
4 interrelated components:
- maladaptive attitudes= develop in childhood
- cognitive triad= negative views of oneself, future, and world
- errors in thinking= 1-arbitrary interferences (logic errors), 2-minimization (of accomplishments), 3-magnification (of problems)
- automatic thoughts= steady stream of negative repetitive thoughts
persistent depressive disorder (formerly, Dysthymia)
generally milder than MDD, fewer and shorter symptomatic periods
- intermittent normal moods
- 1/10 develop MDD
- early onset= higher likelihood of comorbid substance abuse
premenstrual dysphoric disorder
new to DSM-V: mood symptoms develop in women 7-10 days before period and start to improve days after period
treatments= SSRIs, birth control, exercise, sleep…
manic episode
requires symptoms A and B
A= -abnormally and persistently elevated or irritable mood
-AND persistently increased activity or energy level
-lasting at least one week OR requiring hospitalization
B= 3 or more: -grandiose/ increased self esteem
-decreased sleep
-flight of thoughts
-talkative/ distracted
-risky behavior
hypomanic episode
low level mania
1) symptoms at least 4 consecutive days
2) same symptoms as manic, but not as severe
3) change in functioning
4) change in mood
5) not due to drug/ stimulant
rapid cycling
people that experience 4+ mood episodes within one year
BP I
diagnostic criteria: 1- at least one manic episode at some point (hospital or one week long)
2- episode may be followed by depressive episode, but not needed for diagnosis
3-distress/ dysfunction
4-not due to med/ drug
BP II
1- must have had 1+ major depressive episode
2-must have had at least 1 hypomanic ep
3- never have had manic episode
cyclothymic disorder
person experiences at least 2 years of numerous periods of symptoms of both hypomania and mild depression (NOT episodes… symptoms)
-chronic fluctuating mood- not symptom free for over two months
permissive theory
low serotonin may open the door for mood disorder, NE level determines the type
- low 5HT, high NE= mania
- low 5HT, low NE= depression
DA with BP
increased dopamine activity can also lead to mania
-lithium decreases DA activity and can calm mania
depression- behavioral treatment: Lewisohn
1-reintroduce person to pleasurable activities and schedule
2- reward non-depressive behaviors
3- help improve social skills
depression- cognitive treatment: Beck
1- increasing activities
2-challenging client’s negative thinking
3-identifiy illogical thinking
4- change primary maladaptive attitudes
depression-bio treatment
1- antidepressants
2-ECT
3-brain stimulation treatments
*combo of meds and psychotherapy= best
MAO inhibitors
slow body’s production of monoamine oxidase and stop break down of NE (MAO breaks down NE)
- helpful in 1/2 patients
- can take up to 3 weeks to work
- dangerous increase in blood pressure = diet restrictions
tricyclics
- similar to SSRI mode of action
- 60% effective
- take for 10+ days for effects
- side effect= dry mouth and constipation
SSRIs and SNRI (and NRIs)
increase 5HT activity- take 2 to 6 weeks to work and urged to stay on for at least 6 months
-in 25%, cease to work within a few years= switch med
SSRI discontinuation syndrome
when stopped, SSRIs may lead to symptoms of nausea, dizziness, neurological probs in 20% of people who stop abruptly
TMS
creates pulsating magnetic fields to stimulate brain surface
-non invasive and few side effects- comparative effectiveness to antidepressants and ECT
DBS
invasive surgery- rare- deeply implanted electrodes stimulate area 25 in deep brain circuit
VNS
surgical implantation (chest/ neck) to stimulate the vagus nerve
light therapy
primarily for seasonal depression- natural light minus UV, 30 min to 2 hrs/ day
-can improve symptoms in a few days of treatment
therapeutic lifestyle change (TLC)
integrative approach for mild/ mod depression= new lifestyle changes
-6 major changes (exercise, social, omega 3, light, sleep…)
mood stabilizers
lithium was first used in 1949- approved in 1970 by FDA
- very effective for BP; best with mania, but helps depressive episodes too
- people have been overprescribed in past (side Es)
anticonvulsant medications (lamictal)
work by calming hyperactivity in brain- prescribed for rapid cycling
- mood stabilizers have 60% improvement with manic patients and decrease in new mood episodes (preventative)
- Lamictal= effective for depressive episodes
- antidepressants can trigger manic episodes (leading to BP)
- antipsychs for BP with hallucinations/ delusions (short term and may be in combo with other med)
