Week 4 Lectures Flashcards
1
Q
_____ is based on the premise that emotional disorders involve systematic biases, distortions, and/or deficits in thinking that cause people to have exaggerated maladaptive reactions to manageable situations
A
cognitive model
2
Q
collaborative empiricism
A
cbt is directive and active, psychoeducational, and collaborative between pt and doctor
3
Q
T/F CBT involves focus on unconscious vs. conscious thought processes.
A
F –> more conscious
4
Q
schemas
A
unwritten rules by which individuals live their lives and adapt (e.g. unloveability, abandonment, mistrust, incompetence, dependence, entitlement)
5
Q
T/F CBT focuses on present and future more than the past
A
T
6
Q
rational responding
A
automatic thought records and open-ended questioning
7
Q
basic premise of psychodynamic therapy
A
people act the way they do for a reason, though often are not fully aware of these motivations
8
Q
assumption in psychodynamic therpay
A
patterns develop because of mind’s desire to replay old pain as an attempt to master it –> repetition compulsion
9
Q
Unorganized instinctual drives
A
id
10
Q
contact with reality, perception
A
ego
11
Q
moral compass, thoughts and feelings vs values and ideals
A
super ego
12
Q
individual deals with internal conflict by falsely attributing his/her own unacknowledged feelings, impulses, thoughts onto others
A
projection
13
Q
individual has intolerable feelings of powerfulness, unimportance, etc and compensate by attributing exaggerated positive qualities to others
A
idealization
14
Q
individual deals with disturbing feeligns by describing a situation with excessive use of abstract generalizations
A
intellectualization
15
Q
individual has intolerable feelings of powerlessness, etc and compensates by exaggerating negative qualities of others
A
devaluation
16
Q
individual deals with unwanted instincts, ideas, emotions by being unable to remember them
A
repression
17
Q
acute paroxysms of anxiety indicate
A
panic anxiety –> panic attacks are unconscious conflicted feelings that break through to the surface
18
Q
transference
A
replay of feelings, thoughts, perceptions about early relationships with the therapist
19
Q
T/F some amount of anxiety promotes optimal functioning
A
T
20
Q
Yerkes-Dodson Law
A
medium level of arousal is best for performance
21
Q
Which GABA receptor is linked to anxiety?
A
A –> allows CL ions t`o enter cell, leading to ap inhibition
22
Q
Which NE receptor has been more studied in relationship to anxiety and depression?
A
Alpha 2 –> excessive sympathetic activation may produce dysfunctional arousal
23
Q
Behavioral inhibition
A
anxiety related: timidity and withdrawal in novel situations, exaggerated autonomic and HPA responses, slow habituation, familial trait, predisposed to panic disorder and social phobia
24
Q
Neuroticism
A
chronic worry with intermittent periods of dysphoria, moderately heritable
25
Neuroticism is associated with allelic variations in promoter region of ____
serotonin transporter gene
26
Neuroticism is associated with a smaller _____
amygdal and cingulate --> abnormal activity of hippocampal and fronto-limbic circuits
27
T/F Neuroticism predisposes to generalized anxiety disorder
T
28
Reinforcement
increases likelihood of behavior
29
Punishment
decreases likelihood of behavior
30
Mowrer's Two factor theory
anxiety begins with classical conditioning, maintained through operant conditioning (negative reinforcement)
31
Fear Extinction
learning not to fear or new learning and not forgetting --> present CS without US (unconditioned stimuli)
32
T/F fear response can occur in contexts different than where extinction occurred
T --> renewal
33
Modern Learning theory
exposure treatment: new safety learnign to compete with original fear learning; competition resolved by context (internal and external--> time, drug state, therapist office)
34
T/F extinction learning is particularly context specific
T --> must conduct extinction is multipel contexts
35
T/F Extinction abolishes CS-US association
F --> renewal, spontaneous recovery, reinstatement can all occur
36
Which brain region? stress response
locus coeruleus --> noradrenergic
37
Which brain region? emotional representations
Papez circuit --> thalamus to cortex (stream of thinking) to hypothalamus (stream of feeling) and sensory cortex to cingulate
38
The ___ is responsible to fear in response to cue.
Amygdala -->Amygdala essential for fear conditioning regardless of type of stimulus
39
____ responds to fear in response to context
hippocampus and amygdala -->Hippocampus essential for contextual fear conditioning but not for cued conditioning
Consistent with role of hippocampus for spatial and contextual processing
40
Which anxiety disorder? Excessive or unreasonable fear of specific objects/situations with self-recognition of unreasonable fear w/significant distress and interference with functioning
specific phobia
41
T/F specific phobias have a significant genetic factor
T
42
One session treatment
for specific phobia; rapid and effective; durable
43
Which anxiety disorder? fear of being embarrassed or humiliated in social situations
social phobia
44
Tx for social phobia
nefasodoen --> increase in insula, middle frontal gyrus, ACC, hippocampus; decrase in dorsolateral and medial PFC and dorsal ACC (cognitive control and self-reference)
45
Panic vs anxiety
panic = intense, physiological fear (peak in 10 minutes) --> immediate
46
Which anxiety disorder? persistent unexpected panic attacks w/ fear of other attacks and/or concern about implications
panic disorder
47
Which anxiety disorder? fear of places where might have a panic attack
agoraphobia
48
interoceptive fear
greater fear of fear
49
Tx of panic disorders
SSRIs, SNRIs, TCAs, benzos w/low starting dose; cbt --> decreased hippocampus, ACC, cerebellu, pons, medial PFC
50
Which anxiety disorder? excessive and uncontrollable worry >6 months + sleep, muscle, concentration problems
GAD
51
neurobiology of GAD
dampened connectivity between amygdala and ACC/insual --> worry to dampen emotional experience + greater connectivity between amygdala and DLPFC
52
Which disorder? person experienced/witnessed/confronted with event that involved actual or threatened death or serious injury or threat to physical integrity of self or others with response involving intense fear, helplessness, or horror w/ reexperience
PTSD (required symptoms > 1 month)
53
Fear conditioning process
CS (e.g. tone) + US (e.g shock ) --> freezing to tone
54
Traumatic fear conditioning process
dark street cs + mugging us= fear of dark streets
55
T/F PTSD seems to involve impaired fear extinction
T
56
Which fear response return? after passage of time
spontaneous recovery
57
Which fear response return? in specific context
contextual renewal
58
Which fear response return? after unpaired US presentation
reinstatement
59
Which two memories compete for fear extinction
cs + us = fear and cs + no us = no fear --> eg. that was easy in staples vs in dorm room --> context dependence
60
Which part of brain? fear extinction recall
vmPFC essential for recalling fear extinction (if no lesion, can recall fear extinction better --> less fear)
61
Hippocampal size in PTSD
smaller (fear learning)
62
T/F PTSD tx can restore some morphology of brain
T --> increase in hippocampal size
63
Tx of PTSD
exposure therapy
64
Prolonged exposure for PTSD
analog of fear extinction: imaginal and in vivo exposure + discussion and reflection
65
T/F neuromodulation can be invasive or non-invasive
T
66
T/F ECT is more effective than medication for depression
T
67
T/F a contraindication for ECT is cognitive impairment
T
68
Antidepressant effect of ECT may be mediated by increased ____
BDNF
69
T/F hypoxia is an important surgical risk for ECT
T --> have to pre-oxygenate
70
Why is anesthetic followed by muscle relaxant in ECT?
to reduce physical risks of seizures
71
T/F sine currents are associated with worse outcomes in ECT
T --> instead use alternating current
72
T/F narrower time of current application in ECT has better outcomes
T
73
3 factors positively correlated with ECT
quality of seizure (higher frequency EEG spikes), duration of seizure, degree of postictal suppression
74
T/F ECT has 100% relapse rate if stop treatment
T -->effectively 100%
75
Key benefit of TMS
can non-invasively target specific locations in brain --> stimulation AND inhibition depending on frequency
76
T/F no cognitive side effects with TMS
T
77
Main indication for TMS
depression
78
3 factors influencing effectiveness of rTMS
duration, intensity, number of pulses
79
Vagal nerve stimulation
stimulus applied to left vagus --> initially for epilepsy, now antidepressant
80
DBS
electrodes implanted through burr holes and placed using sterotactic neurosurgery --> parkinson's/essential tremor, epilepsy
81
Which brain area affected by bipolar/unipolar depression?
Cg25
82
Which disorder? unwanted thoughts, images, impulses that cause marked anxiety/distress//not simply excessive worries about real-life problems
OCD
83
Doubting obsession
e.g. i know i left the oven on
84
Compulsions
repetitive behaviors or mental acts performed in response to obsessions: neutralizing --> anxious, try to fix it, anxious, try to fix it, cyclical
85
Area of CBT focus for OCD
breaking link between obsession (distress) and compulsion (relief) --> break cycle
86
In OCD CBT: prolonged confrontation with anxiety-evoking stimuli
Exposure in vivo
87
In OCD CBT: prolonged imaginal confrontation with feared disasters
imaginal episode
88
In OCD CBT: blocking of compulsions
ritual prevention
89
In OCD CBT: correcting erroneous cognitions
cognitive interventions
90
Primary OCD scale
Y-BOCS
91
Tx of OCD
SSRI
92
T/F combination CBT and medication therapy for OCD provides additional benefits over meds alone
T
93
"the guilty act" objective element of a crime
actus reas
94
"the guilty mind" subjective element of a crime needed to produce criminal liability
mens rea
95
levels of culpability
1st degree/purpose, 2nd degree/knowledge, 3rd degree/recklessness, negligence
96
2 ways to negate actus rea
argue you have the wrong person or argue did not commit the act
97
2 ways to negate mens rea
self defense or insanity
98
3 reasons why the insanity defense is important to the law
protects fairness of law, would otherwise be useless as a deterrent, constitution forbids cruel and unusual punishment
99
Legal standards for insanity
m'naghten standard, american law inst. model penal code, irresistible impulse test, durham test
100
M'Naghten test
every defendant is presumed to be sane unless he is laboring under a defect of reason from a disease of the mind as not to know the nature and quality of the act he was doing or if he did know it that he did not know that what he was doing was wrong
101
Which test? would the defendant commit behavior if a policeman was at his elbow/right there?
irresistible impulse--> difficult to evaluate impulses
102
Which test? If the crime would be a product of the disease, then insanity is automatically the charge.
Durham Rule
103
Key cases in defining mental illness
McDonald vs. US and Washington vs. US
104
Which test? person is not responsible if at time of event lacked substantial capacity to appreciate criminality of conduct or to conform his conduct to the law as a result of mental disease
model penal code of american law institute
105
Which act shifted burden of proof of insanity to defendant?
insanity defense reform act of 1984
106
Guilty but mentally ill
conviction and criminal sentence --> hospitalized and then prison
107
psychoactive ingredient in marijuana
THC
108
T/F marijuana use as an adolescent is linked to schizophrenia incidence
T
109
marijuana withdrawal syndrome
dysphoria, anorexia, irritability, anxiety, nonspecific somatic complaints
110
marijuana urine test effective in what time span
8-96 hours
111
cannabinoid receptors in immune cells
cb2:: lymphocytes > macrophages > cytokines
112
cannabinoid receptors in organs and fat
cb1
113
which receptors do endogenous cannabinoids bind?
cb1 > cb2
114
stimulant epidemics driven by low/high perceived risk and decreasing/increasing supply
low and increasing
115
Cocaine administration
iv/snort of cocaine powder and smoking of crack cocaine (free base)
116
Cocaine mx
blocks dopamine transporter and increases amount of dopamine in the synapse (but also really complex with other nt)
117
Acute effects of cocaine
euphoria, racing thoughts, increased hr and bp, anorexia, delusions, anxiety
118
Cocaine is metabolized by ____ and it's main metabolite is
plasma esterases and benzylethylene
119
speedball
cocaine and heroin--> enhances positive effects of both drugs, reduce some of the down effects of cocaine
120
cocaine and alcohol
most common combo --> reduces anxiety, cocaethylene is psychoactive
121
CNS toxicity of cocaine
seizures and stroke
122
Cardiac complications of cocaine
chest pain, MI, cardiomyopathy, myocarditis
123
Medical problems of cocaine
hyperpyrexia, intestinal ischemia, perforated nasal symptom, crack baby
124
T/F cocaine produces long-term sensitization
T --> increased AMPA receptor activity in response to cocaine use --> increased desire to use cocaine
125
T/F cocaine affects cortex
T --> reduction in gray matter in prefrontal cortex
126
Process of cocaine addiction
increased drug salience and reduced impulse control result in addiction
127
Tx of cocaine dependence
few withdrawal symptoms (sleepiness, deprx) --> require inpatient care (at least 30 days) --> less than 1/2 clean at 6 months after treatment // topiramate, disulfuram cocaine vax (relapse prevention)
128
Counseling in cocaine dependence
individual drug counseling > group > cbt > supportive therapy
129
contingency management
chances to win prizes for clean urine tests have proven to be most effective psychosocial approach to cocaine addiction
130
What is best tx for cocaine addiction in long term?
CBT
131
Topiramate MOA in cocaine dependence
gaba agonist feedback and glutamate antagonist feedback to dopaminergic neurons in VTA --> less dopamine release with cocaine
132
Disulfuram MOA in cocaine dependence
dopamine b hydroxylase blocker --> increase dopamine and reduce NE --> reduce cocaine high // reduce plasma esterase
133
Cocaine vax --> TACD
attach cocaine to cholera --> make Ab to cocaine
134
Methamphetamine
like cocaine but lasts longer
135
HP Benzodiazepines with short half life
alprazolam, lorazepam, triazolam --> most abusable b/c of short half life and high potency
136
HP Benzodiazepines with long half life
clonazepam
137
LP benzodiazepines with short half life
oxazepam, temazepam
138
LP benzodiazepines with long half life
diazepam, flurazepam, chlorazepate, chlordiazepoxside --> alcohol withdrawal
139
benzo MOA
gaba a binding --> anticonvulsant, anti anxiety --> cross tolerant with alcohol --> withdrawal treatment
140
benzo withdrawal
CNS excitation/seizures because brain has adjusted to benzo use
141
Compare a POD user vs. heroin dependent patient
younger, briefer addiction, less overall use, less likely to inject, more psychosocially stable
142
pseudo addiction
looks like addiction but disappears with adequate meds
