Abnormal Psych Midterm 2

Front 1

obsessions

Back 1

persistent thoughts, ideas, impulses, or images that impinge on consciousness

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compulsions

Back 2

repetitive behaviors or mental acts that people feel they must perform

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OCD

Back 3

obsessions that invade the mind, and compulsive behaviors to ease them; can be compulsions without obsessions but rarely the other way around; time-consuming and distressing

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bio explanation of OCD

Back 4

low serotonin activity; orbitofrontal cortex ("primitive impulses) and caudate nuclei (impulse filter)

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behavioral explanation of OCD

Back 5

operant conditioning

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cognitive explanation of OCD

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strong cognitive reactions to impulses; self-blame, high standards and responsibility

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bio treatments for OCD

Back 7

antidepressants that act on serotonin; 50-80% improve

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behavioral treatments for OCD

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exposure and response prevention therapy; 55-85% improve

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cognitive treatments for OCD

Back 9

education about misinterpretations; examining and challenging obsessions

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OCD related disorders

Back 10

hoarding, hair-pulling, skin-picking, body dysmorphic

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PTSD facts

Back 11

7.8 lifetime prevalence

- 10.4% for women; 5% for men

Known throughout history

- The Iliad: Ajax and herd of sheep, Herodotus and Shakespeare

- names: hysteria, shell shock, soldier's heart

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stressor

Back 12

event that creates demand on us; magnitude determined in part by our appraisal

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stress reactions involve what structures?

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hypothalamus, sympathetic nervous system, HPA Axis (endocrine system)

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hypothalamus

Back 14

almond-sized brain structure; controls many non-conscious activities ex. body temp, hunger, sleep rhythms; when stressed sends out signal to other parts of the body

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sympathetic nervous system

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receives signal from hypothalamus to activate; fight-or-flight ex. pupils dilate, heartbeat quickens, inhibits digestion

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HPA axis

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hypothalamic-pituitary-adrenal axis; when activated, produces cortisol and epinephrine (adrenaline)

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cortisol

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major stress hormone

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epinephrine (adrenaline)

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neurotransmitter associated with arousal and attention

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5 criteria for stress disorders

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1. exposure to traumatic event

2. at least 1 intrusive symptom (dreams, flashbacks)

3. avoidance of associated stimuli

4. memory loss or prolonged negative mood

5. change in reactivity ex. hyper-vigilance, startle response, sleep issues

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acute stress disorder timeline

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symptoms last no more than 1 month; up to 80% of acute cases develop into PTSD

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post-traumatic stress disorder timeline

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symptoms last more than a month

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bio model for stress

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increased cortisol/epinephrine production may stay high after threat has passed...impacts hippocampus (memory) and amygdala (emotions); risk my be transmitted to children

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sociocultural model for stress

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childhood experiences ex. poverty, divorce, abuse

multicultural factors ex. Latinos may experience higher rates of PTSD

-trauma viewed as inevitable/uncontrollable, high value on social support

-trauma severity: more direct contact with objectively bad situation

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humanistic model for stress

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personality factors:

-high tendency for anxiety, high levels of perceived uncontrollability = high risk for PTSD

-low meaning-making = high PTSD

-but resilience is the rule, not the exception

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pharmacotherapy

Back 25

anti-anxiety drugs, anti-depressants; may reduce nightmares, panic attacks, flashbacks

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behavioral exposure

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more efficacious intervention; (re)describe traumatic event in detail and rate anxiety; relaxation training

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why does behavioral exposure work?

Back 27

eye-movement desensitization and reprocessing w/ bilateral stimulation; focus on exposure, not eye movement

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cognitive processing therapy

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imaginal exposure to traumatic event; focus on meaning of thoughts and feeling assc. w/ trauma; identify "stuck points" or maladaptive beliefs about the the world

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group therapy

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trauma victims share experience with each other; develop insight, gain social support, see new perspectives and ways of coping

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critical incident stress debriefing

Back 30

trauma victims discuss feelings and reactions extensively within days of trauma to help normalize and manage stress reactions; but may only help high-risk ppl

Front 31

disorders of somatic symptoms

Back 31

bodily symptoms or concerns are primary i.e. factitious disorder, body dysmorphic disorder

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factitious disorder

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"Munchausen syndrome"; deceptive falsification of physical symptoms or production of injury/ disease; can happen by proxy ex. mom telling child they are sick

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sociocultural model for factitious disorder

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most commonly seen in ppl who;

- received extensive med care as kids

- hold grudges against med profession

- worked in medical/research field

- have little social support/few relationships

- no consistently effective treatments

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3 criteria for conversion disorder

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1. presence of symptom(s) or deficits(s) affecting voluntary or sensory functioning ex. paralysis, blindness, loss of feeling

2. symptoms are static with known neurological/medical diseases

3. significant distress/impairment

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aspects of conversion disorder

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1. after time before extreme stress

2. occurs in ppl who tend to be more suggestible

3. usually identified based on unusual symptom presentation ex. paralysis without atrophy

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psychodynamic model for conversion disorder

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unconscious conflicts from childhood cause anxiety which is converted into more "tolerable" physical symptoms

-primary gain: keep conflict out of awareness

-secondary gain: avoid unpleasant activities or get sympathy from others

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behavioral model for conversion disorder

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rewards received reinforce "sick role"; often seen in ppl with relatives who recently had similar medical problems; but rewards don't outweigh the costs

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cognitive model for conversion disorder

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strong emotions are converted into physical symptoms to communicate them more easily

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sociocultural model for conversion disorder

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in some culture, expression of personal distress through physical symptoms are seen as socially and medically "correct"

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research and treatment for conversion disorder

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little research evidence exist for etiological models; a variety of approaches but effectiveness of treatment remains in doubt

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body dysmorphic disorder

Back 41

OCD-related disorder; preoccupation with one or more self-perceived defects/flaws in physical appearance or body orders; repetitive behaviors based on concerns; significant distress/impairment; relatively unknown by public; highly stigmatized

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body dysmorphic disorder stats

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- 50% of sufferers seek plastic surgery

- 30% confine themselves to their home

- 22% attempt suicide

- in men and women equally

treatment: same as OCD

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dissociative disorders

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disorders associated with major disruption of personal memory or identity i.e. dissociative amnesia, dissociative identity disorder (multiple personalities)

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dissociative amnesia

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inability to recall important autobiographical information that is beyond ordinary forgetting; related to traumatic/stressful events i.e. combat, child abuse, natural disaster; NOT caused by substance/medical condition

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localized DA

Back 45

most common type; loss of all memory during a limited period of time

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selective DA

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next most common; can remember some, but not all things, from a specific time period

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generalized DA

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memory loss extends to time long before upsetting period

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continuous DA

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inability to form new memories; least common

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dissociative fugue

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forgetting things about yourself

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dissociative identity disorder

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"multiple personality disorder"; a person develops two or more distinct personalities with unique sets of memories, behaviors, thoughts, and emotions i.e. 3 faces of Eve

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dissociative identity disorder stats

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on average;

- 15 "alters" for women

- 8 for men

- different personalities may have different abilities, brain activity, and even allergies

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post-traumatic model for DID

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children dissociate during traumatic experiences and develop other personalities to help cope with painful experiences and memories

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sociocognitive model (iatrogenic effects) for DID

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the media, overzealous therapists, and other social cues and expectations led patients to "create" alter

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models for DID

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not mutually exclusive, but differ in emphasis on the origin and treatment approaches

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treatment for post-traumatic DID

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psychodynamic therapy and hypnosis to uncover lost memories and alters; therapist try to bond alters into cohesive personality (fusion); BUT most research from single case studies, may uncover repressed memories that are not there

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sociocognitive approach

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more followed approach; hypnosis techniques make patients more suggestible and help promote the "creation" of new alters; therapists and media unintentionally contributing to an "epidemic" of DID

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evidence for sociocultural model

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abrupt changes in prevalence rate (1970: 79 cases worldwide to 1999: tens of thousands); new diagnoses associated w/ small group of therapists; individuals w/ DID may be more suggestible

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explaining different knowledge between alters

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state-dependent learning

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emotion

Back 59

temporary, subjective states of feeling i.e. sadness, anger, disgust

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affect

Back 60

observable behavior that goes with emotion i.e. facial expression, body language

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mood

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pervasive and sustained emotional response i.e. depression and elation

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mood disorders

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involve discrete period of time dominated by depressed and/or manic mood, reflected in person's behavior; absence of situational cues that would expect mood change; cause clinically significant distress, impairment, and/or harm to person

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unipolar disorders

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MDD, dysthymic disorder

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bipolar disorders

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bipolar I and II

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emotional depression symptoms

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sad, blue, empty, depressed, irritable

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behavioral depression symptoms

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decreased activity, moving slowly or being very fidgety, change in sleep routine

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motivational depression symptoms

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lack of interest/desire to pursue usual activities, low energy

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cognitive depression symptoms

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negative pessimistic view of self, future, world, concentration on difficulties

Front 69

DSM-5 criteria for MDD

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1. presence of 5 or symptoms during 2 week period (for most of day): depressed mood, diminished interest or pleasure, significant weight loss/gain, insomnia/hypersomnia, fatigue/loss of energy, etc.

2. significant distress or impairment

Front 70

DSM-5 criteria for dysthymic disorder

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1. depressed mood for most of the day for at least 2 years

2. similar symptoms to MDD

3. never without symptoms for >2 months

4. no history of (hypo)manic episode

5. significant impairment or distress

Front 71

unipolar depression (MDD) stats

Back 71

median age of onset 25; 8% US adult sufferers in any given year, 40% experience recurrent; women (26%) twice as likely as men (12%)

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gender differences in depression

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1. differences in cortisol, melatonin, and serotonin

2. increased stress in adolescence

3. rumination

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causes of unipolar depression

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reactive (exogenous): depression following clear-cut stressful events

endogenous: occurring as a response to internal factors (no clear reason- out of the blue)

not easy to differentiate

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bio causes of unipolar depression

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genetic, tied to genes of chromosomes

- 5-HTT serotonin transporter gene on chromosome 17 which is responsible for production of serotonin transporters which help transport messages from one neuron to another

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biochemical factors of unipolar depression

Back 75

low activity in norepinephrine; elevated levels of cortisol throughout the day

Front 76

brain circuit dysregulation (unipolar depression)

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PFC: regulates mood & attention; certain inhibitory areas are underactive

Amygdala: expression of negative emotions & memories; hyperactive

Hippocampus: formation and recall of emotional memories; reduced in size

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Lewinsohn's model forunipolar depression

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1. stressor leads to reduction in reinforcers

2. person withdraws

3. reinforcers further reduced

4. more withdrawal and depression

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Beck's cognitive model forunipolar depression

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thoughts are deeply connected to emotions and behaviors; depression characterized by cognitive triad: negative thinking about the self, world, future; cognitive errors: arbitrary and negative inferences based on little evidence

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cognitive model forunipolar depression

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automatic thoughts: negative thoughts that occur automatically in response to a situation and serve to maintain depression

schemas/maladaptive attitudes: enduring, organized representations of prior experience that guide the way ppl perceive and interpret environmental events

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cognitive: learned helplessness theory (Seligman)

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depression is a reaction to the beliefs that: person has no control over rewards/punishments in life, person is somehow responsible for helpless state

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states of learned helplessness

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1. stable vs. temperature (i'm stupid v. didn't study enough)

2. internal vs. external (i'm stupid v. test was unfair)

3. global vs. specific (i'm stupid v. bad at math but good at writing)

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sociocultural model for unipolar depression

Back 82

family-social perspective, decline with social reward; once depressed, may affect social relationships like excessive reassurance-seeking; social support may reduce duration

Front 83

bipolar I

Back 83

presence or history of manic episodes; mixed features and back and forth btwn manic and depressive episodes; causes significant distress or impairment

Front 84

manic episode

Back 84

a week (or longer) period of abnormally and persistently elevated, expansive or irritable mood and increased energy for most of the day; need 3 aspects ex. grandiosity, decreased need for sleep, increased (pressure to keep) talking; significant distress or impairment

Front 85

bipolar II

Back 85

presence or history of major depressive episodes, no history of manic episode; significant distress or impairment

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hypomanic episode

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same symptoms as manic, but less severe and distressing; only requires symptoms last for at least 4 consecutive days; not severe enough to impair social or job functioning or require hospitalization

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cycling

Back 87

shift btwn mood states in bipolar patients; one cycle per 2 years on average; depressive episode more common (3:1)

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suicide rates in mental disorders

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bipolar: 15-20%

schizophrenia: 10-15%

borderline personality: 10-15%

unipolar depression: 5-10%

general pop: 1/30 attempts lead to death

bipolar: 1/3

Front 89

bio causes of MDD

Back 89

low serotonin + low norepinephrine

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bio causes of bipolar

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low serotonin + high norepinephrine

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permissive theory

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serotonin as neuromodulator: low serotonin "opens door" for mood disorder that is then defined by norepinephrine activity

Front 92

brain structure in bipolar disorder

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smaller basal ganglia and cerebellum; lower volumes of gray matter; structural abnormality in raphe nucleus, amygdala, hippocampus, prefrontal cortex; role is unclear

Front 93

bio-behavioral perspective for mood disorders

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zeitgebers (sun/light, temp, routines) give cues to body's natural rhythms and internal clocks (sleep, hunger, etc.); z-disruption -> rhythm disturbance -> associated with onset of manic disorder

Front 94

monoamine oxidase inhibitors (MAOIs)

Back 94

1950s antidepressant, breaks down neurotransmitters, resulting in increased serotonin and norepinephrine but very nonspecific effects; side effects: can't eat foods with tyramine (cheese, bananas, wine) or risk hypertension

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tricyclics

Back 95

named for 3-ring structure; block reuptake of neurotransmitters leading to increased activity at synapse; effective in 60-65%; but chance of relapse and side effects include constipation, drowsiness, blurred vision

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selective serotonin reuptake inhibitors (SSRIs)

Back 96

increase serotonin levels (without affecting other neurotransmitters) by preventing reuptake; harder to overdose, fewer side effect: reduced sex drive, headaches, weight gain

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electroconvulsive therapy (ECT)

Back 97

targeted electrical stimulation of the brain leads to seizures; muscle relaxants and anesthesia used to reduce side effects; 6-12 treatments of 2-4 week period; effective w/ severe depression (60-80% improve); side effects: memory loss immediately after, can be permanent

Front 98

transcranial magnetic stimulation (TMS)

Back 98

electromagnetic coil placed on or above head; sends a current into the prefrontal cortex increasing activity; reductions in symptoms when administered daily for 2-4 weeks; helpful for recurrent/treatment resistant depression; does not have side effects of ECT

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behavioral activation therapy

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Lewinsohn's behavioral model; reintroduce clients to activities associated with sense of pleasure and accomplishment; ignore depressive behaviors; improve social skills; works well for mild-moderate depression though less commonly used

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CBT

Back 100

attend to and correct (negatively) distorted thinking; includes behavioral techniques; collaborative and time-limited

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4 phases of CBT

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1. increase activities and elevate mood (activity log)

2. challenge automatic thoughts (test reality; thought record)

3. identify negative thinking and biases (ID illogical thinking)

4. change core beliefs/schemas (behavioral experiments)

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sociocultural treatment for depression

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interpersonal therapy; focus on problems in current relationships and roles

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4 problems must be addressed in IPT

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1. interpersonal loss

2. roll dispute

3. role transition

4. interpersonal deficits

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bio treatment for bipolar

Back 104

pharmacotherapy: lithium but need to find correct dosage

mood stabilizers like tegretol but side effects in nausea, vomiting, diarrhea, sedation; >60% effective for manic episodes and less powerful for impact on depressive symptoms; risk of relapse

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sociocultural treatment for bipolar

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family-focused therapy; ID conflicts w/i fam, resolve them, reduce "expressed emotion" (critical, hostile, over-involved attitudes and behaviors towards person w/ disorder), improve communication

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interpersonal social rhythm therapy

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focus on maintaining rhythms and resolving interpersonal problems so family can help client cope more effectively

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benefits of combo drug and therapy treatment for bipolar

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reduces hospitalization, improves social functioning, increases ability to obtain and hold a job

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suicide

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an intentional, conscious effort to end one's life; difficult to study b/c low base rate and accidents vs. intentional; 11th leading cause of death but 3rd among ppl 15 to 24

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age and gender differences

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increased prevalence with increased age; women attempt more often than men but men die more often than women

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cultural differences

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whites (men) have the highest prevalence of rate of death by suicide; except Native Americans 1.5 higher times national average

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suicide and mental health

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not classified as mental disorder but co-occur w/ mental disorders; 90% of ppl who die by suicide have: depression, bipolar, schizophrenia, substance use disorder

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risk factors for suicide

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lack of connection to others, acute major stressors, long-term stress, consistent hopelessness, dichotomous thinking ("all or nothing"), alcohol/drug use, mental disorders, prior suicide attempts

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suicide in military

Back 113

more deaths by suicide than in military action in 2012

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interpersonal theory of suicide

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those who desire suicide have perceived burdensomeness and/or thwarted belongingness w/ acquired ability for suicide

Front 115

acquired ability for suicide

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getting used to the threat of pain/danger; repeated and escalating events involving pain and provocation; taboo of suicide diminished w/ habituation (Dr. Thomas Joiner) ex. Kurt Cobain and guns

Front 116

perceived burdensomeness

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death is worth more than my life to loved ones, fam, society; empirically speaking: predicts both ideation and attempts

Front 117

thwarted belongingness

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belief that the person does not (or cannot) have meaningful relationships w/ others; empirically speaking: twins and mothers with many kids at lower risk, national football team wins and lower rates of suicide

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prevention/treatment

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target one of three aspects in interpersonal model; belongingness may be most malleable and most powerful

Front 119

problematic media coverage of suicide

Back 119

dramatization, "no warning" seems like glorification; can affect someone already considering

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suicide myths and stigma

Back 120

it's selfish: no b/c person thinks death is worth more to ppl than their life

it's cowardly: no b/c self-preservation is real and you gotta push past that to hurt yourself

suicide occurs suddenly: there are always signs, or a planning process

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mixed findings with suicide hotlines

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hard to evaluate but it's better to have it than to not

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treatments for ideation

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hospitalization for acute risk; drug treatments (lithium), almost 80% reduction in risk of future suicide

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cognitive treatment for ideation

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challenge thoughts of hopelessness, replace with more realistic or balanced thinking/coping skills

less reattempts, decreased severity of self-reported depression, reduced hopelessness

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what to do when someone is at risk?

Back 124

look for warning signs (mood changes, prized possessions), make a safety plan, be supportive and get help

Front 125

what to do when someone is actively suicidal?

Back 125

remove access to harmful things, convince them to go the hospital, if that doesn't work...call the police