Unit 8 Flashcards
Anxiety Disorders
Psychological disorders characterized by distressing, persistent anxiety or maladaptive behaviors that reduce anxiety.
Involve the activation of the sympathetic nervous system response but at inappropriate (non life-threatening time).
What distinguishes between different anxiety disorders is where the fear and anxiety is focused (what triggers the sympathetic nervous system response).
Panic Disorder
Recurrent unexpected panic attacks; an abrupt surge of intense fear or intense discomfort that reaches a peak within minutes, and during which time four (or more) of the following symptoms occur (can occur from a calm or anxious state).
Panic Disorder Symptoms
- Palpitations, pounding heart, or accelerated HR.
- Sweating.
- Trembling or shaking.
- 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.
- Paresthesias (numbness or tingling sensations).
- Derealization (feelings of unreality) or depersonalization (being detached from oneself).
- Fear of losing control or “going crazy.”
- Fear of dying.
At least one of the attacks had been followed by 1 month (or more) of one or both of the following:
1. Persistent concern or worry about additional panic attacks or their consequences.
2. A significant maladaptive change in behavior related to the attacks.
Not attributable to the physiological effect of a substance or medical disorder.
Not better explained by another mental disorder.
Generalized Anxiety Disorder
Excessive anxiety and worry occurring more days than not for at least 6 months, about a number of events or activities.
The individual finds it difficult to control the worry.
The anxiety and worry are associated with three of the following symptoms (with at least some symptoms being present for more days than not for the past 6 months):
1. Restlessness or feeling keyed up or on edge.
2. Being easily fatigued.
3. Difficulty concentrating or mind going blank.
4. Irritability.
5. Muscle tension.
6. Sleep disturbance.
Distress & impairment.
Not attributable to the physiological effect of a substance or medical disorder.
Not better explained by another psychological disorder.
Phobias
Social Anxiety Disorder (Social Phobia) - Fear or anxiety about social situations in which the individual is exposed to possible scrutiny by others.
Agoraphobia - Fear or anxiety about 2 of the following:
1. Using public transportation.
2. Being in open spaces.
3. Being in enclosed spaces.
4. Standing in line or being in a crowd.
5. Being outside of the home alone.
Specific Phobias - Fear or anxiety about a specific object or situation.
Prevalence of Anxiety Disorders
Any Anxiety disorder (adults) - 18% prevalence.
- Women 60% more likely than men to experience an anxiety disorder.
- 23% of cases severe.
- 42% receiving treatment.
Any anxiety disorder (13-18 year olds) - 25%.
GAD - 3.1% prevalence.
Panic Disorder - 2.7% prevalence.
Social Anxiety Disorder (adults) - 6.8%.
Social Anxiety Disorder (children) - 5.5%.
Agoraphobia (adults) - 0.8%.
Agoraphobia (children) - 2.4%.
Co-morbidities of Anxiety Disorders
As high as 70% of anxiety disorders have a co-morbid condition.
Comorbidity is particularly high between anxiety disorders.
Between GAD and panic disorder 55%.
Social phobia with another anxiety disorder 33%.
Specific phobia with another anxiety disorder 27%.
Co-morbidity with a depressive disorder 45%.
Co-morbidity with a bipolar disorder 20%.
Drug Therapy for Anxiety Disorders
Medication to treat anxiety disorders:
- SSRIs.
- SNRIs.
- Benzodiazepines:
- Examples: Xanax, Klonopin,
Valium.
- Used for short-term
management of anxiety as
needed or in more severe
cases regularly.
- Highly effective in promoting
relaxation and reducing
muscular tension and other
physical symptoms of
anxiety.
Used for short-term management of anxiety as needed or in more severe cases regularly.
Highly effective in promoting relaxation and reducing muscular tension and other physical symptoms of anxiety.
- A “Band-Aid.”
- A controlled substance, can
lead to problems with
tolerance and dependence.
Major Depressive Disorder
A mood disorder in which a person experiences, in the absence of drugs or other medical condition, two or more weeks with five or more symptoms, at least one of which must be (1) depressed mood or (2) loss of interest or pleasure.
Major Symptoms of Major Depressive Disorder
Diagnosis requires either of the following major symptoms over a two-week period of time.
- Depressed mood most of the
day.
OR
- Markedly diminished interest
or pleasure in activities most of
the day.
Other Symptoms of Major Depressive Disorder
Diagnosis requires at least five of the following symptoms over a two-week period of time.
- Poor appetite and weight loss,
or increased appetite and
weight gain.
- Sleeping too much or too little
(insomnia).
- Fatigue or loss of energy.
- Feelings of worthlessness or
excessive or inappropriate
guilt.
- Difficulty concentrating,
thinking, or making decisions.
- Recurrent thoughts of death or
suicide.
Other Important Diagnosis Criteria
- The symptoms must cause near-
daily clinically significant distress
or impairment. - The symptoms must not be
attributable to substance use or
another medical or psychological
disorders.
These are requirements for diagnosis of almost all psychological disorders.
Persistent Depressive Disorder (Dysthymia)
Mildly depressed mood for not more than two years.
Must display at least two of the following symptoms:
- Problems regulating appetite.
- Problems regulating sleep.
- Low energy.
- Low self-esteem.
- Difficulty concentrating and
making decisions.
- Feelings of helplessness.
Characteristics of Psychological Disorders
Prevalence - the percentage of the population who meet the criteria for a psychological disorder at some point in their life.
Depression is common. Lifetime prevalence:
- 16.2% MDD.
- 2.5% Dysthymia.
Twice as common in women as in men.
Three times as common among people in poverty.
Comorbidity - the simultaneous presence of two chronic diseases or conditions in a patient.
Common comorbidities with depression:
- 2/3 of those with MDD will also
meet criteria for anxiety
disorder at some point.
- Other common comorbidities
include substance abuse and
medical conditions.
Heritability - the extent to which genetic individual differences contribute to individual differences in observed behavior.
About one-third of the risk for major depression in adults is inherited.
- Substantially lower than for
some other psychological
disorders, such as
schizophrenia or bipolar
disorder.
- Risk of developing major
depression increases about 2.5
– 3 times for those who have a
first-degree relative with
depression.
Environmental Factors:
- acute life events (major loss)
- chronic stress (i.e. poverty),
- childhood exposure to
adversity (i.e. abuse).
Having a highly threatening life event increases risk of depression from 5 to 16 times in a few months after the event.
Antidepressant Drugs
Drugs used to treat depression, anxiety disorders, OCD, and PTSD.
Antidepressants are agonists, meaning they work by increasing the availability of certain neurotransmitters.
Two classes:
- SSRIs (Selective serotonin
reuptake inhibitor).
- SNRIs (Serotonin-
norepinephrine reuptake
inhibitor).
Common SSRIs
- Lexapro, Paxil, Prozac, &
Zoloft.
Common SNRIs:
- Cymbalta, Effexor, & Pristiq.
First antidepressant drugs developed by accident
while working on antipsychotic medications;
- SSRIs developed in the 1980s.
Electroconvulsive Therapy (ECT)
A biomedical therapy for severely depressed patients in which a brief electric current is sent through the brain of an anesthetized patient.
Inpatient basis.
Severe cases
Patient requires hospitalization often.
- Faster than medications for
therapeutic responses.
- Memory loss before and after
treatments.
- 3-8 sessions.
- Medications are still required
in maintenance phase of
treatment.
Bipolar Disorder
Bipolar I
Mania + MDE*
Bipolar II
Hypomania + MDE
*Not necessary for diagnosis
Bipolar I Criteria
- Criteria have been met for at least one manic episode.
- The occurrence of the manic and major depressive episode(s) is/are not better explained by schizoaffective disorder, schizophrenia… or other psychotic disorder.
May include but does not have to include a major depressive episode
Manic Episode Criteria
A. A distinct period of abnormally and persistently elevated, expansive, or irritable mood and abnormally and persistently increased goal-directed activity or energy, lasting at least 1 week and present most of the day, nearly every day (or any duration if hospitalization is necessary).
When we see “goal-directed” we think positive, like getting stuff done. In reality, goal-directed activity means “goals” even if they aren’t goals they would have outside of mania.
B. During the period of mood disturbance and increased energy or activity, three (or more) of the following symptoms (four if the mood is only irritable) are present to a significant degree and represent a noticeable change from usual behavior. Changes may be:
- Inflated self-esteem or
grandiosity.
- Decreased need for sleep.
- More talkative than usual.
- Racing thoughts.
- Distractibility.
- Increase in goal-directed
activity or psychomotor
agitation.
- Excessive involvement in
activities that have a high
potential for painful
consequences.
C. The mood disturbance is sufficiently severe to cause marked impairment in social or occupational functioning OR to necessitate hospitalization to prevent harm to self or others, OR there are psychotic features.
- Psychosis is characteristized by
a loss of contact with reality
such as delusions or
hallucinations.
D. The episode is not attributable to the physiological effects of a substance or to another medication.
Bipolar II Criteria
A. Criteria have been met for at least one hypomanic episode and at least one major depressive episode.
B. There has never been a manic episode.
C. The occurrence of the manic and major depressive episode(s) is/are not better explained by schizoaffective disorder, schizophrenia… or other psychotic disorder.
Hypomanic Episode Criteria
A. A distinct period of abnormally and persistently elevated, expansive, or irritable mood and abnormally and persistently increased activity or energy, lasting at least 4 consecutive days and present most of the day, nearly every day.
B. During the period of mood disturbance and increased energy or activity, three (or more) of the following symptoms (four if the mood is only irritable) are present to a significant degree and represent a noticeable change from usual behavior. Changes may be:
- Inflated self-esteem or
grandiosity.
- Decreased need for sleep.
- More talkative than usual.
- Racing thoughts.
- Distractibility.
- Increase in goal-directed
activity or psychomotor
agitation.
- Excessive involvement in
activities that have a high
potential for painful
consequences.
C. The episode is associated with an unequivocal change in functioning that is uncharacteristic of the individual when not symptomatic.
D. The disturbance in mood and the change in functioning are observable by others.
E. The episode is not severe enough to cause marked impairment in social occupational functioning or to necessitate hospitalization. If there are psychotic features, the episode is, by definition, manic.
F. The episode is not attributable to the physiological effects of a substance.
Prevalence & Onset
Prevalence - the percentage of the population who meet the criteria for a psychological disorder at some point in their life.
- 1% population prevalence.
- Males and Females = no
difference in prevalence.
- Men > manic episodes.
- Women > depressive
episodes.
- Women > rapid cycling.
- Onset of illness in early 20’s.
Comorbidities with Bipolar Disorder
21 - 61% of people with B.D. abuse or are addicted to substances as compared to 3-13% in the general population.
- Substance use adversely
effects medication, produces
earlier onset of symptoms and
often leads to hospitalization.
Approximately 50% of all Bipolar patients also meet criteria for a personality disorder.
Heritability of Bipolar Disorder
Twin study results
- Identical twins (monozygotic) =
69%.
- Fraternal twins (dizygotic) =
19%.
Biological Factors Correlated with Bipolar Disorder
Over secretion of cortisol, a stress hormone.
Excessive influx of calcium into brain cells.
Abnormal hyperactivity in parts of the brain associated with emotion and movement coordination and low activity in parts of the brain associated with concentration, attention, inhibition, and judgment (during a manic episode).
Medications Prescribed for Bipolar Disorder
Antidepressants.
Mood Stabilizers.
- Lithium carbonate —> Lithium (Widely recommended medication for bipolar disorder). (60 - 80% success in reducing acute manic & hypomanic states).
Antipsychotic Agents (if psychotic features of mania).
Group Differences in Suicide Rates
Racial Differences
- White individuals kills
themselves twice as often as
Black individuals (AAS, 2010).
Gender Differences
- Women are much more likely
to attempt than men.
- Men are two to four times
more likely to die by suicide.
- Men use more lethal methods
such as firearms, which are the
most common method of
death by suicide (49.8%).
Age Differences
- Suicide rates increase with
age, peaking in middle age and
older.
- Teens & young adults = 12.5;
Adults 45-64 = 19.6; Adults 85+
= 19.4 per 100,000.
Nonsuicidal Self-Injury (NSSI)
Refers to any premeditated, self-directed actions that leads to direct damage of body tissues (i.e.like hitting or punching an object to inflict injury to self, cutting, extreme scratching, skin carving, and interference with wound healing and burning) and is normally used by individuals to handle worrying negative affective emotional states.
Over the past year, the person has for at least 5 days engaged in self-injury, with the anticipation that the injury will result in some bodily harm. No suicidal intent.
- The act is not socially
acceptable.
- The act or its consequence can
cause significant distress to the
individual’s daily life.
- The act is not taking place
during psychotic episodes,
delirium, substance
intoxication, or substance
withdrawal.
- It also cannot be explained
by another medical
condition.
- The individual engages in self-
injury expecting to
- Get relief from a negative
emotion.
- To deal with a personal
issue.
- To create a positive feeling.
- The self-injury is associated
with one of the following:
- The individual experienced
negative feelings right before
committing the act.
- Right before self-injury, the
individual was preoccupied
with the planned act.
- The individual thinks a lot
about self-injury even if act
does not take place.
- Associated with Borderline
Personality Disorder, anxiety,
depression, dissociative
disorders, eating disorders,
suicidality, and other
personality disorders.
- Adult prevalence: 1 - 4%.
- Teen prevalence: as high as
15%.
- Individuals with BPD: 70 -
75% (establishing criterion).
- Dissociative disorders: as
high as 69%.
- Eating disorders: 26 - 61%.
- MDD: 42%.
Schizophrenia
A psychological disorder characterized by delusions, hallucinations, disorganized speech, and/or diminished or inappropriate emotional expression.
Schizophrenia is the chief example of psychosis.
Psychosis
A psychological disorder in which a person loses contact with reality, experiencing irrational ideas and distorted perceptions.
Schizophrenia Criteria
A. Two (or more) of the following, each present for a significant portion of time during a 1 month period. At least one of these must be 1, 2, or 3:
1. Delusions - false beliefs, often
of persecution or grandeur,
that may accompany
psychotic disorders.
2. Hallucinations - false sensory
experiences, such as seeing
something in the absence of
an external visual stimuli.
3. Disorganized speech.
4. Grossly disorganized or
catatonic behavior.
5. Negative symptoms.
B. For a significant portion of the time since the onset of the disturbance, level of functioning in one or more major areas, such as work, interpersonal relations, or self-care, is markedly below the level achieved prior to the onset (or when the onset is in childhood or adolescence, there is failure to achieve expected level of interpersonal, academic, or occupational functioning).
C. Continuous signs of disturbance persist for at least 6 months.
- Must include at least 1 month of symptoms (or less if successfully treated) that meet Criterion A.
- During promodal (between onset and full symptoms) or residual periods (less than full symptoms), may only have negative symptoms or reduced form of other symptoms.
This 6-month period must include at least 1 month of symptoms (or less if successfully treated) that meet Criterion A (i.e., active-phase symptoms) and may include periods of prodromal or residual symptoms. During these prodromal or residual periods, the signs of the disturbance may be manifested by only negative symptoms or two or more symptoms listed in Criterion A present in an attenuated form (e.g., odd beliefs, unusual perceptual experiences).
D. Schizoaffective disorder and bipolar disorder with psychotic features have been ruled out.
E. Not attributable to a substance.
F. Differential diagnosis with ASD and communication disorders.
Disorganized Speech
A collection of speech abnormalities that can make a person’s verbal communication difficult or impossible to comprehend.
