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192 Cards in this Set

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What is the diagnostic criteria for generalized anxiety disorder?
A. Excessive anxiety and worry (apprehensive expectation), occurring more days than not for at least 6 months, about a number of events of activities.

B. Person finds it difficult to control the worry.

C. The anxiety and worry are associated with three (or more) of the following symptoms, with at least some symptoms present for most days in the last 6 months.
1) restlessness or feeling keyed up or on edge
2) easily fatigued
3) difficulty concentrating or mind going blank
4) irritability
5) muscle tension
6) sleep disturbance (difficulty falling or staying sleep, or restless or unsatisfying sleep)

I'd say this person Ernie has been worrying about parents in a car crash for 6 months (Jan - August) for more days than not. He can't control this anxiety. He also has 3/6 symptoms: restless because waiting on the telephone. Yet then stays up too much not sleeping so gets fatigued. During the day he thus has difficulty concentrating. One day the phone rings and it's not any news of bad things. He gets irritable. Finally he gets so fatigued that he gets muscle tension and can't pick up the phone anymore.
What do people with GAD associate their fear with?
They associate fear with things that are not scary or threatening.
EMOTIONAL STROOP: Naming colors you see: Why is naming colors hard when the color doesn't match up?
In order to name the color, you have to suppress the automatic reading response.

Some evidence that bilingual better at this because they are used to shifting between languages. Better at supressing/doing opposite things.

Suppress preferential attention to letters seen to pay attention to color.

This is inhibitory control.
EMOTIONAL STROOP: Naming colors you see yet the word has a meaning that is making it difficult for you to get through it. Under what circumstances would it be difficult?
It would be difficult under scenarios where, for example, the word is cancer; if you had cancer, the meaning is relevant to you. You shift attention to the meaning of word, and shift away from things you're supposed to pay attention to
EMOTIONAL STROOP: Give this kind of test to 2 groups of people: one is high in GAD symptoms.
Those with higher anxiety had a harder time getting through list than people with low anxiety.
EMOTIONAL STROOP: What is the mechanism of making it harder?
It's harder because they stop to process the words. They shift their attention preferentially to the anxiety-relevant words; the more they do this, the harder it is to pay attention to the color, and they are slower at reading
EMOTIONAL STROOP: Why is it that higher anxious people pay attention to those anxiety-relevant words?
They are paying attention to threatening cues. They had an experiment of high/low anxiety. High anxiety paid attention to threatening face more than happy face.
EMOTIONAL STROOP: How do we get around trait or state anxiety in testing?
We don't have to "induce" anxiety. Even if not anxious at exact moment, the person with more trait anxiety will pay attention to more threatening things.
EMOTIONAL STROOP: How do feedback loops play into this?
In one study, they made people anxious by making people speak in public. There's a self-reinforcing loop b/c they pay attention to negative information -> more anxious -> more paying attention to negative information (feedback loops)
CONCLUSION (EMOTIONAL STROOP): What on the GAD diagram does Emotional stroop suggest?
More anxious -> more preferential attention to threat
What study suggests the "interpretation of ambiguous information as threatening" in the GAD diagram?
Homophones study. If given a list of words with 12 homophones, people will pick threatening word more.

Average: 14

Anxious; 16-18
HOMOPHONES: Why interpret homophones as threatening?
Evolutionary advantage

Survival
HOMOPHONES: What is the priming effect?
If exposed to dangerous word at first, then subsequent ones are also interpreted that way.
GAD diagram: After attention biases, what are there?
There are also cognitive biases.

Ex) Get a quiz back. Got 12/15. Got 12 answers right, or 3 answers wrong. Preferential attention to negative things (3 answers wrong)

So more likely to interpret that "this is going to threaten my chance of grad school" - cognitive bias for what this means in the future

3 major ones: intolerance of uncertainty; biased probability estimation, and catastrophizing.
Intolerance of uncertainty
Beliefs about how sure you should be about something

ex) you hate not knowing the outcome.

PROS: adaptive (maybe) because it might motivate you to study a lot

CONS: yet also might not be because you are ruminating to solve problem but not doing a lot about it

CONS: A lot of things in life that don't know if __ will happen.
What is biased probability estimation?
Overestimating negative outcomes.



ex) Woman getting a cold or cough; catastrophise and says that it means they have pneumonia or cancer as a healthy woman in 20s...b/c chances are it's pretty low

ex) failing test -> penniless. Yet if gone this far already, statistically low that you are going to fail out.
What is catastrophizing?
Worst case scenario about everything

ex) no grad school -> penniless

ex) bf broke up with me -> no one will love me

It increases fear and anxiety by raising the emotional stakes.
General pathway of GAD diagram?
1) Pay attention to things
2) Interpret
3) Feed into anxiety system going haywire
4) Worry
How does one stop this GAD diagram cycle?
If you get a bad quiz grade, and won't get into grad school...the most adaptive thing to do is just study
Why are worry and adaptive problem solving having inverse relationships?
When someone worries, they are less able to come up with adaptive solutions.

Fight/flight: not logical or thinking straight
How is pathological worry reinforced?
1) FEELS GOOD WHEN SOMETHING DOESN'T COME TRUE, or Managed to ward off all bad things by worrying, so it's working; so when stop -> world is going to go down

ex) only thing keeping people up in the air right now
How is pathological worry reinforced?
You do less about the problem (character of worry is rumination --more likely to focus on potential outcomes and not generating potential solutions or engaging in problem solving)
How is pathological worry reinforced?
MOST INFLUENTIAL THEORY: worry is negatively reinforced because it decreases fear

Worry is a form of cognitive avoidance.
How is it that worry decreases fear???
Worry is a cognitive, linguistic thought process that is future-oriented, whereas fear is a autonomic, physiological response to the present, here and now

So worry reduces fear in present

Reduces short-term arousal and fear (autonomic rigidity) b/c interferes with emotional processing of stressful or threatening stimuli

Reduction of fear negatively reinforced
What is ironic about worry and fear?
It results in increased arousal and greater intrusive thoughts in the long-term.
How does one challenge each step of GAD diagram?
IDENTIFY TRIGGERS (preferential attention to threat; interpreting ambiguous information as threatening)

CHALLENGE PATHOGENIC BELIEFS of intolerance of uncertainty; biased probability estimation; catastrophization
What is also one other reason why worry is somehow adaptive?/Gives evolutionary advantage?
Intrusive thoughts can actually make you shake and sweat, helping you prepare for the future.
How is GAD twisted worrying?
Normally, if someone points a gun at you, you recognize threat and panic. You filter everything out except gun; you have to interpret gun as threatening and visualize outcome -> worry

Then pull this out of situation that relates to someone's survival.

ex) if you're sick-> cancer; ignoring fact that you don't have a fever but just focusing on fact that you are sick.

GAD - people thinking situation is more threatening than it actually is.
The 3 symptoms or more for 6 months of GAD also are all physical symptoms of __?
Sympathetic nervous system
What is autonomic rigidity?
In one study, they put people in a lab and showed them a scary movie. Or tell them that they will be watching a scary movie. So group asked to worry worried more, yet have less of a fear response.

The worry is shutting down this automatic fear response = autonomic rigidity
How does worry increase greater intrusive thoughts in long-term?
Rebound: Yet worriers also people who are thinking of a scary movie a week later.
What is a panic attack?
Sophie:

1) Heart palpitations or increased heart rate - b/c of scarecrow

2) Sweating - b/c of scarecrow

3) Trembling or shaking - scarecrow

4) Feeling of choking -

Chest pain or discomfort

Nausea or abdominal distress

Feeling dizzy, unsteady, lightheaded or faint

Derealization or depersonalization

Fear of losing control of going crazy

Fear of dying

Paresthesias

Chills or hot flashes
In a panic attack, what else is there besides just bodily sensations?
Cognitive aspect - think that something bad is happening to you, so body feels worse
What is panic disorder?
Recurrent, unexpected panic attacks

At least 1 month of persistent concern about panic attacks, worry about the implications of the attack, and/or significant change in behavior related to attacks
What is difference between someone who has panic disorder and someone who has suffered a panic attack only?
Most people experience at least 1 panic attack, know it's distressing yet it's over in like 5 minutes; yet ppl with panic disorder are scared about having one consistently
What is the fear of fear model?
First, there's a trigger or anxiety-producing situation.

Then, physical sensations, catastrophic thoughts, increase in arousal, more physical -> panic.

Later, physical sensations -> conditioned stimulus
What is interceptive conditioning?
An emotional response to your own body sensations
How do catastrophic automatic thoughts operate?
They operate so quickly that people with panic disorder start having them before they realize what is actually going on.

Like even if you spin someone with panic disorder in a chair, you can make them hyperventilate
What did the CO2 study do?
CO2 makes people feel like they are suffocating.

If you go back to the panic model, then you can counter the catastrophic thoughts by giving them a safe person b/c they associate that person with safety

- less panic
What are other ways to decrease catastrophic automatic thoughts?
Comfort people; make people feel like they have more control over what will happen to them
What is agoraphobia?
It is avoidance - anxiety about being in places or situations where escape may be difficult (or potentially embarrassing) or where help would be unavailable

situations are avoided or endured with great distress
What are things that people avoid?
Exercise - feel short of breath, dizzy, sweaty -> symptoms of a panic attack

Or even social situations, movie theaters, sex, caffeine, drugs, family reunions, houses
Is panic disorder highly treatable and what treatment is most effective?
It is highly treatable

75-95% of people with CBT are panic-free at the end (people on medication, benzodiazepines), have a higher likelihood of relapse.
What are some anti-anxiety (anxiolytic) medications?
Benzodiazepines (Zanax, Lithium, Adavan)

Negative reinforcement - potent relaxation induced by drugs
How do anxiolytic medications work?
They are GABA (neurotransmitter) agonists, or enhance GABA action
What is GABA?
It is the major inhibitor neurotransmitter in the brain

Some are emotional centers. So decrease anxiety
What happens when you put CBT and drugs together?
In the short-term, those with anti-anxiety medications often do better; yet in the long-term, people with benzos actually have higher relapse rates
Why is it that people on anxiolytic medications relapse more in the long-term??
They don't have to fully experience their anxiety

In real life situations without drugs to help, then the anxiety is higher than what you experience in therapy
Why is it that people on anxiolytic medications relapse more in the long-term??
They also never learn that the anxiety can habituate on its own
Other disadvantages to anxiolytic medications?
You can also develop a tolerance to them; the brain and live gets more efficient at metabolizing the drug, and so it's less potent for the brain.

Yet this causes homeostatic mechanisms to downregulate receptors for GABA.

Body is overwhelmed by signal, so signals are less potent.
What is intensive exposure therapy?
Drinks caffeinated water to heighten her anxiety and increase physical response.

Experiences a panic attack before door closes; then finally doors close; then repeat situation over and over again and anxiety decreases.

Habituated to elevator.

Learned that what she feared was not dangerous.
Why is intensive exposure therapy sometimes avoided?
B/c people must face their fears
What did lady learn in panic attack?
Had a panic attack, yet came out OK; anxiety went away/habituated over time
What is CBT?
Cognitive behavioral therapy - did something that is different than what would be normally done.

Creates a new learning experience

Directly targets those thoughts.
What is unique about post-traumatic stress disorder?
Unlike depression, which can have variable causes (sometimes, it doesn't matter--just matters that there was a depressive response), PTSD is actually caused by a stressful and traumatic event.
What is trauma?
It is an actual/threatened death or serious injury; threat to physical integrity of self or others; person's response involved intense fear, helplessness, or horror.
Trauma is a ___ cause, yet ___ of PTSD
Trauma is a necessary cause, yet not a sufficient cause of PTSD.
What are some examples of trauma?
Being in the Holocaust, being raped, being in war.
Is repressed trauma rare?
Yes; very, very rare; most uncovered memories are false memories.
What is one cluster of PTSD?
Like Frank:

One cluster is arousal, including insomnia, irritability and anger, difficulty concentrating, hypervigilance, and exaggerated startled response.
Why is hyper vigilance both adaptive and not adaptive?
In situations like war, it is adaptive because you don't know if someone is a civilian or soldier. You need to be hyperattentive to every little detail. Yet in everyday life, this is not adaptive. Also, maintaining level of
What would someone would PTSD do if someone jumped out at them?
Would have an exaggerated startle response
What is the pathophysiologic model of PTSD?
There is a hypoactive (not that active) medial prefrontal cortex (PFC) and anterior cingulate cortex (ACC); there is a hyperactive amygdala. Not enough hypoactive, too much hyperactive fear.
What does the medial prefrontal cortex do?
It overrides the fear response.
If you show anyone a scary threatening face, what will brain do?
It will process that as a threat, and will have amygdala activity in response to that.
When you show happy and fearful faces to people with/without PTSD, what is the outcome?
Limbic system of people with PTSD - responds most dramatically to happy and fearful faces.

Amygdala/Limbic system - PTSD: exaggerated response to happy and fearful faces.
HYPERACTIVE LIMBIC RESPONSE.

Anterior cingulate cortex:
Show controls, greater activity than PTSD people for fearful face, and less activity than PTSD peopel for happy face.
HYPOACTIVE ACC RESPONSE.

Yet PTSD people have more response against happy faces.
How can you know if going to war caused ACC hypoactivity/amygdala hyperactivity and not that it was a predisposing risk factor?
Prospective longitudinal study: look at soldiers before trauma exposure; do comprehensive battery of genetic, psychiatric testing (30 days before), track trauma, and test after also
What are some regional differences in the brain between victims with and without PTSD?
Activity in brain tracked through structural MRI; orthogonal slices of brain
What is the ACC volume correlations with PTSD symptoms?
The more severe the PTSD, the less volume there was of ACC.
What is the second cluster of PTSD?
It is reexperiencing, through recurrent and intrusive recollections of the event; recurrent dreams of the event; acting or feeling as if the traumatic event were recurring (reliving, illusions, hallucinations, dissociative flashbacks), intense distress at exposure to trauma cues, and psychological reactivity to trauma cues.
What are flashbacks?
Reliving event in your mind. Predominantly visual, replaying event like you can see it happening in your mind. It doesn't have to be visual--it can be olfactory, kinetic, or tactile (literally feel like it's happening again)--very distressing.
What is the difference between a flashback and hallucination?
A hallucination may or may not be tied with previous experiences; a flashback is a memory, and you know you have it (insight)...vs. hallucinations - content not based in reality, vs. flashback, tied to experience, a story.
What is the memory paradox?
People with PTSD are both plagued by acute remembrances of the event, yet if you ask them to describe what happened, there are huge gaps and distortions and nonlinearities of narrative.
What is the difference between memory "about" trauma and memory "of" trauma?
About trauma: verbally accessible, autobiographical narrative, time context (where in larger context of life it's situated), can tell someone about it, incorporates cognitive appraisals and "after the fact" information

Memory "of" trauma: situationally accessible (cued), "here and now", no cognitive appraisals; experiential/sensory
What is a cognitive appraisal?
After-the-fact judgments about how dangerous, scary, or likelihood of survival was in situation

ex) "I was terrified--> now I am safe." "It took 45 minutes, this is what happened"
What is the one of the reasons why you get false memories?
People with PTSD don't have a lot of narrative memory.
What are triggers of trauma?
When car breaks down; in therapist's office; part of experiential/sensory memory
What are predominant theories of memory "of" trauma?
Difficulty with memory "about" trauma and keep experiencing "of" trauma

Not just disorder of arousal, but also of memory. Hippocampus?
What is the relationship between hippocampal volume and PTSD?
Negative correlation (inverse relationship) - smaller hippocampus, more PTSD.

Fits with model of memory.

Using prospective study to see if it's an outcome or predisposing risk factor.
What is the relationship between twin's hippocampal volume and other twin's developing PTSD?
1 twin served in Vietnam, got PTSD; other twin got deferrment and didn't serve and get PTSD

Same home. Same genetics. Differ with respect of exposure to trauma.

Smaller hippocampal volume of twin, more PTSD severity

Hippocampal - lower verbal ability -> memory problem
What is cluster 3 of PTSD?
Avoidance and numbing, like thoughts, feelings, and conversations; activities, places, or people; inability to recall aspects of trauma; diminished interest/participation in activities; detachment from others; restricted range of affect; sense of foreshortened future.
What are the external/internal cues of trauma?
External cues: people, places, activities
Internal stimuli: emotional numbing
What happens to people who are continually hyperaroused? How is this negatively reinforcing?
They shut down emotionally or want to avoid cues, prelonging fear conditioning and hyperarousal.

Withdrawal/disruption to life

ex) everytime experience a car backfiring and then get hyperaroused, then next time you avoid that cue and prolong fear conditioning and hyperarousal.

Don't know that some cues are actually harmless.
What are people doing to treat each 3 clusters?
"Pulling the bandage off" - live with it, not forget the trauma.
What are components of video for PTSD?
Full sensory -- see it, on a platform, feel vibrations, smell smells (diesel fuel), hear sounds to HABITUATE to whatever the cause is. Also, so that it won't OVERGENERALIZE to harmless cues, as there are a complex set of stimuli to habituate to.
Why is the PTSD video good for people whose memories are situationally cued?
It is good because they cannot articulate all aspects until they are actually in that situation.

They get a new narrative of what happened to them--verbally accessible memory.
Why is the exposure therapy so counterintuitive and controversial?
Normally, you habituate to the fear so that you do not avoid things anymore. Yet war is actually a physical danger, the anxiety is adaptive in war; not abnormal to be scared.

The only problem is that they are not in that situation now; when encounter same cues in daily life, anxiety has habituated.
What is the 3-part component in treating PTSD?
Habituating hyperarousal; facilitating formatin of new, verbally accessible memories, and cut through cycle of avoidance.
Controversies and problems for PTSD: Are memories for trauma accurate?
Sometimes, not super-accurate. B/c they have preexisting vulnerabilities in memory.
What study did they do for memory for trauma?
59 National Guard soldiers, 1 month and 2 years following return reported memories -- 61% reported 2 or more "new" traumatic memories.
For people who had to recall their memories, what happened to those with PTSD?
Most discrepancy for memories -- is it that 2 years later ones are accurate, b/c willfully repressing them, or is that there are difficulties forming new memories?
What is the diathesis-stress explanation for PTSD?
Diathesis is preexisting neurological deviations; stress that is necessary is trauma exposure.
Depression is not simple sadness or losing interest. It is also these things (SIGECAPPS), S:
S: Sleep disturbance (insomnia, hypersomnia): dragging; distressing; can depend on the day; classic symptom is early morning wakefulness
I stands for:
I: loss of INTEREST (anhedonia, lack of pleasure)
G stands for:
G: guilt or worthlessness, sense that they feel depressed, and not being good enough, worthless about being depressed
E stands for:
Lack of energy; run down; difficult to motivate to do simple everyday things, like laundry or chores
C stands for:
Difficulty concentrating; can't read, focus on movie, study an exam or test; maybe preoccupied with guilty sad thoughts or blank
A stands for:
Lack of Appetite (like sleep, is vegetative)
P stands for:
Psychomotor retardation or psychomotor agitation: not just cognitive, but "slowing" speech, physical response, walking through molasses, catatonic, facial expressions flat; or psychomotor agitation, its opposite: feeling wound up; physically restless, yet everything take 5x slower
S stands for:
Suicidal ideation: fantasies about death and killing oneself

Not so much an active plan as a constant preoccupation with thoughts about being dead
What is necessary for diagnosis of depression?
You need sadness or anhedonia (loss of interest), plus 4 other things nearly every day for two weeks.
Why is depression a polythetic diagnosis?
There are many characteristics of depression, yet no 2 people's depression looks exactly the same.

Some people could be more "sleep, eat all time" type, some are "insomniacs, or have guilt and psychomotor retardation"
What is the prevalence of depression in women and men? Is it increasing or decreasing? Age of first onset?
20-25% of women, 9-12% of men; increasing prevalence, decreasing age of first onset
What are reasons for depression rates going up?
Perhaps stressful lives, underreported previously? Mass madness? Better at detection? Less stigma?

Puberty getting earlier, so expanding people's risk and window of vulnerability?
Why more common in women?
More likely to talk about problems than men.

Also more at risk immediately after puberty and pregnancy: Female pubertal hormones and hormones that change during pregnancy/childbirth causes a serotonin change -> more likely to be depressed.

Stereotype: socialize in a way where people pick apart problems over and over again
How is multi-tasking implicated in depression?
Positive: If fail in one area, at least have another role that can play.
According to Aaron Beck, who pioneered the shift from psychoanalytical to CBT, what did he say about Freud + depression?
Freud: biology can't explain cognitive processes. Depression is due to hostility that people experienced yet ran against wall of repression (cutting nasty impulses), and went downwards.

Unconcious: filled with bad feelings; if think them then feel bad
What did Aaron Beck ask about Freud and dreams?
Wanted to see if depressed patients actually showed hostility in dreams.

Found that actually, depressed people showed less hostility in dreams
Aaron Beck and CBT: how is it scientific?
CBT evaluates whether or not a particular interpretation of self is correct. Be scientific - look for evidence, conduct a behavioral experiment, and find out.

ex) depression after breakup...conclude unlovable, and can't live without him.

question: cannot live without a man? when happy? in grad school, yet no man then!
How do life events trigger automatic thoughts?
Like someone with panic disorder who focuses on the bad things in the future, depressed people focus thoughts on self.
What is Beck's Cognitive Model of Depression?
First, life events trigger automatic thoughts about self ('love doesn't exist') -> cognitive distortions (more global)-> schemas that people have about themselves (core belief)

Over time, accumulation of negative automatic thoughts lead to negative thoughts.
What can cognitive therapy do?
It can change automatic thoughts, cognitive distortions, and core beliefs, to prevent relapse.
What are some cognitive distortions? (all or nothing)
All or nothing thinking:
ex) got B-> need to make a perfect score or I'm a failure; need to be best person or else not a good person; need to be attractive or else hideously ugly.
What is the cognitive distortion of overgeneralizing?
I'm too unlovable -> never going to be in a relationship
What is the cognitive distortion of personalization?
too busy -> unlovable?
maybe too busy, distracted, distressed
What is the cognitive distortion of emotional reasoning?
"No way I'll get tenure there"..."doesn't feel like I can get tenure there"
What are downsides to using drugs to treat depression?
Side effects, overdosing, need to be carefully monitored, and tradeoffs
What is Prozac?
A selective serotonin reuuptake inhibitor.

Side effects still present, yet not in need of high monitoring as before.

Blocks reuuptake transporters, causing more serotonin in cleft, binding more to serotonin receptors and causing more neuron response.
In what situations are antidepressants more useful?
In a meta-analysis (data from multiple studies), found a that antidepressants are effective treatments for depression if person has moderate to severe depression (vegetative or suicidal ideation)

Cognitive therapy is effective for mild depression (no vegetative symptoms or suicidal ideation)
What is a reuuptake transporter?
It is a channel that is like a vacuum that sucks up extra serotonin. If extra serotonin is hanging out in the cleft, cell needs a mechanism to put it back.
What is the counter to the faulty monoamine hypothesis?
Maybe scarcity of serotonin receptors; something free-floating in synapse cannot have effects; if it doesn't increase receptor binding, then there is no effect.
What is the counter to the theory that people with depression don't have enough serotonin?
Takes 3-4 weeks; some people feel better immediately; placebo effect - takes a month for antidepressant to reach maximum effectiveness; maybe increasing amount of serotonin causes adaptive changes in the receptor, so more long-term changes to receptor
What is down-regulation of receptors?
They keep sending the signal, decreasing receptor to neurotransmitter affinity
What did people looking at specific genotypes for depression focus on?
Serotonin transporter gene that codes for production of transporter; some people have a promoter region (promoting expression of gene, a 'go' signal) that is repeated multiple times more often than other people

Long version - Serotonin transporter more effective than people with short version
What is a polymorphism?
People differing genetically; yet here the difference is significant. The function of the gene differs whether you have long or short.
What do you anticipate, then, for depression (WHICH IS WRONG!!)
You anticipate that since long version makes a better serotonin transporter, that it that these people have more depression.

Actually, it's that people with short version have more depression?
Why is it that people with short version have more depression?
The more serotonin you have, the more your body reduces the number of receptors in the post-synaptic neuron.
Why is statement "reason you are depressed is because you don't have enough serotonin" wrong?
We know that people who have more serotonin

SSRIs increase serotonin yet also cause long-term changes in balance between receptor and serotonin
What is the connection between long/short copy of serotonin receptor gene and connectivity between ACC and amygdala?
Those with at least 1 short copy have less connectivity between ACC and amygdala.

The connectivity meant less regulation of amygdala and thus less regulation of emotion and fear responses.
What experiment did they conduct to see automatic negative thoughts and genes?
In an analogue study, induced sad mood in normal people.

On X axis, ll, sl, and ss.
Y-axis: negative automatic thoughts.

As people had greater numbers of short gene (less connectivity), reported greater numbers of negative automatic thoughts.
How can we see that the cognitive therapy model and biological model intersect?
SS -> more negative automatic thoughts

Gene-environment interaction.
Outside of the lab, what is correlation between ss and negative life events?
Highest risk of depression in those with ss

ss = more sensitive to environments...flourish under good, and not under bad
What is ironic processing?
Thought, "I can't concentrate" -> in trying to supress thoughts, they actually surface
Outside of the lab, what is correlation between ss and negative life events?
Highest risk of depression in those with ss

ss = more sensitive to environments...flourish under good, and not under bad
What is ironic processing?
Thought, "I can't concentrate" -> in trying to supress thoughts, they actually surface
What were the initial effects of Prozac?
Symptom relief; volume went down; medication did extraordinary things to brain
What happened later?
Relapse after man killed chicken
What were the initial effects of Prozac?
Symptom relief; volume went down; medication did extraordinary things to brain
What happened later?
Relapse after man killed chicken
What did mom say?
"City sickness"
Prayed over by the church
What is final conclusion?
Biopsychological model - has vulnerability to OCD, yet can cultivate "space" and freedom and health in here
Children, adults, normality and OCD?
Compulsive behaviors in children that are normal (Magical Thinking) or even borderline compulsive traits in adults, yet don't get in the way of normal functioning.
What is the continuum of bipolar disorders?
Euthymic -> Cyclothymic -> Bipolar II -> Bipolar I (with manic episodes)
What are manic episodes?
Elated, expansive, or irritable mood; grandiosity; inflated self-esteem; need less sleep; racing thoughts or flight of ideas; rapid or pressured speech; reckless or impulsive behavior; enhanced energy; increased goal-directed behavior; distractibility
What is "goal directed behavior" and how does it look to an outside observer?
Doing things that seem like they are accomplishing something, yet not rationally

ex) grad student in lab writing scientific encyclopedias
What might it feel like for you to say to stop being so productive?
Like wanting to party -> "let's just not party, guys" -> counter hedonic, opposite to their emotional state
Why might elatedness, anger, irritability go together?
Angry - motivates you towards things; want to get from here to there, so want obstructions out of the way; motivates others to get out of way

Positive emotions - happiness, going towards goals at a rate you find acceptable
Why is it that people with bipolar disorder have it chronically?
Want to have manic episodes - less sleep and more productivity

Positive affect is incredibly reinforcing -> Chronic problem

College years - irregularities in schedules (regular sleep, exercise, eating)

Mood stabilizers, like lithium, are prescribed to stabilize mood, NOT selective in neurochemical effects; so hugely disruptive side effects (lethargy)

-> hard to fully recover, (1/4 after 1 year) hard to work outside home (1/3)
What is goal dysregulation in bipolar disorder?
Behavioral activation system towards goals is dysfunctional.
How are disruptions in Circadian rhythms implicated in bipolar disorder?
Patient (premorbid) was hyperthymic, cycled between depression and hypomania (doesn't last quite as long, don't need as many symptoms; irritability, anger vs. elation), lasted more than 6-8 weeks

lithium failed to prevent cycling

Adhere to regimen of 14 hours enforced darkness

Didn't change anything except increased amount to darkness and sleep, and made sure it was happening at exact same time

2x a day measured - checked with psychologist 1x a week

euthymic
What is the graph showing for mood and days?
After treatment,

MOOD
before: mostly depressed, some hypomania
after: cluster in middle, euthymic

ACTIVITY:
before: all over the place
after: all days clustered for mood clustered around middle

SLEEP:
before: sometimes too much or too little
after: Cluster around 8
What was the point of the sleep study?
Combination of pharmocotherapy is most effective treatment

Bipolar not just unipolar + mania, but rather the goal disregulation, behavioral schedule, and routine is unique to bipolar disorder
What is the difference between mood-congruent psychotic symptoms and psychotic symptoms?
Mood-congruent: if you feel expansive/elated, then delusions congruent in content with mood symptoms; MOOD IS PREDOMINANT ASPECT.

schizophrenia - may have depression/mania due to psychotic symptoms.
What does it mean for schizophrenia to have a dimensional spectrum?
There is a schizophreniform spectrum, of less to very severe; yet related to each other in terms of psychosis
What is the criteria for schizophrenia?
Hallucinations, delusions, disorganized speech and behavior, negative symptoms (emotional flattening, alogia, anhedonia, avolition)

at least 2 of these symptoms for 1 month in context of signs of impairment for 6 months

except if you have severe or bizarre hallucinations or delusions, or 2 voices talking to each other
What are positive symptoms of schizophrenia?
Things there that should not be, like hallucinations, delusions
What are hallucinations?
Most commonly auditory
Something that doesn't exist is experienced
What are delusions?
Beliefs not grounded in reality

ex) CIA monitoring thoughts through lights (paranoia)

ex) I am 2nd coming of L. Ron Hubbard (grandiose)
What are negative symptoms?
Things that aren't there but should be (alogia, anhedonia, avolition)

shut down

lack of emotion, pleasure, motivation
What are atypical antipsychotics? What are old-class of antipsychotics?
Atypical: treat negative and positive symptoms

Positive: treat only positive symptoms, can't do much for negative (maybe thats why used to be harder to intervene?)
What kind of symptoms did Jerry exhibit?
He exhibited symptoms of delusions (grandiosity, paranoid), disorganization, disturbances in mood, mannerisms, purposelessness

Delusions - people killing him b/c of sins

Flat affect - doesn't match situation or thoughts

Voice tell him to do things or guilt him; voices scare and distress him; or voices telling him to leave the place

disorganized behavior - twirling hair

Lack of insight - want to get off cigarettes and go to medical school

Thought process grammatically correct, yet strung in a way that does not make sense; 5 steps missed in conversation; word salad; content is meaningless
What are the subtypes of schizophrenia?
Paranoid, disorganized, catatonic, undifferentiated

Patients may not fit neatly into some categories
If it's any disorder that exemplifies diathesis-stress model, what it is?
Schizophrenia; inherited biological vulnerabilities interact with environmental insults (in utero, birth, childhood, adolescence) that shapes disorder that emerges in young adulthood
What is the age of onset of schizophrenia?
At 18-24 in men and 21-27 women
What are early life events (in utero) that point to schizophrenia?
Maternal viral infection
Schizophrenia has correlation with month born in; mothers are more likely to get sick in the flu during February rather than August.
What were some false yet early 20th century predominant hypotheses about environmental stressors of schizophrenia?
Relationship to mother and child induced psychotic symptoms (schizophrenegetic mother)
What are some gene factors involved in schizophrenia?
More related you are to a person, more you are at risk for schizophrenia. Yet not totally 100% concordance rate.
What is the rate if you are a twin?
50% of twins versus 1% of population
What underlies the genetic risk for schizophrenia?
Perhaps dopamine; in quasi-experiments (natural environment), dopamine plays a causal role for positive symptoms of schizophrenia (hallucinations, disorganized speech and behavior, delusions, things that shouldn't be there but are there)
How was dopamine first implicated in schizophrenia? (Parkinson's)
People with Parkinson's have catatonia (inability to move) and tremors. They cannot initiate goal-directed motor movement.

There is death of cells in the basal ganglia that make dopamine - so Parkinson's - lack of dopamine.

If you give people synthetic precursors to dopamine (L-Dopa), they get psychotic symptoms (hallucinations or delusional beliefs)
What is meth, dopamine related to schizophrenia?
Methamphetamine increases dopamine in the system. One side effect of meth is that it can make you psychotic.
What do anti-psychotic medications do?
They block dopamine receptors (dopamine antagonists)
What does L-Dopa and meth do?
They are dopamine agonists, increasing psychotic symptoms
What is COMT?
Catechol-O-Methyl Transferase, an enzyme that metabolizes dopamine (Pac-Man going through brain and chewing dopamine)
How is COMT implicated in schizophrenia?
Some people's COMT gene have a higher activity than other people's COMT gene's COMT activity.

Val - most active COMT or active in gobbling up dopamine
How is it that if you have most active COMT (val) you might have more schizophrenia?
Val - highest in marijuana use.
What is one study they conducted to see COMT and teen marijuana use and schizophrenia?
There was a gene (COMT) x environmental (marijuana use) interaction.

High genetic risk + marijuana use -> schizophrenia rates higher
Why might marijuana matter?
Marijuana deinhibits dopamine. If you have inhibition of inhibition of dopamine, then have higher dopamine release of brain
What else might be implicated in genes? (home videos)
Looked at people who were schizophrenic vs. siblings who were not and looked at behavioral differences.

An unbiased person rated the behavior.

Signs already were visible in early childhood even to untrained observers' eyes.

Motor differences
What is expressed emotion?
They are negative or intrusive attitudes and feelings expressed about the patient.

Might include disapproval, resentment, rejection, overidentification with the patient, self-sacrifice
What is the relapse rate for families with high EE vs. low EE?
High EE families had 50% relapse (versus 15% in low EE).
What are some other risks to developing schizophrenia?
Trauma - 51-97% have experienced a sexual or physical assault
How does having schizophrenia set you up for more trauma?
79% were sexually assaulted women in last 12 months

Socially marginalized

Lack of social skills
How is stress related to EE?
Schizophrenic patients already have a lot of stress; they might be "pushed over the edge" because stress increases cortisol, increasing dopamine transmission in the brain
T/F: When you develop disease, environmental stressors don't matter.
FALSE: They do! High EE families and traumatic events
How do schizophrenic people hear voices?
They hear it and get so startled that they turn around as if someone is actually in the room.
What is the content of voices?
Very distressing and negative

ex. "You're nothing"
What is the effect of hearing voices?
Withdrawal, difficult to do simple cognitive tasks

Positive and negative and cognitive symptoms reinforce each other
What did psychologist do after hearing voices?
Put earplugs and told herself that she was experiencing it because of white noise--> out of situation in 10 minutes -> classic cognitive therapy reframe

like butterflies and ladybugs -> reframe experience to get less disgust and repulsion
How does one treat schizophrenia most effectively?
Medication and CBT/talk therapy, allowing people to bridge gap between where they are and ideal situation
How many bipolar patients can work full-time outside home? How many unable to work?
1/3 work outside home

1/2 unable to work at all
Percent of patients "fully" recovered within 12 mo?
24%