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218 Cards in this Set
- Front
- Back
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what is the leading cause of disability worldwide?
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major depression (depression accounts for 10% of all disability)
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emotion
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the state of arousal defined by the subjective states of feeling (ex: sadness, anger, disgust)
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affect
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pattern of observable behaviors (ex: facial expression, pitch of voice, body movements)
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mood
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a pervasive and sustained emotional response that can color perception
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depression
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can refer to a mood or to a clinical syndrome, a combo of emotion, cognitive & behavioral symptoms
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clinical depression
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depressed mood accompanied by other symptoms such as loss of energy, loss of pleasure, fatigue, changes in sleep & appetite
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mania
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flip side of depression; disturbance of mood accompanied by euphoria, grandiosity, decreased need for sleep, pressured speech
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2 broad types of mood disorders
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1. involves only depressive symptoms
2. involves manic symptoms (bipolar disorders) |
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5 types of depressive disorders
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1. major depressive disorder - single episode
2. major depressive disorder - recurrent episode 3. persistent depressive disorder - dysthymia 4. premenstrual dysphoric disorder 5. disruptive mood dysregulation disorder **4 & 5 are new to dsm-5 |
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3 types of bipolar disorders
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1. bipolar 1 disorder
2. bipolar 2 disorder 3. cyclothymia |
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general emotional symptoms of mood disorders
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-depressed or dysphoric mood
-eurphoria -irritability -anxiety |
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general cognitive symptoms of mood disorders
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-slowed thinking
-guilt and worthlessness -rumination -sped up thoughts -grandiosity -suicidal thoughts |
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general somatic symptoms of mood disorders
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-aches and pains
-changes in sleep & appetite -loss of sexual desire |
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general behavior symptoms of mood disorders
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-psychomotor retardation
-gregarious and energetic |
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criteria for MDD
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-must have sad mood or loss of interest/pleasure (anhedonia)
-plus 4 of the following symptoms: sleeping too much/too little, psychomotor retardation/agitation, poor appetite & weight loss or increased appetite & weight gain, loss of energy, feelings of worthlessness or excess guilt, difficulty concentrating, thinking or making decisions, recurrent thoughts of death or suicide -symptoms present nearly everyday most of the day for at least 2 weeks -symptoms are distinct & more severe than a normative response to a significant loss |
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psychomotor retardation
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slow thoughts & movements
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psychomotor agitation
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can't sit still; pace, fidget, & wring hands
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single episode vs. recurrent episodic MDD
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-single: symptoms tend to be present for a distinct period & then dissipate over time
-recurrent: once depression occurs, future episodes likely (avg # of episodes is 4) |
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subclinical depression
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-sadness plus 3 other symptoms for 10 days
-significant impairments in functioning even though full diagnostic criteria aren't met |
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criteria for chronic/persistent depressive disorder (dysthymia)
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-depressed mood for most of the day more than half the time for at least 3 yrs (1 yr for children/adolescents)
-plus 2 other symptoms during that time: poor appetite/overeating, sleeping too much or too little, poor self esteem, trouble concentrating or making decisions, feelings of hopelessness -symptoms don't clear for more than 2 months at a time |
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premenstrual dysphoric disorder
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-in most menstrual cycles during the past yr, at least 5 of the following symptoms from sec B & C were present in the final week before menses onset & became minimal in the week after menses
-at least one of the following: affective lability, irritability, depression mood, hopelessness or self-deprecating thoughts, anxiety -at least one of the following: diminished interest in usual activities, difficulty concentrating, lack of energy, changes in appetite, overeating or food craving, sleeping too much/too little, subjective sense of being overwhelmed or out of control, physical symptoms such as breast tenderness or swelling, joint/muscle pain or bloating |
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what effects do the symptoms of premenstrual dysphoric disorder have on the individual?
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-symptoms lead to significant distress or functional impairment
-symptoms aren't an exacerbation of another mood/anxiety disorder or personality disorder -symptoms present w/prospective daily ratings over 2 cycles -symptoms present when oral contraceptives aren't being taken |
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disruptive mood dysregulation disorder
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-severe recurrent temper outbursts (verbal/behavioral expressions of temper that are out of proportion in intensity/duration to the provocation)
-temper outbursts inconsistent w/developmental level -temper outburst occur at least 3x/week -negative mood between temper outbursts most days -symptoms have been present at least 12 months & don't clear for more than 3 months at a time -temper outburst & negative mood are present in at least 2 settings (at home, school, w/peers) & are severe in at least 1 setting -age 6 or older (or equivalent developmental level) -onset before age 10 -there's never been a distinct period lasting more than 1 day during which elevated mood & at least 3 other manic symptoms were present -behaviors don't occur exclusively during the course of MDD & aren't better accounted for by another mental disorder -diagnosis can't coexist w/oppositional defiant disorder, ADD/hyperactivity disorder, intermittent explosive disorder, or bipolar disorder |
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depressive disorders course & outcome
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-avg age of onset is 32
-length of episodes vary widely -min duration=2 weeks -remission: pd of recovery -relapse: return of active symptoms -approx. half of depressive patients recover in 6 months |
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frequency of depression
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-depression is common
-lifetime prevalence: 16.2% MDD; 2.5% dysthymia -3x as common among people in poverty |
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gender differences in depression
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-women=2-3x more vulnerable to depression than men
-women more likely than men to present for mental health services -more difficult for men to admit to subjective feelings of distress -gender diff aren't typically observed for bipolar mood disorders |
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prevalence of MDD by culture
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-prevalence varies across cultures
-1.5% in Taiwan -19% in Beirut, Lebanon -people who move to the U.S. from Mexico have lower rates than people of Mexican descent who were born in the U.S. |
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cross cultural differences
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-each culture has its own ways of interpreting reality including expressing or communicating symptoms of physical & emotional disorder
-clinical depression is a universal phenomenon that's not limited to western/urban societies |
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symptom variation across cultures
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-latino cultures: complaints of nerves & headaches
-Asian cultures: complaints of weakness, fatigue, & poor concentration -small distance from equator (longer day length) & higher fish consumption assoc w/lower rates of MDD |
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epidemiology & consequences of MDD
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-symptom variation across life span
-children: headaches & stomach aches -older adults: distractability & forgetfulness -co-morbidity: 2/3 of those w/MDD will also meet criteria for anxiety disorder at some point |
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what does depression mean for family members?
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children of depressed mothers have higher rates of:
-depression & anxiety thruout lifespan -aggression & externalizing behavior probs -poor academic achievement & lower iq -negative affect, lower self-concept & self esteem -insecure attachment w/mothers -abnormal prefrontal & cortisol activities Marriages also have higher rates of conflict & divorce infants & children of depressed mothers (research has been done studying both clinical depression & depressive symptomatology) |
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what is the defining feature of each of the 3 bipolar disorders?
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manic symptoms
-differentiated by how severe & long lasting manic symptoms are -mania & depression |
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mania vs. hypomania
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mania: state of intense elation or irritability accompanied by other symptoms (flight of ideas)
hypomania: less extreme than mania (change in functioning that doesn't cause serious probs) |
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mania & hypomania episodes
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-distinctly elevated/irritable mood
-abnormally increased activity/energy -at least 3 of the following are noticeably changed from baseline (4 if mood is irritable): inc in goal-directed activity/psychomotor agitation, unusual talkativeness; rapid speech, flight of ideas or subj impression that thoughts are racing, dec need for sleep, inc self esteem; grandiosity, distractibility; attn. easily diverted, excessive involvement in activities that are likely to have painful consequences (reckless spending, sexual indiscretions, or unwise bus investment), symptoms present for most of the day, nearly everyday |
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criteria for manic episode
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-symptoms last for 1 wk, or require hospitalization or include psychosis
-symptoms cause significant distress/functional impairment |
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criteria for hypomanic episode
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-symptoms last at least 4 days
-clear changes in functioning that are observable to others, but impairment isn't marked -no psychotic symptoms are present |
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criteria for bipolar I
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-at least one episode or mania
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criteria for bipolar II disorder
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-at least 1 major depressive episode w/at least 1 episode of hypomania
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criteria for cyclothymic disorder (cyclothymia)
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-milder, chronic form of bipolar disorder
-lasts at least 2 yrs in adults (1 yr in children/adolescents) -numerous periods w/hypomanic & depressive symptoms -doesn't meet criteria for mania or major depressive episode -symptoms don't clear for more than 2 months at a time |
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2 chronic mood disorders
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1. persistent depressive disorder
2. cyclothymic disorder |
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onset for bipolar disorder
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-onset usually occurs btwn ages 18-22 yrs
-first onset can be depression or mania -avg duration of a manic episode runs between 2 & 3 months |
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prevalence for bipolar disorder
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-prevalence lower than MDD
-long term course is often intermittent -long-term prognosis is mix |
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are there gender differences in bipolar disorder?
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-no gender differences
-women experience more depressive episodes |
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outcome for bipolar disorder
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-severe mental illness
-1/3 were unemployed a yr after hospitalization -suicide rates high -50% of people with bipolar I will experience 4 or more episodes -2/3 people w/bipolar disorder meet criteria for a comorbid anxiety disorder -unable to work 25% of the time |
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course specifiers (subtype of mood disorder)
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-melancholic features (primarily a specifier of depression)
-psychotic features (primarily a specifier for bipolar disorders) -post partum |
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pattern specifiers (subtype of mood disorder)
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-rapid cycling: at least 4 episodes w/in the past yr (only for bipolar disorder)
-seasonal affective disorder *refer to overall patter of episodes over time |
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how are mood disorders heterogeneous?
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same disorder but diff symptoms
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dopamine sensitivity in depression vs. mania
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depression: diminished dopamine receptor sensitivity
mania: enhanced dopamine receptor sensitivity |
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which disorder is among the most heritable of disorders?
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bipolar (twin studies)
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genetic factors of mood disorders
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-heritability estimates: 37% MDD, 93% bipolar disorder
-much research in progress to identify 1 specific gene involved but the results of most studies have not been replicated (prob polygenetic) -DRD4.2 gene (influences dopamine function) appears to be related to MDD -genetic risk and sensitivity to stress |
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3 imp neurotransmitters (NTs)
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norepinephrine, dopamine & serotonin
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NTs in MDD vs. Mania
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-original models focused on absolute levels of NTs
-MDD: low levels of norepinephrine, dopamine & serotonin -Mania: high levels of norepinephrine and dopamine, low levels of serotonin |
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what do new models of NTs focus on?
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-sensitivity of postsynaptic receptors
-dopamine receptors may be overly sensitive in BD but lack sensitivity in MDD -depleting tryptophan, a precursor of serotonin, causes depressive symptoms in individuals w/personal or fam history of depression -individuals who are vulnerable to depression may have less sensitive serotonin receptors |
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brain imaging (structural vs. functional)
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structural studies: focus on number of or connections among cells
function activation studies: focus on activity levels |
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levels on activity among ppl w/mood disorders shown in functional activation studies
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amygdala: elevated
subgenual anterior cingulate: elevated dorsolateral prefrontal cortex: diminished during emotion regulation hippocampus: diminished |
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what is the hormonal system known as?
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the hypothalamic-pituitary-adrenal (HPA) axis
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overactivity of HPA axis
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-triggers release of cortisol (stress hormone)
-amygdala overreaction |
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findings that link depression to high cortisol levels
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cushings syndrome: causes oversecretion of cortisol; symptoms include those of depression
injecting cortisol in animals produces depressive symptoms dexamethasone suppression test: lack of cortisol suppression in people w/history of depression |
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life events of psychosocial factors
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-prospective research: 42-67% report a stressful life event in yr prior to depression onset (ex: romantic breakup, loss of job, death of loved one); replicated in 12 studies across 6 countries
-lack of social support may be 1 reason a stressor triggers depression -stressful life event linked to manic episodes as well |
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interpersonal difficulties related to psychosocial factors
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-high levels of expressed emotion by fam members predicts relapse
-marital conflict also predicts depression |
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how does behavior of depressed ppl often lead to rejection by others?
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-excessive reassurance seeking
-few positive facial expressions -negative self disclosures -slow speech & long silences |
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why do some ppl become depressed after stressful life events & others do not?
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-response styles & gender: ruminative style (women) & distracting style (men)
-interpersonal factors & soc behaviors : some depressed ppl create difficult circumstances that inc levels of stress -integration of cognitive & interpersonal factors : vulnerability to depression is influenced by childhood experiences |
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do negative life events cause depression or does depression lead to negative events?
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a special class of circumstances (those involving major losses of imp ppl or roles) seem to play a crucial role in precipitating unipolar depression
-depression more likely to occur when life events are assoc w/ feelings of humiliation, entrapment & defeat |
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cognitive theories: cognitive vulnerability
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-humans are not only social but thinking organisms
-hopelessness theory: ways in which ppl perceive, think about & remember event influence feelings -attributional style: negative thoughts about self & pessimistic view of the environment maintain depression |
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neuroticism
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-tendency to react w/higher levels of negative affect
-predicts onset of depression |
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negative triad
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negative view of self, world, future
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negative schema
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underlying tendency to see the world negatively
-negative schema cause cognitive biases |
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cognitive biases
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tendency to process info in negative ways
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beck's theory of depression
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negative schema, cognitive biases & negative triad lead to depression
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example of attributions for why someone failed their GRE math exam
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-stable: I lack intelligence/I lack math ability
-unstable: I am exhausted/I am fed up with math |
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social & psych factors in bipolar disorder
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-triggers of depressive episodes in bipolar disorder appear similar to the triggers of major depressive episodes
-negative life events, neuroticism, negative cognitions, expressed emotion, & lack of soc support |
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predictors of mania
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reward sensitivity & sleep disruption
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psych treatment for depressive disorders
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-cognitive therapy
-interpersonal psychotherapy -mindfulness-based cognitive therapy (MBCT): strategies, including meditation, to prevent relapse -behavioral activation (BA) therapy: inc participation in positively reinforcing activities to disrupt spiral of depression, withdrawal, & avoidance -behavioral couples therapy: enhance communication & satisfaction |
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cognitive vs. interpersonal therapy
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cognitive: focuses on helping patients replace self-defeating thoughts w/more rational statements; current experiences; effective for unipolar depression
interpersonal: focuses on current relationships, esp familial; attempts to improve relationships by building communication & prob solving skill |
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electroconvulsive therapy (ECT)
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-biological treatment for mood disorders
-reserved for treatment non-responders -induce brain seizure & momentary unconsciousness (unilateral ECT) -side effects (mem loss) -ECT more effective than meds, but unclear how ECT works |
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SSRIs
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-biological treatment for depressive disorder
-most frequently used antidepressant -easier to use than other antidepressants -fewer side effects (sexual dysfunction, weight gain) -less dangerous in event of overdose |
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tricyclics (TCAs)
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-biological treatment for depressive disorders
-imipramine & amitriptyline -more side effects (constipation, drowsiness, drop in BP, blurred vision) -equal in efficacy to SSRIs |
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MAO-Is: Phenelzine (Nardil)
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-biological treatment of depressive disorders
-not as effective as tricyclics -side effects: consuming foods w/tyramine (cheese & chocolate) often inc BP -can be used safely when foods such as beer, cheese & red wine are avoided -also used in treatment of anxiety disorders, particularly agoraphobia & panic |
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meds for bipolar disorder
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-lithium: up to 80% receive at least some relief w/this mood stabilizer
-potentially serious side effects (lithium toxicity) -newer mood stabilizers: anticonvulsants (Depakote), antipsychotics (zyprexa); both also have serious side effects |
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psych treatment of bipolar
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-psychoeducational approaches: provide info about symptoms, course, triggers & treatments
-fam-focused treatment (FFT): educate fam about disorder, enhance fam communication, improve problem solving -psychotherapy: prelim data suggests that meds & psychotherapy together are more effective than meds alone |
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treatment effectiveness
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-published studies may overestimate the effectiveness of meds
-combining psychotherapy & antidepressant meds inc odds of recovery over either alone by 10-20% -meds quicker, therapy longer lasting effects -later studies: CT as effective as meds for severe depression; CT more effective than meds at preventing relapse |
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suicide ideation
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thoughts of killing oneself
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suicide attempt
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behavior intended to kill oneself
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suicide
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death from deliberate self injury
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non-suicidal self injury
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behaviors intended to injure oneself w/o intent to kill oneself
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epidemiology of suicide/suicide attempts
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-suicide rate in US is 1/10,000 in a given yr; worldwide 9% report suicidal ideation at least once in their lives, & 2.5% have made at least one suicide attempt
-guns are most common means of suicide in us (60%) -men are 4x more likely than women to kill themselves; women more likely than men to make suicide attempts that don't result in death -men usually shoot or hang themselves -women more likely to use pills |
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models of suicide
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-psych disorders: 1/2 of suicide attempts are depressed
-neurobiological models: heritability of 48% for suicide attempts; low levels of serotonin; overly reactive HPA system -soc factors: economic recessions; media reports of suicide; soc isolation & a lack of soc belonging -psych models: prob-solving deficit; hopelessness; life satisfaction |
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preventing suicide
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-talk about suicide openly & matter of factly
-most people are ambivalent about their suicidal intentions -treat the associated mental disorder -treat suicidality directly -suicide prevention centers |
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overview of anxiety disorders
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-most common psychiatric disorders
-28% report anxiety symptoms -most common are phobias -they share similarities w/mood disorders |
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symptoms of anxiety vs. fear
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anxiety: assoc w/the anticipation of future probs; involves more general/diffuse emotional reactions; emotional experience is out of proportion to the threat
fear: experienced in the face real immediate danger; usually builds quickly in intensity; helps behavioral responses to threats |
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general symptoms of anxiety disorders
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-ppl w/anxiety disorders share a preoccupation w/, or persistent avoidance of, thoughts or situations that provoke fear or anxiety
-diagnosis of anxiety disorders depends on several types of symptoms |
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excessive worry (symptoms of anxiety disorder)
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-cognitive activity assoc w/anxiety
-a relatively uncontrollable sequence of negative, emotional thoughts that are concerned w/possible future threats or danger -worriers are preoccupied w/"self-talk" |
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normal vs. pathological worry
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distinctions hinges on quantity and quality of worrisome thoughts
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phobias
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-disruptive fear of a particular obj or situation
-fear out of proportion to actual threat -must be severe enough to cause distress or interfere w/job or social life -avoidance |
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general panic attack symptoms
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-sudden intense episode of apprehension, terror, feelings of impending doom (intense urge to flee, symptoms reach peak intensity w/in 10 mins)
-physical symptoms include: labored breathing, heart palpitations, nausea, upset stomach, chest pain, feelings of choking & smothering, dizziness, sweating, lightheadedness, chills, heart sensations, & trembling -other symptoms include: depersonalization, derealization, fears of going crazy, losing control or dying |
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brief historical perspective of anxiety disorders
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-anxiety & abnormal fears didn't play prominent role in psychiatric classification systems during the 2nd half of the 19th century
-freud & his followers were responsible for some of the 1st extensive clinical descriptions of pathological anxiety states |
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3 main types of anxiety disorders as described in dsm-5
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anxiety disorders, obsessive-compulsive & related disorders, & trauma & stressor related disorders
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criteria for all anxiety disorders
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-symptoms must interfere w/imp areas of functioning or cause marked distress
-symptoms not caused by drug or medical condition -fears & anxieties are distinct from the symptoms of another anxiety disorder |
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diagnostic criteria for a specific phobia
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1. marked & disproportionate fear consistently triggered by specific objs or situations
2. obj or situation is avoided or else endured w/intense anxiety 3. symptoms persist for at least 6 months |
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disproportionate fear of a particular obj or situation
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-common ex : fear of flying, snakes, heights, etc
-fear out of proportion to actual threat -most specific phobias cluster around a few feared objs & situations -high comorbidity of specific phobias -although there are some common themes, ppl can develop a phobia of anything |
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dopamine
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plays major role in sensitivity of reward system
-guides pleasure, motivation, & energy in MDD |
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diagnostic criteria: soc anxiety disorder
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1. marked & disproportionate fear consistently triggered by exposure to potential scrutiny
2. exposure to the trigger leads to intense anxiety about being evaluated negatively 3. triggers situations are avoided or else endured w/intense anxiety 4. symptoms persist for at least 6 months |
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how is soc anxiety disorder more intense & extensive than shyness?
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-persistent intense fear & avoidance of soc situations
-fear of negative evaluation or scrutiny -exposure to trigger leads to anxiety about being humiliated or embarrassed socially -onset often adolescence -2 broad headings: performance anxiety & interpersonal interaction -fear of humiliation or embarrassment |
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diagnostic criteria for panic disorder
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1. recurrent unexpected panic attacks
2. at least 1 month of concern about the possibility of more attacks, worry about the consequences of an attack, or maladaptive behavioral changes because of the attacks |
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agoraphobia
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-from greek word "agora" or marketplace
-usually described as fear of public places -anxiety about inability to flee anxiety-provoking situations (crowds, stores, malls, churches, etc) -most complex & incapacitating phobic disorder -at least half of agoraphobics don't suffer panic attacks |
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diagnostic criteria for agoraphobia
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1. disproportionate & marked fear or anxiety about at least 2 situations where it would be difficult to escape or receive help in the event of incapacitation, embarrassing or panic-like symptoms such as : being outside of the home alone, travelling on public transportation, open spaces, being in shops or theaters, standing in line, being in a crowd
2. these situations consistently provoke fear/anxiety 3. these situations are avoided, require the presence of a companion, or are endured w/intense fear or anxiety 4. symptoms last at least 6 months |
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generalized anxiety disorder (GAD)
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-involves chronic, excessive, uncontrollable worry that lasts @ least 6 months & interferes w/daily life (worries lead to significant distress); often can't decide on solution or course of action
-other symptoms: restlessness, poor concentration, tiring easily, irritability, muscle tension -common worries: relationships, health, finances, daily hassles -often begins in adolescence or earlier (I've always been this way) |
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diagnostic criteria for GAD
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1. excessive anxiety & worry at least 50% of days a number of events or activities (fam, health, finances, work, school)
2. person finds it hard to control worry 3. worry is sustained for at least 6 months 4. anxiety & worry are assoc w/at least 3(only 1 for kids): restlessness/feeling keyed up or on edge, being easily fatigued, difficulty concentrating or mind going blank, irritability, muscle tension, sleep disturbance |
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most common form of mental disorder
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anxiety disorders
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what is the expected long-term outcome for ppl w/anxiety disorders?
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-anxiety disorders are often chronic conditions, some ppl don't recover
-frequency & intensity of panic attacks tend to dec during middle age -agoraphobic avoidance typically remains stable -most anxiety disorders are very treatable if ppl seek treatment |
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frequency of anxiety disorders
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-rates for anxiety disorder have been found to be lower when people over the age of 60 are compared to younger adults
-anxiety may inc as people move into their 70s & 80s -only type of anxiety disorder that begins in late life is agoraphobia |
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comorbidity
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-80% of those w/anxiety disorders meet criteria for another anxiety disorder
-subthreshold symptoms (don't meet full DSM) very common -causes of comorbidity: symptoms used to diagnose the various anxiety disorders overlap- soc anxiety & agoraphobia might both involve a fear of crowds -etiological factors may inc risk for more than 1 anxiety disorder -75% of those w/anxiety disorder meet criteria for another psych disorder -disorders commonly comorbid w/anxiety: 60% w/anxiety also have depression, substance abuse, personality disordrs, med disorders (coronary heart disease) |
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gender factors for anxiety disorder
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-women=2x as likely as men to have anxiety disorder
-possible explanations: women more likely to report symptoms, men more likely to be encouraged to face fears, women more likely to experience childhood sexual abuse, women show more biological stress reactivity -relapse rates also higher for women than men |
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cultural factors for anxiety disorders
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-cross cultural comparisons: ppl in western societies often experience anxiety in relation to their work performance, whereas other societies may be more concerned about fam issues or religious experiences; few epidemiological studies have attempted to collect cross-cultural data using standardized criteria
-culturally specific symptoms: taijin kyofusho (Japanese fear of offending/embarrassing others); kayak-angst (inuit disorder in seal hunters at sea similar to panic) -ratio of somatic to psychological symptoms appears similar across cultures |
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evolutionary perspective of anxiety disorders
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-adaptive & maladaptive fears
-often focused on evolutionary significance of anxiety & fear -emotional responses are adaptive -mobilize responses that help the person survive in the face of both immediate danger & long-range threats |
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why do some negative life events lead to depression while others lead to anxiety?
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-nature of the event may be an imp factor in determining the type of mental disorder that appears
-stressful life events, particularly involving danger & interpersonal conflict, can trigger the onset of certain kinds of anxiety disorders and depression -for depression, an event(s) involving severe loss (lack of hope) is more likely to have occurred |
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childhood adversity
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-concept includes experiences such as maternal prenatal stress, multiple maternal partner changes, parental indifference (neglect) & physical abuse
-children who are exposed to higher levels of anxiety are more likely to develop anxiety disorders later in life |
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attachment relationships & separation anxiety
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-according to attachment theory, anxiety is an innate response to separation, or the threat of separation, from the caretaker
-several studies have found that people w/anxiety disorders are more likely to have had attachment probs as children |
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behavioral inhibition
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-tendency to be agitated, distressed, and cry in unfamiliar or novel settings
-observed in infants as young as 4 months -may be inherited -predicts anxiety in childhood & social anxiety in adolescence |
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personality risk factors (anxiety disorders)- neuroticism
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-react w/negative affect
-linked to anxiety & depression -higher levels linked to double the likelihood of developing anxiety disorders |
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learning processes
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-specific fears might be learned thru classical conditioning
-process by which fears are learned suggests that the process is guided by a module, or specialized circuit |
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preparedness model
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-research results appear to suggest that conditioned responses to fear-relevant stimuli (spiders, snakes) are more resistant to extinction than those to fear-irrelevant stimuli (flowers)
-human beings seem to be prepared to develop intense, persistent fears only to a select set of objs or situations |
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cognitive factors
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-perceptions, memory, & attention all influence reaction to events
-play a crucial factor in the development & maintenance of various types of anxiety disorders -4 aspects: perception of controllability, catastrophic misinterpretation, attentional biases, thought suppression |
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perception of control
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-ppl who feel that they are able to control events in their environments are less likely to show symptoms of anxiety than ppl who believe they are helpless
-feelings of lack of control contribute to the onset of panic attacks among patients w/panic disorder |
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catastrophic misinterpretation
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-panic attacks can be precipitated by internal stimuli, such as bodily sensations, thoughts or images
-ppl may misinterpret bodily sensations as a catastrophic event -a person's automatic, negative thoughts may also lead to behaviors that are expected to inc safety, when they are, in fact, counterproductive |
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attn. to threat & biased info processing
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-ppl prone to excessive worrying & panic are unusually sensitive to cues that signal the existence of future threats
-recognition of danger cues triggers maladaptive, self-perpetuation cycle of cognitive processes that quickly spin out of control |
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is it useful to struggle actively against unwanted thoughts?
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recent evidence suggest that trying to rid one's mind of a distressing or unwanted thought can have the unintended effect of making the thought more intrusive
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genetic factors for anxiety
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-sheds light on the relationship between anxiety and depression
-twin studies suggest heritability -about 20-40% for phobias, GAD, & PTSD -about 50% for panic disorder -relative w/phobia increases risk for other anxiety disorders in addiction to phobia -anxiety appears to be modestly heritable between 20-30% |
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neurobiological risk factors for anxiety disorders
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-neurobiological
-fear circuit overactivity: amygdala, medial prefrontal cortex deficits -neurotransmitters: poor functioning of serotonin & GABA; higher levels of norepinephrine |
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etiology of specific phobias
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-conditioning
-mowrer's 2 factor model 1. pairing of stimulus w/aversive UCS leads to fear (classical conditioning) 2. avoidance maintained thru negative reinforcement (operant conditioning) |
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3 extensions of 2 factor model
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1. modeling: seeing another person harmed by stimulus
2. verbal instruction: parent warning a child about danger 3. those w/anxiety tend to acquire fear more readily - and be more resistant to extinction |
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cognitive factors of etiology of soc anxiety disorder
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-unrealistic negative beliefs about consequences of behaviors
-excessive attn. to internal cues -fear of negative evaluation by others (expect others to dislike them) -negative self evaluation (harsh, punitive self-judgment) |
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interoceptive conditioning
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classical conditioning of panic in response to internal bodily sensations
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etiology of panic
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-cognitive factors: catastrophic misinterpretations of somatic changes; interpreted as impending doom (I must be having a heart attack); beliefs inc anxiety & arousal (creates vicious cycle)
-anxiety sensitivity index - high scores predict development of panic |
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etiology of GAD
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-gaba system deficits
-borkovec's cognitive model: worry reinforcing b/c it distracts from negative emotions & images; allows avoidance of more disturbing emotions (distress of previous trauma); worrying decreases psychophysiological arousal; avoidance prevents extinction of underlying anxiety |
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best treatment for anxiety disorders
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anxiety disorders are 1 of the areas of psychopathology in which clinical psychologists & psychiatrists are best prepared to improve the level of the client's functioning
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psychoanalytic psychotherapy
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emphasis in this type of treatment is on fostering insight regarding the unconscious motives that presumably lie at the heart of the patient's symptoms
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systematic desensitization
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-initially developed for the purpose of treating anxiety disorders, esp phobias
-crucial feature of the treatment involves systematic maintained exposure to the feared stimuli -progressive relaxation -a hierarchy of feared stimuli |
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situational vs. introceptive exposure
(exposure & response prevention treatments) |
situational: used to treat agoraphobic avoidance (procedure involves the person repeatedly confronting the situations that have been previously avoided)
interoceptive: aimed at reducing the person's fear of internal, bodily sensations frequently assoc w/panic |
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relaxation skills training
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involves teaching the client to alternately tense & relax specific muscle groups while breathing slowly & deeply
-this procedure is described to clients as an active coping skill |
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breathing retraining
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-involves education about the physiological effects of hyperventilation & practice in slow breathing
-client learns to control breathing thru repeated practice using muscles of the diaphragm, rather than the chest |
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cognitive therapy intervention
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-identify cognitions that are relevant to their probs
-recognize the relation between these thoughts & maladaptive emotional responses -examine evidence that supports or contradicts these beliefs -teach clients more useful ways of interpreting events -helps clients to review how they think about situations in their lives, decatastrophisize (what if the worst case scenario happened?) -sessions followed by extensive practice & homework assigments |
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anxiolytics
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-drugs that reduce anxiety
-benzodiazepenes: valium, Xanax -antidepressants: tricyclics, SSRIs, SNRIs -d-cycloserine (DCS) : enhances learning during exposure treatment |
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antianxiety meds
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-most frequently used minor tranquilizers are from the class of drugs known as benzodiazepines (valium & Xanax)
-these drugs reduce many symptoms of anxiety, esp vigilance & subj somatic sensations -they have less effect on worry & rumination |
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side effects of benzodiazepines
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-sedation accompanied by mild psychomotor & cognitive impairments
-probs in attn. & memory, esp among elderly -potential for addiction - the most serious effect of benzodiazepines |
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what is the preferred form of meds for treating all forms of anxiety?
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-selective serotonin reuptake inhibitors (SSRIs)
-include: Prozac, luvox, Zoloft, paxil -fewer unpleasant side effects and are safer to use -withdrawal reactions are less prominent |
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do psych treatments have any advantages over meds for treatment of anxiety?
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-in actual practice, anxiety disorders are often treated w/a combo of psych & biological procedures
-selection of specific treatment components depends on the specific group of presenting symptoms |
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schizophrenia
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-major disturbances in thought, emotion & behavior
-can disrupt interpersonal relationships, diminish capacity to work or live independently -significantly inc rates of suicide and death -lifetime prevalence ~1% -onset typically late adolescence or early adulthood -diagnosed more frequently in African americans (may reflect diagnostic bias) |
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proposed DSM-5 criteria for schizo
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1. delusions
2. hallucinations 3. disorganized speech 4. abnormal psychomotor behavior (catatonia) 5. negative symptoms (blunted affect, avolition, asociality) |
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3 major clusters of schizo symptoms
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1. positive (delusions, hallucinations)
2. negative (avolition, blunted affect, asociality) 3. disorganized (disorganized behavior & speech) |
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proposed dsm-5 criteria for schizophrenia
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-disruption in work, relationships or self-care
-signs of disorder for at least 6 months; at least 1 month of the symptoms above or, if during a prodromal or residual phase, negative symptoms or 2 or more of symptoms 1-4 in less severe form |
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types of delusions
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persecutory, thought insertion, thought broadcasting, outside control, grandiose delusions, ideas of reference
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types of hallucinations
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1. auditory: 74% have this symptoms
2. visual 3. hearing voices: inc levels of activity in broca's area during hallucinations |
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behavioral deficits
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avolition, adociality, anhendonia, blunted affect & alogia
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2 domains of negative symptoms
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1. experience domain: motivation, emotional experience, socialty
2. expression domain: outward expression of emotion; vocalization |
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disorganized speech
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-formal thought disorder
-incoherence -loose associations (derailment) |
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disorganized behavior
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-odd/peculiar behavior
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catatonia
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motor abnormality
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catatonic immobility
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maintain unusual posture for long periods of time (e.g. stand on one leg)
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waxy flexibility
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limbs can be manipulated and posed by another person
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genetic factors of schizo
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-genetically heterogeneous
-fam studies: relatives at inc risk -adoption studies: inc likelihood of developing psychotic disorders -familial high-risk studies: differing negative vs. positive symptomatology |
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association stuides
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-2 genes assoc w/schizophrenia (DTNGP1 & NGR1)
-2 genes assoc w/cognitive deficits (COMT & BDNF) |
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genome wide scans
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-identification of gene mutations
-several identified but results need to be replicated |
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dopamine theory
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disorder due to excess levels of dopamine
-drugs that alleviate symptoms reduce dopamine activity |
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revised dopamine theory
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-excess numbers of dopamine receptors or oversensitive dopamine receptors
-excess dopamine localized mainly in the mesolimbic pathway -mesolimbic dopamine abnormalities mainly related to positive symptoms -underactive dopamine activity in the mesocortical pathway mainly related to negative symptoms |
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why doesn't dopamine theory completely explain disorder?
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-antipsychotics block dopamine rapidly but symptom relief takes several weeks
-to be effective, antipsychotics must reduce dopamine activity to below normal levels |
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other neurotransmitters involved in dopamine theory
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-serotonin, GABA, glutamate, medication that targets glutamate shows promise
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prefrontal cortex (&schizo)
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-ind w/schizophrenia show impairments on neuropsychological tests of prefrontal cortex
-ind w/schizo show low metabolic rates in prefrontal cortex -disrupted communication among neurons due to loss of dendritic spines |
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structural & functional abnormalities in temporal cortex (schizo)
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-temporal gyrus
-hippocampus -amygdala -anterior cingulate -reduced gray matter & volume evident |
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environmental schizophrenia factors
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-damage during gestation or birth
-obstetrical complications rates high in patients w/schizophrenia -viral damage to fetal brain -presence of parasite, toxoplasma gondii, assoc w/ 2.5x greater risk of developing schizo -in finnish study, schizo rates higher when mother had flu in 2nd trimester of pregnancy |
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psychological stress of schizo
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reaction to stress: ind w/schizo & their first degree relatives more reactive to stress
SES: highest rates of schizo among urban poor; sociogenic hypothesis; social selection theory (research supports soc selection) |
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fam factors of schizo
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-schizophrenogenic mother: cold, domineering, conflict inducing; no support for this theory'
-communication deviance (CD): hostility & poor communication; inconclusive at this time |
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expressed emotion (EE)
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-hostility, critical comments, emotional over involvement
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bidirectional assoc
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-ususual patient thoughts --> inc critical comments
-inc critical comments --> ususual patient thoughts |
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developmental histories of kids who later developed schizo
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-lower iq
-more often delinquent (boys) & withdrawn (girls) -coding of home movies: poorer motor skills & more expression of negative emotion |
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high risk studies in schizo
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-id a number of factors that predict developing schizo
-having a biological relative w/schizo -a recent decline in functioning -high levels of positive symptoms -high levels of social impairment -lower iq in childhood is a predictor of later onset of schizo & that the iq deficits are stable across childhood |
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1st generation antipsychotics (med treatment of schizo)
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-reduce agitation, violent behavior
-block dopamine receptors -little effect on negative symptoms -extrapyramidal side effects -tardive dyskinesia -neuroleptic malignant syndrome |
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2nd generation antipsychotics (med treatment of schizo)
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-clozapine (clozaril)
-impacts serotonin receptors -fewer motor side effects -less treatment noncompliance -reduces relapse -side effects: can impair immune symptom functioning; seizures, dizziness, fatigue, drooling, weight gain -new meds may improve cognitive functioning: olanzapine (zyprexa) & risperidone (Risperdal) |
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psychological treatments for schizo
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-recommended treatment: meds plus psychosocial intervention
-social skills training: teach skills for managing interpersonal situations; involves role-playing & other practice exercises both in group & in vivo -fam therapy to reduce expressed emotion -cognitive behavioral therapy -CET -case management |
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how does fam therapy reduce expressed emotion?
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-educate fam about causes, symptoms, & signs of relapse
-stress importance of meds -help fam to avoid blaming patient -improve fam communication & problem solving -encourage expanded support networks -instill hope |
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cognitive behavioral therapy
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recognize & challenge delusional beliefs
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cognitive remediation training or cognitive enhancement therapy (CET)
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seek to enhance basic cognitive functions such as verbal learning ability
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case management
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multidisciplinary team to provide comprehensive services
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brief psychotic disorder
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-symptom duration of 1 day to 1 month
-often triggered by extreme stress, such as bereavement |
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schizoaffective disorder
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-symptoms of both schizo & mood disorder
-dsm5 likely to require appearance of major depressive or manic episode |
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delusional disorder
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-delusions may include: persecution, jealousy, being followed, erotomania (loved by a famous person), somatic delusions
-no other symptoms of schizo |
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attenuated psychosis syndrome
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possible new category in dsm5
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in the dsm 4, obsessive-compulsive & related disorders & trauma disorders were included w/what?
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anxiety disorders
(now they are separate) |
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ocd
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repetitive thoughts & urges (obsessions)
repetitive behaviors & mental acts (compulsions) |
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body dysmorphic disorder
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repetitive thoughts & urges about personal appearance
-preoccupied w/imagined or exaggerated defect in appearance -perceive themselves to be ugly or monstrous -women focus on skin, hips, breasts, legs -men focus on height, penis size, body hair, muscularity -engage in compulsive behaviors: check appearance often in mirrors; camouflage appearance (tanning, makeup, plastic surgery) |
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hoarding disorder
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repetitive thoughts about possessions
-can't part w/acquired objs -extremely attached to objs -resistant to relinquishing objs -66% are unaware of severity of problem -33% engage in animal hoarding (animals often receive inadequate care) -severe consequences: squalid living conditions, negatively impacts relationships |
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obsessions
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-intrusive, persistent, & uncontrollable thoughts or urges
-experienced as irrational -most common: contamination, sexual & aggressive impulses, body probs |
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compulsions
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-impulse to repeat certain behaviors or mental acts to avoid distress (cleaning, counting, touching, checking)
-extremely difficult to resist the impulse -may involve elaborate behavioral rituals -compulsive gambling, eating, drinking NOT considered compulsions (since pleasurable) |
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DSM 5 for OCD
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1. obsessions or compulsions
2. obsessions or compulsions are time consuming (require at least 1 hr/day) or cause clinically significant distress or impairment |
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when does ocd develop?
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-either before age 10 or during late adolescence/early adulthood
-1.5x more common in women |
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ocd often chronic
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-only 20% complete recovery
-75% have comorbid anxiety disorder -66% have major depression -33% have hoarding symptoms -substance abuse common |
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dsm 5 criteria for body dysmorphic disorder
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-preoccupation w/1 or more perceived defect in appearance
-person has performed repetitive behaviors or mental acts (mirror checking, seeking assurance, or excessive grooming) in response to appearance concerns -preoccupation is not restricted to concerns about weight or fat |
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dsm 5 criteria for hoarding disorder
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-persistent difficulty discarding or parting w/possessions
-perceived need to save items -distress assoc w/discarding -symptoms result in accumulation of a large number of possessions that clutter active living spaces to the extent that their intended use is compromised unless others intervene |
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genetic links
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BDD & hoarding = higher likelihood of fam member w/OCD
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hyperactive regions of the brain
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-orbitofrontal cortex
-caudate nucleus -anterior cingulate |
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operate reinforcement
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compulsions negatively reinforced by the reduction of anxiety
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cognitive factors of OCD
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-lack of a satiety signal
-yadasentience: subjective feeling of completion; knowing that you have thought enough or cleaned enough; individuals with OCD have a yadasentience deficit -attempts to suppess intrusive thoughts - trying to suppress thoughts may make matters worse |
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etiology of Body Dysmorphic Disorder
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-focus on details of appearance
-no actual distortion of physical features -attend to physical attractiveness features (facial symmetry) -miss the gestalt, or the whole picture -become engrossed in small flaws -believe in an exaggerated importance of appearance |
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etiology of hoarding disorder
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-evolutionary perspective: adaptive to stockpile vital resources
-cognitive behavioral factors: poor organizational abilities, unusual beliefs about possessions, avoidance behaviors -comorbid w/ocd: may share some genetic & neurobiological factors |
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treatment of obsessive-compulsive & related disorders
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-meds : ssris (serotonin reuptake inhibitors); tricyclic antidepressants : anafranil (clomipramine)
-exposure plus response prevention (ERP) : not performing ritual exposes the person to the full force of the anxiety provoked by the stimulus; exposure results in the extinction of the conditioned response (anxiety) -cognitive therapy: challenge beliefs about anticipated consequences of not engaging in compulsions (usually also involves exposure) |
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traumatic stress
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an event that involves actual or threatened death or serious injury to self or others and creates intense feelings of fear, helplessness, or horror
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historical perspective of diagnosis of ASD & PTSD
|
-maladaptive rxns to trauma have long been an interest to the military
-"shell shock" or "combat neurosis" -Vietnam war prompted much interest in PTSD due to delayed rxns to combat being very common |
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PTSD & ATSD: disaster & emergency workers
|
-not immune to trauma's aftereffects
-emergency works are less than half as likely to develop PTSD as victims -training, preparation, & sense of purpose appear to be protective -hardiness: sense of commitment, control, challenge facing stress |
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does childhood trauma effect later parenting?
|
pitt mother & child project measures
-mothers depression = 18 mo -observed rejecting parenting (24 mo.) -observed child noncompliance (42 mo.) -mom report of internalizing & externalizing (42 mo.) -controls: neighborhood risk, single mom, status, SES, minority status -frequency of trauma: any sort = 93%; interpersonal = 71%; trauma during childhood = 50% |
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common risk factors w/other anxiety disorders for PTSD
|
-genetic, overactive amygdala, childhood exposure to trauma, selective attn., neuroticism, & negative affectivity
-2 factor model of conditioning also applicable |
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unique factors of PTSD
|
-severity & type of trauma
-neurobiological (smaller hippocampal volume linked to PTSD) -avoidance coping, dissociation, mem suppression -intelligence, soc support, & ability to grow from the experience enhance coping |
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psych treatment of PTSD
|
-exposure to memories & reminder of the original trauma
-either direct (in vivo) or imaginal -virtual reality (VR) effective -more effective than meds or supportive therapy -treatment can be difficult at first -possible inc in symptomatology -cognitive therapy: enhance beliefs about coping abilities, adding CT to expose doesn't improve treatment response -treatment of ASD may prevent PTSD: shows benefits even 5 yrs after traumatic event |
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antidepressants for ptsd
|
-antidepressants & therapeutic reexposure are first-line therapies for ptsd
-effectiveness of ssris is likely at least partially due to the high comorbidity between ptsd & depression -traditional antianxiety meds aren't effective in treating ptsd |
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3 main categories of traumatic stress
|
1. hyperarousal : persistent expectation of danger
2. intrusion: imprint of the traumatic event 3. constriction: numbing response |
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hyperarousal
|
persistent expectation of danger
-hypervigilance, startle response -insomnia -lack of sense of safety -physiologic changes leading to elevated baseline of arousal - always ready for danger, generalized anxiety, specific fears |
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intrusion
|
-memory intrusions of event
-flashbacks, nightmares, avoidance of similar situations/environments -affective dysregulation -poor attn. due to preoccupation & disrupted cognitive functioning -attempts to master the trauma - reenactments of trauma in role of victim or abusing others |
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constriction
|
-numbing response; "freezing"
-interpersonal isolation -emotional restriction, detachment -dissociation -amnesia for part/all of traumatic event -turning to substances to numb -constriction of present life & future -lack of agency |
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3 stage process of trauma treatment
|
1. safety
2. mourning 3. reconnection -only stage one treatment activities recommended for brief interventions |
