Week 8 Flashcards
Assumption/theory of psychodynamic therapy
unconscious reasons underly action. Past experiences determine perception. Patterns develop from mind’s desire to “replay”/”master” old pain (repetition compulsion)
Outcome data of PDT and CBT
long term PDT most effective. Short term, PDT and CBT equally effective
Conceptual framework of ego psychology
Impulse (drive) –> Prohibition (fear) –> Defense (coping) –> compromise (behavior)
Projection
Defense mechanism: false attribution of feelings onto another
Idealization
Defense for feelings of powerlessness, unimportance: attribute exaggerated positive qualities to people that they associate with
Devaluation
Defense for feelings of powerlessness: exaggerate negative qualities of others
Intellectualization
Defense for disturbing feelings: excessive use of abstract generalization or 3rd person.
Repression
defense for unwanted instincts/emotions/ideas: expel from consciousness, often break through (ie panic attacks). Is not Denial (disavow reality) or Suppression (conscious decision to disavow emotions–more “mature”)
Core problems
Things exposed by therapist/patient underlying
Transference
Replay of patterns from old relationships on
Theory of CBT
Emotional disorders involve systematic biases/distortions of thinking
Standard techniques of CBT
Rational Responding (how else can I view this situation) Self-monitoring (Take stock) Behavioral "experiments" Role-playing Metaphors Guided imagery Homework
Yerkes-Dodson Law
inverse U shaped curve (performance vs arousal)
Areas implicated in anxiety
ACC, insula, amygdala (repsonds to fearful stimuli even when below level of consciousness)
Phases of anxiety/General Adaptation Syndrome
Alarm: “fight or flight.” glucose mobilized
Resistance: glucose preserved
Exhaustion: collapse (exhaustion of reserves, failure of electrolyte balance, structural/funcional damage)
Learning theory of anxiety
Formed by Classical conditioning, maintained by operant conditioning.
Safety learning competes with fear learning.
Extinction (inhibiting CR) is context dependent, so conduct extinction in multiple contexts!
Generalized Anxiety Disorder Criteria
Excessive and uncontrollable worry >6mos + Additional problems (sleep, muscle, concentration)
GAD neurobio/genetics
distinct mechanism from panic (functional deficiency in GABA). Genetic factors; strongly related to neuroticism and depression
PTSD criteria
A. Experience: actual or threatened injury, response of intense fear, helplessness, horror
B:Re-experience. Intrusive recollections, nightmares, flashbacks, emotional/physical reactions to reminders
C: Avoidance of trauma-related stimuli and numbing
D: Increase arousal (hypervigilance, difficulty sleeping, outbursts, etc). Foreshortened horizon
E: Duration >1month
F: distress/impairment
Neural basis of PTSD
impaired extinction of fear response. Lesioned vmPFC
Hippocampus reduced –> overgeneralized fear response
Tx for PTSD
SSRIs, exposure therapy improve hippocampus size and amygdala disfunction
Hallucination vs Illusion vs Flashback vs Delusion
Hallucination: perception w/o stimulus
Illusion: mis-interpretation of stimulus
Flashback: re-experiencing/re-living, including sensory perception (~waking dream)
Delusion: Fixed false belief. Specific.
Panic Disorder criteria
Attacks + preoccupation (w or w/o agoraphobia)
Social phobia criteria
fear of embarrassment + fear of scrutiny (can also have panic attacks)
ECT (indications, contra-indications)
Indications: MDD, BPD, Catatonia, severe autism, PD.
Contra: CVD, craniotomy/skull fracture, cognitive impairment, seizure disorder, substance abuse
ECT electrode placement
Start right unilateral (fewest side effects), progress to bi-temporal, left uni
Factors determining ECT quality
1) Quality of seizure 2) Length of seizure 3) degree of suppression
TMS benefits, indications, downsides
geographically specific, excitation and inhibition. Approved for depression (as effective as anti-depressants). Expensive!
Vagal nerve stimulation
initially for epilepsy, works for treatment-resistant depression
Conceptual underpinnings of treatment for suicide
suicide as primary problem: inappropriate coping behavior
Effective treatment for suicidality
Reaching out, Cognitive Therapy: “safety plan” (replacing coping mechanism)
OCD Criteria
Obsessions (unwanted thoughts/impulses that are egodystonic, with attempts to suppress/ignore)
Compulsions: Repetitive behavior/mental act aimed at reducing distress or preventing feared event. Neutralizing!
brain areas for OCD
orbital cortex: caudate
Learning theory of OCD and treatment implications
Obsessions –> Distress –> compulsions –> relief –> reinforcement of compulsions
Tx: Break Distress –> compulsions link! (with exposure therapy)
Therapies for OCD
Combined treatment does not impede monotherapy, better than med alone but week evidence for superiority to CBT alone.
big site/implementation effect for CBT
frequency of non-medical use of Rx
opioid > sedative > stimulants
benzo MOA
binds GABA-A
pseudo-addiction (opioids)
looks like addiction but disappears with adequate meds
Most common illicit drug in ER reports
Cocaine
MOA cocaine
blocks DA reuptake
How drugs act on mesocorticolimbic dopamine system
Alcohol: indirect, partly through opioid receptors
Heroin: VTA neurons, results in stimulating NAc
cocaine/nicotine: directly on NAc neurons
CNS toxicity of cocaine
Seizures, stroke
Cardiac complications of cocaine
Chest pain, MI, cardiomyopathy, myocarditis
Especially when combined with alcohol –> cocethelene
Sensitization with cocaine
paradoxical (not tolerance). LTP in VTA cells (via NMDARs)
Neuro effects of long-term use
Frontal lobe activity dec –> impulse control —> more use (cycle)
Tx cocaine dependence
very difficult to treat. Voucher programs short-term. CBT long term. No effective medications. Topiramate (GABA inc on VTA) and disulfiram work OK. Vaccine could be promising
Marijuana and addiction
Long-term using now getting addicted (difficult to treat. Block CBs–>depression)
Marijuana impairment
high: ~2hrs. impairment ~10hrs (implications for driving)
Cannabinoids and psychosis
endogenous are anti-psychotic. But marijuana use as a teenager increases risk for schizophrenia
Cannabinoid subtypes
CB1: all over brain, especially emotion/reward areas
CB2: lymphocytes, macrophages, etc.
OCD vs OCPD
OCPD is egosyntonic
OCD epi
women > men (except in Munich)
