Intro to Mental Psycholpathological Conditions

Question 1

Overview

Answer 1

advantages/disadvantages of diagnosis

DSM-IV Multiaxial System

introduce “diathesis-stress” explanatory perspective

describe major categories of anxiety, modd-disordered, and pyschotic disturbances

etiology and treatment

bio-pyscho-social model

Question 2

how is the DSM-IV multiaxial classification system used?

Answer 2

split up into 4 axises that are used to communicate with others

standard way to carefully assess conditions and classify mental disorders

Question 3

what is the first axis of the DSM-IV?

Answer 3

axis I - clinical disorders and other conditions that may be a focus of clinical attention

targetable, treatable, and changeable-can eliminate!

schizophrenia, mood disorders, anxiety disorders, sexual and gender disorders, sleep disorders, eating disorders

Question 4

what is axis II of the DSM-IV?

Answer 4

once established, these may be able to be reduced but are usually permanent

mental retardation and personality disorders

antisocial personality disorder, paranoid personality disorder, borderline personality disorder

Question 5

what is axis 3 of the DSM-IV

Answer 5

general medical conditions that may be relevant to mental disorders

cancer, epilepsy, obesity, parkinson’s disease, alzheimer’s disease

Question 6

what is axis IV of the DSM-IV?

Answer 6

psychosocial and environmental problems that might affect the disgnosis treatment, and prognosis of mental disorders

social and life stressers

unemployment, divorce, legal problems, homelessness, poverty, parental overprotection

Question 7

what are the value and danger of labels for categorization and diagnosis?

Answer 7

faciliates professional communication and leads to shorthand description/ implied meaning

however… can stigmatize and lead to self-fulfilling prophesies

Question 8

videoclip on David Rosenhan’s classic study: “On being sane in insane places”

Answer 8

study was done to prove that the admittance to pyschiatric hospitals is too easy

faked symptom that they heard voices but abandoned symptom once they got there - no one realized that they were sane

experience there was described as dehumanizing (no visitors, little connection with others, like “store houses” for those people who weren’t understood)

*need to realize that people are very human and unhappy - looking past the label

impact on development of DSM’s: single symptoms are inadequate bases for diagnosis

DSM’s subsequently ariculated detailed “diagnostic criteria” because it was hard for people to heal and feel better if labeled/ not cared for

Question 9

how must mental disorders be assessed before diagnosis?

Answer 9

assessment uses structured and unstructed interviews

assessment utilizes behavioral info

assessments profit from pyschological testing info

see how people view world, how they appear, what others say, use symptom checklists, and evaluate personality tests - look at ALL sympotms

Question 10

what are the main categories for the causes of mental disorders? which one links several perspectives?

Answer 10

family and sociocultural factors

cognitive-behavioral factors (how we think and behave)

biological factors (how personalities differ genetically and how brain processes differently)

*the “diathesis-stress” model integrates multiple perspectives - helps us understand why people might have a disorder (not manifesting)

Question 11

what is the “diathesis-stress” model?

Answer 11

a general framework for explaining the causes (etiology) of pyschopathological conditions

diathesis = predisposing factors

tendency toward a behavior - having genes leave us more vulnerable

(ex. genetics, personality traits, environment, early and prolonged stressors and stress-responses resulting in emotionally and behaviorally maladaptive “circuits” in the brain)

stress = precipitating factors or “triggering factors”

we have genes but… what flips it on?

(ex. sterssful major life events associated with the onset of pyschopathological symptoms in adulthood)

*symptoms are product of predispositions being actualized or triggered by environment under cirucmstances (stressors)

Question 12

what are neurotic disorders?

Answer 12

non-pyschotic disorders

no delusions or hallucinations

no markedly impaired reality testing

operationally, absence of markedly impaired reality testing is seen in persons who are aware their thinking/ feelings are distorted, unreasonable, etc.

Question 13

what are the main types of anxiety disorders?

Answer 13

generalized anxiety disorder

panic disorder

phobic disorders

OCD

post-traumatic stress disorder

Question 14

what is generalized anxiety disorder?

Answer 14

excessive anxiety and worry more days than not for 6 months

person finds it difficult to control the worry

very debilitating - can’t control feelings

Question 15

what are the symptoms of generalized anxiety disorder?

Answer 15

anxiety/worry associated with at least 3 of the following symptoms…

restlessness/feeling keyed up or on edge

being easily fatigued (nervous system activated a lot when anxious, causes exhaustion)

difficulty concentrating or mind going blank

irritability

muscle tension

sleep disturbance

Question 16

what is panic disorder?

Answer 16

a disorder characterized by the sudden occurrence of multiple pyschological and pysiological symptoms that contribute to a feeling of stark terror/ panic attacks

(approx. 22% of the US pop reports having at least one panic attack)

has to be enough to be problematic - extreme distress (can’t breathe, need to escape)

Question 17

how is agoraphobia linked with panic disorder?

Answer 17

agoraphobia: an extreme fear of venturing into public places; correlates with panic disorder

panic disorder causes us to be afraid of certain things - over time, they are negatively reinforced, physiological symptoms occur in given situations

therefore… one stops going places/ doing things to avoid panic attacks

Question 18

what are phobic disorders?

Answer 18

afraid of specific things - debilitating to life and create extreme distress and impairment

agoraphobia: fear of venturing into public places

social phobia: fear of social situations because you are afraid people are thinking negatively about you

specific phobias: snakes, heights, spiders, etc.

Question 19

video clip: sportswriter

Answer 19

man had extreme distress and drank to overcome it - led him to sleep through the interview

his fear for drinking and work was made worse through this operant conditioning - negatively reinforced

now scares him to leave apartment - has no social interaction and has panic attacks 5-6 times a week

symtomology: panic attacks
diagnosises: panic disorder (anxiety) with agoraphobia
etiology: avoided dealing with panic and it became worse, made worse through situations (divorce and inconsistent jobs) - learned conditions
treatment: drugs (zanax) for overall anxiety and exposure to fears so he can overcome them

Question 20

what is OCD?

Answer 20

a disorder in which repetitive, intrusive thoughts (obsessions) and ritualistic behaviors (compulsions) designed to fend off those thoughts interfere significantly with an individual’s functioning

roughly 1.3% of the population suffers

moderate heritability

*flooded with anxiety and very debilitating

Question 21

what is the difference between obesessions and compulsions in OCD?

Answer 21

obsessions = thought associated with behavior

ex. with germs- thinking “i am going to die”

compulsions = behavior to eliminate obsessions

ex. washing hands

Question 22

OCD video clip

Answer 22

mom fears child will be taken at stop sign when driving and that someone will kidnap her kid when she is at home

her kid always has to be in front of her - if not she has to spin around in circles and check surroundings

she knows that thoughts are irrational but can’t stop them

mostly affected by contamination

washes hands continuously and in a certain manner - afraid of contaminating Jake (uncontrollable since he was born)

debilitating and irrational - affects jake negatively too

Question 23

what are the causes of OCD?

Answer 23

caudate nucleus dysfunction (abnormal structure)

caudate nucleus is part of the basal ganglia - basal ganglia is involved in impulse suppression

therefore. .. people with OCD are not able to supress impulses like normal people
theory: impulses leak into consciousness and prefrontal cortex becomes overactive (brain tries to keep a kid on impulses and therefore it is more active)

strep infection - strep sometimes causes OCD symptoms when it affects the caudate nucleus and it becomes fully manifested

Question 24

what is post-traumatic stress disorder?

Answer 24

anxiety-related

fear of re-experiencing traumatic event (like a war or car accident) - extreme anxiety is created when the person “relives” the experience

Question 25

what are the factors that make up anxiety disorders?

Answer 25

focus on threatening events, content - overly vigilant when looking at cues

“the doctor examined emma’s growth” - measured height vs. looking for a cancerous tumor (interpret it in an anxious or threatening way)

biological factors play role

inhibited temperaments related to anxiety

increased CNS activation related to panic disorders

Question 26

what study was done to prove that panic seems to be biologically driven?

Answer 26

after hyperventilating vs. after inhaling carbon dioxide

panic disorder patients had a higher percentage reporting panic

controls did not have a higher percentage of panic

therefore… some are more prone to biological changes that cause panic attacks

Question 27

What are treatments for anxiety disorders that focus on behavior and condition?

Answer 27

for specific phobias, the sources of anxiety are better addressed with cognitive-behavioral approaches than with medication alone

systematic desensitization uses “fear hierarchies” to help people learn to manage dimensions of fear

1. teach person skills to manage anxiety
2. expose them gradually to their fears
3. pair relaxed state and fear together *it is a learning theory

virtual treatments can help reduce fear

Question 28

what are cognitive and cognitive behavioral therapy?

Answer 28

cognitive therapy: involves helping a client identify and correct any distorted thinking about self, others, or the world

• cognitive resurecting - a therapeutic approach that teaches clients to question the automatic beliefs, assumptions, and predictions that often lead to negative thinking with more realistic and positive beliefs
• mindfulness meditation - teaches an individual to be fully present in each moment, to be aware of his or her thoughts, feelings, and sensations; and to detect symptoms before they become a problem

cognitive behavior therapy (CBT): a blend of cognitive and behavioral therapeutic strategies

used for depression treatment and other disorders like skitzophrenia and bipolar disorder (not just anxiety disorders)

questions asked - what is the worst thing that can happen? how would you manage that? - ask and provide skills/ restructure world skills

Question 29

what are common irrational beliefs and the emotional responses they can cause?

Answer 29

anxiety and stress - i have to get this done immediately, i must be perfect, something terrible will happen

embarrassment and social anxiety - everyone is watching me, I won’t be able to make friends, people know something is wrong with me

sadness, depression - I’m a loser and will always be a loser, nobody will ever love me

anger, irratibility - she did that to me on purpose, he is evil and should be punished, things ought to be different

*need self talk - what is actual rational? help rethink

Question 30

how do medications help with anxiety disorders? what is the best way to treat anxiety disorders?

Answer 30

SSRI’s help social phobia BUT cognitive and behavioral methods are treatments of choice

• serotonin is important in treatment for depression

panic disorder treatments often combine medication and CBT, but relapse is less with CBT

• CBT + impiramine provides best results

*learned component is more important because it helps manage anxiety in other situations - prevents future problems

Question 31

what is the most effective treatment for OCD?

Answer 31

OCD treatments blend medication and CBT with a focus on “exposure” and “response prevention”

work through irrational thoughts - unlearning*

exposes them to fears

prevents them from OCD like behaviors

exposure and ritual prevention + clomipramine provide best result - CBT is important because there is a large learned piece (unlearn responses to change disorder)

Question 32

are mood disorders and anxiety related?

Answer 32

yes they are linked

over 70% of people with depression experience anxiety

people with these disorders that have depression…

panic - 20%

phobia - 15%

social phobia - 40%

OCD - 10%

Question 33

what is the suicide risk between different genders and races?

Answer 33

white males have highest risk followed by

black men

white women

black women

Question 34

what is the cause of suicide? what is the best prevention?

Answer 34

suicide is the 11th leading cause of death in the US and the third among high school and college students

50% of those who commit suicide do so during a depressive state

there are a variety of motive for suicide

• may be biological
• may be “contagious” (the werther effect) - once one person commits suicide it is seen as more attainable and therefore more people kill themselves
• world view becoming very distorted due to depression

prediction and prevention is difficult, however warning signs are abundant

• hard to tell if someone seems fine externally but internally makes a commitment (sometimes people miss this cue)

Question 35

what is a “major depressive episode”? DSM-IV diagnositic criteria…

Answer 35

profound persistent period of depression that exists for 2 or more weeks as indicated…

• depressed mood
• markedly diminished interest and pleasure
• significant weight loss or weight gain
• insomnia or hypersomnia
• pyschomotor agitation (irratibility - can’t sit still, very moody) or pyschmotor retardation (no energy to move in normal way)
• fatigue or loss of memory
• feelings of worthlessness and excessive guilt
• diminshed ability to think, concentrate, and make decisions
• recurrent thoughts of death or suicidal ideation

deep, desperate, and empty - not rational but it is there belief/ reality at the time

Question 36

what are 2 important quotes that Kay Redfield Jamieson stated?

Answer 36

she wrote “An Unquiet Mind” - has bipolar disorder herself

“I felt as though only dying would release me from the overwhelming sense of inadequacy and blackness that surrounded me”

“others imply that they know what it is like to be depressed because they have gone though a divorce, lost a job, or broken up with someone. But these experiences carry with them feelings. Depression, insteadm is a flat, hollow, and unendurable. It is also tiresome. People cannot abide being around you when you are depressed. Tehy might think they ought to, and they might even try, but you know and they know that you are tedious beyond belief; you’re irritable and paranoid and humorless and lifeless and critical and demanding and no reassurance is ever enough”

Question 37

what are psychotic features? which are featured in mood disorders?

Answer 37

hallmarks of psychosis: delusions and hallucinations

lose contact with reality - “marked impairment in reality testing”

presence of pyschotic features in mood disorders is seen in:

• mood-congruent delusions: depressive delusions of utter worthlessness/ repulsiveness of self, manic delusions of grandeur, unlimited power and influence - extreme sense of worthlessness
• hallucinations - typically auditory (manic/ match elevated sense of mood = skitzophrenia NOT depression - need to cure depression aspect of skitzophrenia)

Question 38

what are depressive disorders?

Answer 38

dysthymic disorder or dysthymia (neurotic depression)

chronic (2 years duration or more) “low grade” depression (doesn’t meet criteria for “major depression” though still very serious/debilitating) indicated by 2 or more of the following…

• poor appetite or overeating
• insomnia or hypersomnia
• low energy or fatigue
• low self-esteem
• poor concentration or difficulty making decisions
• feelings of hopelessness

same symptoms as a major depressive episode

people are impaired in function BUT not as extremely - person still functioning and doing well but not happy

Question 39

what is also known as manic depression? what does it include?

Answer 39

bipolar disorder

includes depression and manic episodes - alternating moods

most genetically based (need medications and passed down through families)

Question 40

what are the three things bipolar disorders include?

Answer 40

manic (elevated mood) and/or hypomanic episodes

bipolar disorders (include depression)

cyclothymia (hypomanic and no major depression)

Question 41

video clip: “Latiffa: Goddess of Wind and Rain”

Answer 41

she feels as if she has a “new energy and power”

her boyfriend dumped her and she is kicked out of her house but she said that she would pray for him

very excited and distracted easily - happy and unstable mood

doesn’t sleep - says she prays instead and has a “special mission” to live by

says she never felt this way before

discussion: not distressed, elevated happiness, delusions, scattered and very distractable
diagnosis: manic with pyschotic features

Question 42

what is a manic episode? DSM-IV diagnostic criteria…

Answer 42

manic mood episodes show as a distinct period of abnormally and persistently elevated, expansive, and/or irritable mood indicated by three or more of the following…

• inflated self esteem or grandiosity - really confident and great
• dcreassed need for sleep - don’t feel they need it
• more talkative than usual or pressure to keep talking - “i can’t speak as fast as thoughts are going” (talk very fast)
• flight of ideas or subjective experience that thoughts are racing - jump from thought to thought due to “fast mind”
• distractibility (i.e. attention too easily drawn to unimportnat or irrelevant external stimuli) - very unfocused state
• increase in goal-directed activity or pyschomotor agitation (period of time where they are very productive - have “artist’s mind”
• excessive involvement in pleasurable activities that have a high potential for painful consequences (i.e. unrestrained buying spress, sexual indiscretions, foolish business investments)

mind is escalating - irrational actions due to elevated state

extremely debilitating

Question 43

what is a “hypomanic episode?”

Answer 43

• restless, consumed with confidence, energized
• not as prone to the gloom following mania
• “of course i live near the edge - the view is better”
• “ill just tell them i had a lot of coffee”
• “you never sleep too much, you are on”

dr jamison wrote: “exuberance” book about this…

• hypomanic statse generate bursts of creative work
• but there can be problems… the view may be better on the edge, but it is easy to lose your balance
  *

Question 44

what is the problem with hyopmanic episodes?

Answer 44

feels great for people while in the initial state - collapse is the problem

can only respond effectively from medications (even though many people reject them because it eliminates the “highs”) - need to be kept at level state

very biological/ genetic

Question 45

what are the two types of bipolar disorder?

Answer 45

bipolar 1:

• Hx of manic episode(s)
• Hx of depressive epidsode(s) - for most people

bipolar 2:

• Hx of hypomaic episodes
• Hx of major depressive episode(s)
• not at same level as bipolar 1 - not as happy

Question 46

what is cyclothymia?

Answer 46

2-year duration of numerous alternating periods of hypomanic (low-level manic) symptoms and depressive symptoms (shy of major depressive episodes)

cycling mood - not fully bipolar

never diagnose if they have had a manic episode

Question 47

what is bipolar disorder (without pyschotic features)?

Answer 47

present mental state can be principally a “manic episode” or a “mixed episode” or a “major depressive episode”

*diagnosis is “bipolar” as long as there has been a past history of mania

specifically, if currently depressed with a history of manic episodes, the diagnosis becomes “bipolar disorder, depressed”

the mood disturbance is sufficiently severe to cause marked impairment in occupational functioning or in usual social activities or relationships with others or to necessitate hospitalization to prevent harm to self of others, or there are pyschotic features

• note that this criterion distinguishs hypomanic episodes from manic episodes
• in hypomanic episode there is NOT “marked impairment” and NOR are there ever “psychotic features”
• in manic episodes there is always “marked impairment” and sometimes pyschotic features. thus the sx’s are more severe, mroe interfering with adaptive functioning, in mania than in hypomania

Question 48

what is a mixed episode?

Answer 48

alternation between modd states within an episode

the special case of “rapid cycling” - going back and forth in a rapid manner - nonfunctioning until stabalized

mood never goes back to normal - go to manic to depressed (back and forth)

Question 49

what is the video example of woman with pyschomotor retardation?

Answer 49

hard for her to imagine manic states because she is so deep in her depression

wants release

does not more - both talking and physical movement (takes a lot of evergy for them to talk - physical slowing) - NO energy

“people say I have this problem” - not convinced due to mood

diagnosis: bipolar

current episode: depressed (previous manic episodes)

Question 50

“i’m brillient” videoclip

Answer 50

this video example hovers near the thresholdfor diagnosis of “bipolar dispolar, manic with pyschotic features” (in this clip we see him during, then after the presence of a manic episode)

man has hallucinations

talks a lot and very fast - speaks mind and has inappropriate comments

when on meds he speaks slower and makes more sense a lot more normal

he has grandiose illusions but they aren’t outside of reality - don’t have form (instead heightened sense of hearing, more under control than latifa)

chatoic and always says “i am brillient”

Question 51

how do the fluctuations in unipolar and bipolar disordered individuals differ?

Answer 51

there is a wide variability between persons in the “course” of the disorder

look at graphs…

unipolar - no manic, goes from normal to depressed

bipolar - spends less time in normal mood state if not using meds, fluctuates between manic, normal, and depressed

Question 52

what causes mood disorders?

Answer 52

depression is caused by a combination of factors: combination, situational, and biological

Question 53

what are the biological components in mood disorders?

Answer 53

twin studies show 4x higher rates in MZ twins

medications targeting norephinephrine and serotonin modulate mood - suggests role of neurotransmitters

• increasing serotonin or NE = improved mood
• NE too high = manic

heritability estimates for major depression range from 33% to 45%

depression may involve NE and serotonin, and/or diminished activity in the left prefrontal cortex and increased activity in the right prefrontal cortex

• more pesimistic = more prone to major depressive episode

Question 54

what is the etiology/ causation of mood disorders?

Answer 54

diathesis-stress models predominate:

• not doomed by genes… but genes important

genetic predisposition data

• MZ concordance: bipolar 72% (need meds) and unipolar disorder 40%
• DZ concordance 14% and unipolar disorder 11%

Question 55

how do genetic dispositions affect the neurobiology of mood in unipolar and bipolar disorder patients?

Answer 55

unipolar: neurotransmitter deficiencies genetically regulated?

bipolar disorders have a stong biological base

• concordance in MZ twins exceeds 70%
• genetic research suggests polygenic causation (multiple genes)
• kay jamison is a champion of combining medication with pyschotherapy - diathesis stress model applies here (dealing with stressors)

Question 56

what is seasonal affective disorder (SADS)?

Answer 56

further support for biological basis for depression

develop depression with less sunlight - anxiety increases

• body responds to loss of light
• treatment: prototherapy (light) therapy increases light exposure

Question 57

what do situational components include?

Answer 57

the negative reactions of others to depressed persons can produce rejection and isolation in a “downward spiral”

• exercise and sleep decreases
• people can’t snap out of it because there is no way to elevate them out of it (no energy)

social support may buffer and protect vulnerable persons

• quality not quantity

more stressful events = higher risk for experiencing major depression

Question 58

what biological and pyschological factors did aaron beck note?

Answer 58

noted dysfunctional attitudes and negative mood states in depressed individuals

helpless theory: the idea that individuals who are prone to depression automatically attribute negative experiences to causes that are internal, stable, and global (more depressive due to depressive thoughts)

depressed individuals tend to have depressive biases in thinking and memory

• way they interpret things (continues to feel worse)
• mindsets contribute to depression - affects mood and how we feel physcially

Question 59

what are the cognitive components of depression?

Answer 59

beck’s “cognitive traid” focuses on negative and irrational views of self, present, and future as causes

• distorted - makes them feel worse

“errors in logic” magnify depressive negatively

more vulnerable - pessimistic, self-blaming

Question 60

what are the conclusions from diathesis-stress analyses?

Answer 60

genetic and non-genetic factors are influential as predisposing factors

stress is influential as a precipitating/triggering factor, but who experiences stress (and thus who is most vulnerable) is influenced not only by objective MLE’s and objective hassels, but also by cognitive and personality predispositions

all filtered through us - personality traits strengths and weaknesses (resilliance)

Question 61

how do we treat depression?

Answer 61

pyschoanalytic theory

behavioral theory

cognitive and social learning theories

Question 62

what are typical approaches to pyschotherapy?

Answer 62

freud’s pyschoanalysis/pyschodynamic theories

humanistic-existential approaches

• carl rogers - unconditional positive regard (unconditional love) - acceptance
• abraham maslow - not meeting all needs to be all we can be - physcological stress

behavioral, cognitive-behavioral, and cognitive approaches

eclecticism, the trend toward time-limited, disorder-specific therapy

• division 12 APA standard: “efficacious and specific therapy”

Question 63

what is the pyschoanalytic theory?

Answer 63

anger turned inwards: the punishing role of the harsh superego (punishing and judgemental)

goal: insight, make the unconscious conscious, expand the ego’s control

how?

• free association - talk about whatever comes to mind
• analysis of transference - experiencing and interacting with therapists (building a good relationship) to help them understand who they are through their interactions with therapist
• dream analysis

Question 64

what is the behavioral learning theory?

Answer 64

an insufficiency of contingencies of positive reinforcement

goal: change behavioral responses to increase reinforcement of non-depressed behavior
ex. exercising is very impotant in motivation (helps to motivate)

Question 65

what are the cognitive and social learning theories?

Answer 65

the basic idea: emotions and moods are caused by cognitive processes (perception, thinking, cognitive appraisal, underlying reasoning processes, etc)

depression and depressive mood episodes result from irrational thinking, irrational beliefs, irrational cognitions

• too hard on self - change to feel better and to be realistic about strengths and weaknesses

seligman’s ABC model

Question 66

what is seligman’s ABC model?

Answer 66

borrowed from ellis

the ABC’s…

• adversity (what we do when we encounter it)
• beliefs (thoughts become beliefs, habits)
• consequences (beliefs cause behaviors, results) - reporting what happened

learning to argue with yourself

remember: if the cost of failure is high, optimism may not be the best strategy

Question 67

what is the cognitive process in depression?

Answer 67

expectations of uncontrollability (pessimistic cognitive styles)

• bandura’s “self efficacy”: low motivation, low expectation for controlling pleasure and happiness (reinforcement), low effort

Tx goal?

alter expectations through exploring “rationality” of cognitions and altering behavior to change reinforcement probabilities

Question 68

what is beck’s “cognitive triad”?

Answer 68

sees 3 fundamental distortions in rational processing

• negative view of self
• negative view of the world
• negative view of the futre

treatment - need to change these

Question 69

what is the ABC approach?

Answer 69

ellis says a “musterbatory” cognitive style underlies human neurotic suffering

“in order to be happy i must…”

commands about how things should be

we make ourselves miserable with our thinking. we disturb ourselves with “internal sentences” involving many “musts, shoulds, oughts, demands, commands”

over expectation to world - “i must do well otherwise i am not good”

ex. lost job - different orientations lead to different thoughts (i am worthless vs. i deserve better)

Question 70

summary of cognitive approaches

Answer 70

for seligman, beck, and ellis - emotional disorders (depression in particular) result from irrational distortions in the cognitive processing of events

ABC = events don’t cause depression (or anxiety, or emotional distress in general), thinking about events does

ABCDE = given the cause (cognitive distortions), the treatment targets cognitive distortions through disputation/reappraisal

adversity (appraise as adversity), belief, consequence, dispute, evaluate again

Question 71

what biological therapies are necessary for some disorders?

Answer 71

pyschotropic medications affect neurotransmitter processes

anti-anxiety drugs affect GABA (neurotransmitter)

depression drugs affect serotonin and NE

anitpyschotic drugs affect dopamine

Question 72

what are antidepressant drugs used?

Answer 72

biological therapies are necessary for some disorders

medications work in 60% of cases

MAO inhibitors - inhibit enymatic deactivation of NE and 5-HT (serotonin) - more enzyme based and complicated side effects

trycyclics - inhibit reuptake of NE

SSRI’s - mainly use these because they have fewer side affects

Question 73

how do SSRI’s work?

Answer 73

*look at diagram

message is sent across the synaptic gap

message is received; excess neurotransmitter molecules are reabsorbed by sending neuron

*prozac blocks normal reuptake of the neurotransmitter serotonin; excess serotonin in synapse enhances its mood-lifting affect

Question 74

what are the differences in the 3 antidepressant meds?

Answer 74

MAO’s inhibit the breakdown of NE, serotonin, and dopamine

SSRI’s block the reuptake of serotonin

trcyclic antidepressants block the reuptake of serotonin and NE

Question 75

is pyschotherapy only focused on biological therapy?

Answer 75

NO

pyschotherapty is focused on depressive thinking and behavior (CBT)

• 60% efficacy in reducing acute symptoms
• shows FAR greater efficacy in reducing relapse than meds alone

Question 76

what is ECT?

Answer 76

electroconvulsive therapy

records heart rate, intravenous line is sedative and a muscle relaxant, measures blood-oxygen levels, measures muscle tension, stimulating electrodes record brain waves

why does it work?

• used in cases of severe depression (not responding to other meds) - bound and determined to kill themselves
• don’t know why it works
• siezing person - controlled - some memory impairment
• electro balance in the brain - rearranges? helps control?
• brain chem - jump starts neurotransmitter funciton

Question 77

what are other effective treatments are available for depression?

Answer 77

SAD responds to phototherapy

exercise helps depression too

ECT is the single most effective treatment for severe depression - saves lives, negative public views notwithstanding

Question 78

what is the treatment for bipolar disorder?

Answer 78

medication (almost always need meds): lithium carbonate has unique anti-manic properties with 80% positive response in actively manic patients (also reduces depressions)

• used to stabalize but metal can be toxic ( negative side effects)
• often do not like meds that take away pleasure

adjunctive pyschotherapy for

• medication management
• family and social relationships - can create stressors, want to alleviate stress and prevent breakdowns
• education
• problem solving and “reality testing” - “voices aren’t real” (shows delusions are NOT reality)

Question 79

why is lithium the most effective for bipolar disorder?

Answer 79

only 20% of bipolar patients who maintain their meds experience relapse

lithium stablizes mood, but the mechanisms are unclear, and the effect is greater on mania than depression

but many patients discontinue meds because of the “intoxicating pleasure” of manic states

Question 80

in sum… what are the most effective mood disorder treatments?

Answer 80

treatments that focus on behavior and cognition are superior for anxiety disorders

many effective treatments are available for depression

lithuim is most effective for bipolar disorder

pharmacological treatments are superior for schizophrenia

60-70% respond to meds (MAO, SSRI, tricyclides)

CBT is the BEST - provides skills to alter behavior, have skills when episode happens to prevent disorder

Question 81

what are common factors that enhance treatment?

Answer 81

pyschotherapy helps, and common underlying factors contribute to all pyschological approaches:

• caring therapists - empathy and support
• catharsis and “confession” - theraputic in that they confess concerns and things that they are ashamed about