CHAPTER 3, 5, 6 & 7

Question 1

What 2 processes are central to the study of psychopathology and eventually the treatment of psychological disorders?

(Ch 3)

Answer 1

The processes of (1) clinical assessment and (2) diagnosis

Question 2

Define clinical assessment

(Ch 3)

Answer 2

The systematic evaluation and measurement of psychological, biological and social factors in a person presenting with a possible psychological disorder

Question 3

Define diagnosis

(Ch 3)

Answer 3

The process of determining whether a presenting problem afflicting an individual meets the established criteria for a specific psychological disorder as set in a standard classification system for abnormal behaviour such as the DSM-5

Question 4

What is the origin of the term ‘diagnosis’ and what does it mean?

(Ch 3)

Answer 4

Came from the Greek prefix – dia (through/setting apart/separating) and the term – gnosis (knowing/knowledge)

Diagnosis, thus means gaining knowledge by setting things apart and studying attributes of isolated phenomena in the world and how they interrelate in order to form an opinion about the whole

Question 5

What are the 2 components/bodies of information needed to reach a diagnostic conclusion?

(Ch 3)

Answer 5

1) Psychological tests, 3rd party reports and lab investigations (secure symptoms and signs and interpret adjunctive sources of info)
2) Knowledge of normal functioning and behaviour and their pathological counterparts

These bodies are integrated to form a comprehensive understanding of the whole individual within society

Question 6

What are the 2 constituents essential for clinical practice? Describe each and provide an example for each

(Ch 3)

Answer 6

1. Symptom – characterises a state, condition or entity (constitutes any state that indicates the perceived presence or absence of something and the change from a former state/a manifestation of a state or condition that may indicate abnormality as reported by the afflicted individual)
   E.g. – an elderly person complaining that they struggle to walk to the shops and lose breath easily whereas they used to be more capable
2. Sign – a manifestation of a state or condition that may indicate abnormality that is observed by another person (requires use of sense and observation)
   E.g. – the family member or psychologist of an elderly person complaining that they struggle to walk to the shops and lose breath easily whereas they used to be more capable

Question 7

What are the similarities and differences between symptoms and signs?

(Ch 3)

Answer 7

Similarities: both characterise the manifestation of a state or condition that may indicate abnormality
Differences: reported by the afflicted individual (symptom) and reported/observed by another person (sign)

These may be difficult to distinguish, however, as the boundary is not clear cut
It is more important to hone one’s skills to understand another human by allowing the person to express their experience, integrating that with what is observed and describing the phenomena at hand

Question 8

What are the 3 pieces of information needed for the diagnostic process?

(Ch 3)

Answer 8

1. Primary component – Who: Who is the individual in the consultation?
2. Secondary component – Why: Why is this individual being consulted?
3. Tertiary component – What: What can be observed and described?

Question 9

What assessment methods are used to answer the 3 pieces of information needed for the diagnostic process?

(Ch 3)

Answer 9

These are answered using assessment methods in the diagnosis process such as:
1. the systematic collection of information (history)
2. examination (observing mental state and behaviour)
3. special, adjunctive (accompanying) and supportive investigation (standardised tests such as psychological and neuropsychological/physiological tests which serve to confirm/deny hypotheses rather than detecting the problem in the first place)

This helps in understanding the individual, their situation/context and the problem presented

Question 10

What are the 3 paths/approaches to diagnosis? Describe them

(Ch 3)

Answer 10

1. Algorithmic approach: diagnosis based on a decision process/algorithm (algorithmic approach) in which all observations are considered against all their possible causes
   Often used by those new to the diagnostic process (novice psychologists/clinicians)
2. Hypothetico-deductive method/approach: clinician forms a hypothesis about the problem right from the outset in which the individual’s history presents the main substance of the hypothesis; this method exemplifies the logical underpinnings of the diagnostic process; focused and direct further enquiry is needed to confirm/deny these hypotheses
   Often used by those familiar yet not fully experienced (intermediate psychologists/clinicians)
3. Pattern-recognition approach: Recognising patterns which includes recognising the typical, predictable co-occurrence of events and observations
   Often used by those familiar with the diagnostic process (experienced psychologists/clinicians)

A combination of these 3 approaches is most effective and reliable (can also switch between 3 depending on individual and situation to get more accurate diagnostic formulations)
The examination and special investigations provide similar conclusions/information

Question 11

Describe the algorithmic approach to diagnosis and provide a pro and con of this approach

(Ch 3)

Answer 11

Algorithmic approach: diagnosis based on a decision process/algorithm (algorithmic approach) in which all observations are considered against all their possible causes
Often used by those new to the diagnostic process (novice psychologists/clinicians)

Pros of algorithmic approach – exhaustive/comprehensive
Cons of algorithmic approach – time-consuming

Question 12

Describe the hypothetico-deductive method/approach to diagnosis and provide a pro and con of this approach

(Ch 3)

Answer 12

Hypothetico-deductive method/approach: clinician forms a hypothesis about the problem right from the outset in which the individual’s history presents the main substance of the hypothesis; this method exemplifies the logical underpinnings of the diagnostic process; focused and direct further enquiry is needed to confirm/deny these hypotheses
Often used by those familiar yet not fully experienced (intermediate psychologists/clinicians)

Pros of the hypothetico-deductive method – objective, reliable & valid (allows hypothesis confirmation/denial when tested against empirical evidence which provides more accurate diagnoses)
Cons of the hypothetico-deductive method – may be biased and overly simplistic (disregards complex and context dependent situations)

Question 13

Describe the pattern-recognition approach to diagnosis and provide a pro and con of this approach

(Ch 3

Answer 13

Pattern-recognition approach: Recognising patterns which includes recognising the typical, predictable co-occurrence of events and observations
Often used by those familiar with the diagnostic process (experienced psychologists/clinicians)

Pros of pattern-recognition approach – efficient
Cons of pattern-recognition approach – ignores unusual presentations of symptoms/signs

Question 14

Which diagnostic approach is best?

(Ch 3)

Answer 14

A combination of these 3 approaches is most effective and reliable (can also switch between 3 depending on individual and situation to get more accurate diagnostic formulations)

Question 15

Which diagnostic approach/condition is considered dangerous (perilous) and why?

Answer 15

Pathognomonic diagnosis: pathognomonic = one symptom or sign/one set of symptoms or signs that uniquely define a state or condition
These conditions are rare, and this approach is dangerous as it can lead to overlooking other potential causes or problems and potentially missing other relevant medical or psychological issues

Question 16

Define pathognomonic (diagnosis)

Answer 16

Pathognomonic - means one symptom or sign/one set of symptoms or signs that uniquely define a state or condition

Pathognomonic diagnosis - findings that are distinctive or characteristic of a particular disease or condition and can be used to make a diagnosis

Question 17

Explain the course of the clinical process

(Ch 3)

Answer 17

Clinical process – collecting a lot of information across a broad range of an individual’s condition –> get overall sense of functioning –> rule out problems in irrelevant areas –> concentrate on areas that seem most relevant –> determine what source/cause is

Question 18

What are the 2 main types/levels of diagnosis?

(Ch 3)

Answer 18

1. Phenomenological/experiential diagnosis
2. Syndromal diagnosis

Question 19

Name and describe the 2 main types/levels of diagnosis?

(Ch 3)

Answer 19

1. Phenomenological/experiential diagnosis:
   Only/solely reliant on observed and reported information (clinical information) that is available
   Without behavioural and developmental information of course of condition over time, no further conclusions can be drawn
2. Syndromal diagnosis:
   Involves the recognition of the occurrence of predictable clusters of phenomena
   More information is provided on the presentation, as enough phenomena can be observed to recognise clustering
   Syndrome = means ‘running together’
   E.g. Delirium is a syndrome characterised by decreased arousal, poor attention, hallucinations and other cognitive disturbances
   All phenomena/symptoms must co-exist and co-occur at the same time and at a higher rate than chance alone to be considered for a diagnosis of a condition or for the constitution of a syndrome
   Without evidence on what caused it and what its outcome may be, it is only a phenomenological diagnosis
   The syndrome needs to be combined with the evolution (course, cause, outcome) of the pathology (abnormal behaviour) over time in order to develop a syndromal diagnosis and reach the level of disorder
   Most psychological/mental conditions are understood at this descriptive, syndromal and disorder level of diagnosis

Question 20

What are some other types of diagnoses?

(Ch 3)

Answer 20

Pathogenic, aetiologic and anatomical diagnoses
Functional diagnosis
Differential diagnosis

Question 21

Name and describe some other types of diagnoses

(Ch 3)

Answer 21

• Pathogenic, aetiologic and anatomical diagnoses
  Pathogenic (leading to disease), aetiologic (causes) and anatomical (body structure) diagnoses are much less understood however there are developments in the neurocognitive field (anatomical)
  Example of pathogenic – Huntington’s disease (mutations in genes leading to disease)
  Example of aetiologic – neurosyphilis (caused by infection of the CNS)
  Example of anatomical - Alzheimer’s disease (more information on the connection between brain structures and Alzheimer’s disease)
• Functional diagnosis
  The diagnosis of mental health conditions where physical symptoms, such as movement or sensory problems, are present but cannot be explained by a neurological or other medical condition like that of pathogenic, aetiologic and anatomical diagnoses
  This diagnosis is useful as it emphasises the functional implications of a condition (ways in which a mental health disorder affects a person’s ability to function effectively in various aspects of their life)
  This is very useful in diagnosis and treatment plans for traumatic brain injuries, chronic psychotic conditions and neurodevelopmental disorders as it focuses on long-term effects
• Differential diagnosis
  There are many possible explanations (pathways, causes, courses, etc) to account for an individual’s presentation of symptoms/signs, especially when less information is provided or available
  This leads to multiple hypotheses and potential disorders and thus, the existence of a differential diagnosis
  Differential diagnosis: a list of possible conditions that conform to the available clinical information
  As the diagnostic process continues, more information is collected, more is understood about the presenting problem and more accurate hypotheses are made until the most relevant one results in a diagnosis (final diagnosis is arrived at only once other hypotheses and disorders have been eliminated through further investigation)

Question 22

Define differential diagnosis

Answer 22

a list of possible conditions that conform to the available clinical information

Question 23

What are the 3 levels of understanding abnormal psychology? Describe them

(Ch 3)

Answer 23

1. Syndrome
   * ‘Running together’
   * Implies the clustering of given symptoms, signs and results of special investigations
   * These need to occur regularly and predictably so as to constitute a syndrome or condition
   * Syndrome: a set of clinical and supporting info that co-occurs at a frequency greater than change
2. Disorder
   * Makes up a syndrome along with its clinical course
   * In addition to its presenting symptoms & signs, behaviour over time is also included
   * This leads to more knowledge on how the abnormality developed
   * Nothing is known about the cause however
3. Disease
   * Consists of a combination of clinical phenomenology (manifestation of presenting phenomena), course of behaviour, pathogenesis (how disorder developed) and aetiology (cause)

Question 24

What are the 3 concepts that determine the value of clinical assessments?

(Ch3)

Answer 24

1. Reliability
2. Validity
3. Standardisation

These are the requirements needed to prove the efficiency and accuracy of assessment, as based on evidence

Question 25

Define reliability and its two subtypes (Ch3)

Answer 25

Reliability: the degree to which a measurement is consistent (e.g. over time or among different raters) Reliability can be improved through carefully designing assessment devices/tools and conducting research on them to ensure: (1) Inter-rater reliability: consistency across two or more raters (two or more raters get the same answers) (2) Test-retest reliability – consistency across time (stability from one assessment to the next over time)

Question 26

Define validity and its two subtypes (Ch3)

Answer 26

Validity: the degree to which a technique measures what it is designed to measure/whether a technique assesses what it is supposed to Can test validity by using: (1) Concurrent validity – extent to which the results of one assessment measure corresponds with that of an existing measure/comparing results of one assessment measure with a better known assessment measure to test the validity of the first/newer assessment (2) Predictive validity – ability of an assessment measure to predict a future outcome

Question 27

Define standardisation and describe what it includes and what 3 things the process applies to (Ch3)

Answer 27

Standardisation: the process of establishing specific norms and requirements for a measurement technique to ensure it is used consistently across measurement occasions/the application of certain standards to ensure consistency across different measurements This includes: * Instructions for administering the measure * Evaluating the measures findings * Comparing findings to data for large numbers of people This process applies to (1) evaluation of data, (2) testing and (3) scoring

Question 28

What are some aspects of a clinical encounter? (Ch3)

Answer 28

Aspects of a clinical encounter – systematic, structured, goal-directed, rooted in scientific evidence, unthreatening, open-ended questions

Question 29

What are some things to avoid during a clinical encounter? (Ch3)

Answer 29

Things to avoid in clinical encounters – disorganisation, unstructured, directionless, pure and subjective theory, threatening, leading or closed questions (distort facts & exclude info)

Question 30

What role does a psychologist take on during a clinical encounter? (Ch3)

Answer 30

A scientist-practitioner role

Question 31

What are the 3 components of the clinical encounter? (Ch3)

Answer 31

3 components of the clinical encounter: 1. Clinical history 2. Mental state examination 3. Behavioural observations

Question 32

What components of the diagnostic process does the clinical history focus on? (Ch3)

Answer 32

The primary (who) and secondary (why) components

Question 33

What does the process of collecting clinical information include?

Answer 33

* Taking a conversational and non-confrontational communication style and approach * Asking ‘who’, which provides identifying and demographic information and informs the clinician about risks and possible precipitants (causes of actions/events) * Enquiring about the patient’s basic information – demographics (name, age, location, relationships, education, work, religion and socio-cultural context), social and developmental background, personal experiences and past & current significant events * Enquiring about past and present illnesses and treatments, family history and negative habits or activities such as drinking, smoking or using illicit substances * Asking ‘why’, which provides informational essential for a diagnostic hypothesis (further info and questioning leads to a more accurate diagnosis) * Enquiring about the patient’s primary complaint, issues/troubles/problems, thoughts, emotions and how others view the issue * Collecting information that is relevant to the primary complaint – symptoms/symptom cluster, accompanying features, aspects that aggravate/relieve symptoms of issue, temporal pattern of symptoms and emergence of symptoms/issue * Asking direct questions related to the information collected above * Knowing the information at face value as well as understanding the context and deeper meaning or implications behind this information * Being aware of information that is useful/relevant and information that is not (depending on the context) * Adapting or shifting the interview and questions based on the information provided

Question 34

What does the way in which the individual relays information provide insight into? (Ch3)

Answer 34

Insight into the individual's cognitive abilities, motivation, mood, strengths, weaknesses, vulnerability and reality testing

Question 35

What is a difficulty that psychologists face during clinical encounters? (Ch3)

Answer 35

Asking personal/uncomfortable questions in the most respective and least invasive manner

Question 36

Can information typically collected during the mental state examination be collected during the clinical encounter? (Ch3)

Answer 36

Yes, sometimes information that is usually collected during the mental state examination (such observing someone’s state in which they are e.g. experiencing hallucinations during the interview) can become part of the documentation of clinical history if they are reported by the individual themselves (subjective phenomena), instead of through observation (e.g. the patient expressing that they are experiencing hallucinations during the interview)

Question 37

What are the 6 main areas of information collected during the clinical encounter stage of assessment? (Ch3)

Answer 37

1. Identifying and demographic information 2. Primary or presenting complaint 3. Systematic enquiry 4. Medical history 5. Habits 6. Psychosocial adaptation and functioning

Question 38

What are the elements of clinical history part of the identifying and demographic information that are collected during the clinical encounter? (Ch3)

Answer 38

* Name * Age * Gender/sex * Date of birth * Location * Relationship status: married, common law, traditional, co-habiting, single * Social context: family, friends, partner, community * Education * Language * Occupation * Financial status * Religion * Culture

Question 39

What are the elements of clinical history part of the primary or presenting complaint that are collected during the clinical encounter? (Ch3)

Answer 39

* Nature * Associated features * Severity * Temporal pattern * Aggravating and relieving factors * Onset, course and development

Question 40

What are the elements of clinical history part of the systematic enquiry that are collected during the clinical encounter? (Ch3)

Answer 40

Clusters of symptoms, affecting other systems, that are observed & should be surveyed such as: * Mood, emotions and feelings: changes, patterns, stability, reactivity, feelings of hopelessness, elation, euphoria and irritability * Anxiety: apprehension, trepidation, tension, headaches, abdominal discomfort, changed bowel habits, panic, re-experiencing phenomena * Neurovegetative features: sleep (quality and quantity), nightmares, parasomnias, appetite, eating patterns, energy and motivation * Obsessions and compulsions: ability to recognise origin of these and be able to resist them * Reality testing: perceptual disturbances including hallucinations, illusions, misidentifications and disturbed ideations (delusions, overvalued ideas, magical thinking) * Withdrawal indicators: cravings, typical features of specific withdrawal syndromes * Other symptoms: dissociation phenomena, somatic concerns, memory distortions, forced thinking, parasitised thoughts, motor concerns, strange bodily sensations

Question 41

What are the elements of clinical history part of the medical history that are collected during the clinical encounter? (Ch3)

Answer 41

* All previous and current conditions - their onset, course and severity (conditions include psychiatric disorders, responses to stress, traumatic brain injury and other neurological and anatomical conditions such as epilepsy, AIDS or autoimmune diseases) * All previous and current treatments, responses, compliance - including therapies, inpatient treatment and rehabilitation

Question 42

What are the elements of clinical history part of the habits that are collected during the clinical encounter? (Ch3)

Answer 42

* Substance use - drinking (caffeine/alcohol), smoking (nicotine) and illicit drugs * Onset, frequency, severity of intoxication, withdrawal, dependence and abstinence

Question 43

What are the elements of clinical history part of the psychosocial adaptation and functioning that are collected during the clinical encounter? (Ch3)

Answer 43

* Early development - education (academic performance, learning problems, strengths, social, sports) * Adolescence * Relationships - parents, siblings, extended family, romantic and platonic, authority figures, etc * Occupational history * Beliefs, religious and cultural practices * Goals and ideals

Question 44

What is the difference between the primary complaint and the systematic enquiry? (Ch 3)

Answer 44

Primary complaint – the problem foremost in the mind of the patient Systematic enquiry – a tool to include or exclude symptoms that accompany the presenting problem (helps understanding and the formation of a better diagnostic hypothesis)

Question 45

What is a central idea to clinical practice? (Ch 3)

Answer 45

Reliance on other sources of info is central to the clinical practice and the clinician has to be able to switch between these sources in order to build a comprehensive understanding of a patient Sometimes the patient does not believe they have a problem and the presenting complaint is thus, conceptualised by someone else This indicates that the history is often reliant on information provided by others, as well as the patient themselves

Question 46

What is the Mental State Examination (MSE) process part of? (Ch 3)

Answer 46

The MSE is part of/an addition to the medical and neurological examinations and is a freestanding stage as psychologists do not physically examine patients

Question 47

Define Mental State Examination (MSE) (Ch 3)

Answer 47

A brief but systematic overview or observation of global mental functioning across the domains of consciousness, arousal, cognitive ability, thoughts, emotions, reality testing, communication and behaviour

Question 48

What is the MSE a process of? (Ch 3)

Answer 48

The MSE is not a process of administration but rather a process of observation – using senses to get insight into a patient through interaction and then reporting this info in a systematic manner Clinicians need to organise observations of patients in a way that gives them sufficient information to determine whether a psychological disorder may be present or not These examinations are not typically structured as that would make them time-consuming, these are usually performed relatively fast during clinical encounters Consistency, organisation and systematisation = easier and more accurate communication between clinicians

Question 49

What approach is used to record mental state? (Ch 3)

Answer 49

Hierarchal approach: simple, systematic & descriptive rationale

Question 50

What are the 5 domains of the hierarchal approach? (Ch 3)

Answer 50

1. General appearance 2. Cognition 3. Mood and affect 4. Reality testing and organisation 5. Behaviour

Question 51

Describe general appearance as a domain of the hierarchal approach (Ch 3)

Answer 51

(1) General appearance * Initial, observable physical characteristics and demeanour of a patient * Provides useful info about appearance, physical state, contact and co-operation

Question 52

Describe cognition as a domain of the hierarchal approach (Ch 3)

Answer 52

(2) Cognition * Provides an indication of the integrity of the patients CNS and general health * Analysis of state of cognitive functioning – at level of that typical of their demographic/context or indication of an impairment/lack * Observation of consciousness – aware and present or unconscious/comatose * Observation of cognitive/higher functions – memory, attention, language, perception, decision-making and problem-solving * Observation of neurological functions – stability/irritability; emotional stability/incontinence * Provides insight into potential impairment, disease and other psychological phenomena and thus a call for immediate action/examination or not * Cognitive disturbances are essential to identify as soon as possible due to their potential severity, risk of harm and reversibility * Thus, focusing on primacy/precedence of cognitive signs before they worsen is life-saving

Question 53

Describe mood and affect as a domain of the hierarchal approach (Ch 3)

Answer 53

(3) Mood and affect * Disturbances here account for disturbances in reality testing, hence this placement in the hierarchy

Question 54

Describe reality testing as a domain of the hierarchal approach (Ch 3)

Answer 54

(4) Reality testing * Thinking, thoughts, apperceptions and organisation

Question 55

Describe behaviour as a domain of the hierarchal approach (Ch 3)

Answer 55

(5) Behaviour * Observation of motoric behaviours - tension, fidgeting, lethargy, mannerisms, stereotypies or movement disorders

Question 56

What do informal behavioural observations during the MSE provide information on and allow? (Ch 3)

Answer 56

* Allow clinician to determine which areas of the patient’s behaviour/condition to focus on and what should be assessed more formally or in more detail * Allows for hypotheses to be formulated regarding which disorder/s may be present * Allow more understanding about the patient’s troubles and the exploration of possible diagnostic alternatives * Allow more insights into the patient’s strengths and weaknesses – physical, psychological and social (support, relationships, security and vulnerabilities)

Question 57

What should the MSE do? (Ch 3)

Answer 57

- utilise methods that put the patient at ease - utilise appropriate listening skills - practice patience, facilitate communication - elicit patients trust and empathy - emphasise patient confidentiality and ethical codes - avoid threatening, abusive or counterproductive methods of obtaining info

Question 58

What are the features of the general appearance domain of the MSE? (Ch 3)

Answer 58

* Mobility * Activity * Injuries * Hygiene (smell of alcohol or ketones) * Neatness * Clothing * Engagement * Interaction * Co-operation

Question 59

What are the features of the cognition domain of the MSE? (Ch 3)

Answer 59

* Arousal * Attention: focus, sustain, shift, resist distraction * Memory: short and long-term, episodic, visual and spatial memory * Language: fluency, understanding, naming, repetition, reading and writing, aphasia (language disturbance) * Speech: mechanical production of verbal communication, dysarthria (speech disturbance) * Praxis: performance of previously learnt complex motor tasks (ideational and ideomotor) * Gnosis: recognition of things across all sensory modalities * Executive functioning: problem-solving, planning, organisation, reasoning, processing speed * General intelligence and adaptive function estimate

Question 60

What are the features of the mood and affect domain of the MSE? (Ch 3)

Answer 60

* Mood: depressed, irritable, manic, anxious, labile, reactivity * Affect: nature, congruence, range of expression and reactivity * Hedonic tone * Motivation

Question 61

What are the features of the reality testing domain of the MSE? (Ch 3)

Answer 61

* Thinking: speed, coherence, association, logic * Thoughts: thought content, ideas, delusions, preoccupations, obsessions * Apperceptions: hallucinations, illusions, misidentifications * Organisation: logical organisation, communication and behaviour

Question 62

What are the features of the behaviour domain of the MSE? (Ch 3)

Answer 62

* Intensity: agitation, retardation, purposefulness, goal-directedness * Adventitious behaviours: stereotypies, mannerisms, tremor, other movement disorders * Compulsions * Catatonia * Behaviour before and after consultation

Question 63

What are other observations noted during the MSE? (Ch 3)

Answer 63

* Interactions during encounter - with parent, etc * Judgements and insights into situation * Reliability * Anticipated compliance

Question 64

What are 7 clinical aids that contribute to the understanding and diagnosis of a patient? (Ch 3)

Answer 64

(1) Physical Examination (2) Semi-structured Clinical Interviews (3) Behavioural Assessment (4) Psychological Testing (5) Neuropsychological Testing (6) Neuroimaging (7) Psychophysiological Assessment

Question 65

Describe physical examination as an aid during clinical assessment (Ch 3)

Answer 65

Physical exam & special medical investigations Most people go to a GP/health clinic however it is essential for those who have time lapsed between consultations and differences in presenting problems over time to still undergo a physical/medical examination during psychological assessment Many physical conditions are disguised as or believed to be psychological disturbances due to their emotional, cognitive or behavioural affects (failure to recognise this can have severe consequences) Examples – cardiac ischaemia (insufficient blood supply to the heart muscle but only has the symptom of panic), an hypothyroidism (deficits in thyroid hormone but only has the symptom of depression) or MS (disease of white matter of CNS but only has the symptom of psychosis) A physical & medical examination is performed when a clinician suspects a neurocognitive deficit/condition/disorder (e.g. Alzheimer’s disease) in a patient Standardised screening tools – Folstein Mini Mental Status Examination (MMSE) or Montreal Cognitive Assessment (MOCA) These are designed to detect cognitive impairment and monitor progress through serial administration (testing sequentially over time) Other tests – standardised rating scales (for severity, frequency and intensity of symptoms/phenomena) which help with following the course of a condition Clinician must – be aware of medical conditions, substance abuse and environmental toxins that may contribute to the patient’s problems and must ascertain, if these exist within the patient, whether these merely co-exist with or are causal of a psychological disorder by looking at the onset of the issue Physical examination provides info on and is influenced by: * The understanding, co-operation, motivation, trust & behaviour of the patient (influence degree and nature of physical exam) * Neurocognitive state and motor abnormalities of the individual * Evidence of self-mutilation, deliberate self-harm, eating disorders and substance use Examples – neurocognitive state (impulsivity), motor abnormalities (psychotic patients may resist passive movements), self-mutilation & self-harm (scars on arms), eating disorders (salivary gland enlargement) and substance abuse (needle tracks in arms, dead nose tissue from snorting or nodules in the skin)

Question 66

When is it essential for patients to seek out a physical/medical examination? (Ch 3)

Answer 66

Most people go to a GP/health clinic however it is essential for those who have time lapsed between consultations and differences in presenting problems over time to still undergo a physical/medical examination during psychological assessment

Question 67

Why are many physical conditions disguised as or believed to be psychological disturbances? What are some examples of this? (Ch 3)

Answer 67

Due to their emotional, cognitive or behavioural affects (failure to recognise this can have severe consequences) Examples – cardiac ischaemia (insufficient blood supply to the heart muscle but only has the symptom of panic), an hypothyroidism (deficits in thyroid hormone but only has the symptom of depression) or MS (disease of white matter of CNS but only has the symptom of psychosis)

Question 68

When is a physical & medical examination performed? (Ch 3)

Answer 68

When a clinician suspects a neurocognitive deficit/condition/disorder (e.g. Alzheimer’s disease) in a patient

Question 69

What are some standardised screening tools for the neurocognitive examination? (Ch 3)

Answer 69

Folstein Mini Mental Status Examination (MMSE) Montreal Cognitive Assessment (MOCA)

Question 70

What are the standardised screening tools for neurocognitive testing designed to do? (Ch 3)

Answer 70

These are designed to detect cognitive impairment and monitor progress through serial administration (testing sequentially over time)

Question 71

What are some other tests that screen neurocognition? What do these aid in? (Ch 3)

Answer 71

Other tests – standardised rating scales (for severity, frequency and intensity of symptoms/phenomena) which help with following the course of a condition

Question 72

What does the physical examination provide info on and what is it influenced by? What are some examples of this? (Ch 3)

Answer 72

* The understanding, co-operation, motivation, trust & behaviour of the patient (influence degree and nature of physical exam) * Neurocognitive state and motor abnormalities of the individual * Evidence of self-mutilation, deliberate self-harm, eating disorders and substance use Examples – neurocognitive state (impulsivity), motor abnormalities (psychotic patients may resist passive movements), self-mutilation & self-harm (scars on arms), eating disorders (salivary gland enlargement) and substance abuse (needle tracks in arms, dead nose tissue from snorting or nodules in the skin)

Question 73

What must a clinician do during psychological assessment regarding the physical examination process? (Ch 3)

Answer 73

Clinician must – be aware of medical conditions, substance abuse and environmental toxins that may contribute to the patient’s problems and must ascertain, if these exist within the patient, whether these merely co-exist with or are causal of a psychological disorder by looking at the onset of the issue

Question 74

Describe what the clinical history of physical examination focuses on? (Ch 3)

Answer 74

* Focus on physical symptoms and enquiries into physical systems in the systematic enquiry stage of the clinical history

Question 75

What information is collected during the physical examination? (Ch 3)

Answer 75

* Vital signs: blood pressure, pulse, respiration * General observations: distress, colour of skin, oedema (swelling), nutritional state, injuries and growths * Cardiovascular: heart exam, pulse, quality of blood flow * Respiratory: chest movement, palpitations, percuss (chest tapping to check for lung tissue abnormalities) * Abdominal: swelling, distention, percuss * Rectal examination * Pelvic, urological and gynaecological examination * Musculoskeletal: bones and joints * Ear, nose & throat * Eyes * Oral cavity and teeth * Dermatological: skin and appendages * Neurological: cranial nerves, motor ability, muscle tone, reflexes, adventitious movement, somatosensory

Question 76

What are the 3 info collection methods and styles of interviews used on and available to patients? (Ch 3)

Answer 76

1. Unstructured interviews * no set structure or systematic format 2. Semi-structured interviews * follow a systematic format but allow for alteration if needed * include questions phrased and tested to elicit useful information in a consistent manner * includes departing from set questions to follow up on specific issues * most important areas are covered during an interview * designed to explore specific suspected abnormalities (e.g. DSM-5 (ADIS-5)) * cons – robs interview of spontaneity, may be applied too rigidly which may inhibit the patient from sharing valuable info that is not directly relevant to the specific question 3. Fully-structured interviews * sometimes entirely computer-based * used in some settings such as research settings * not widely accepted due to their rigidity

Question 77

Describe semi-structured interviews (Ch 3)

Answer 77

* follow a systematic format but allow for alteration if needed * include questions phrased and tested to elicit useful information in a consistent manner * includes departing from set questions to follow up on specific issues * most important areas are covered during an interview * designed to explore specific suspected abnormalities (e.g. DSM-5 (ADIS-5)) * cons – robs interview of spontaneity, may be applied too rigidly which may inhibit the patient from sharing valuable info that is not directly relevant to the specific question

Question 78

What is the ADIS-5? And how is it administered? (Ch 3)

Answer 78

ADIS-5 = The Anxiety Disorders Interview Schedule for DSM-5 The clinician asks if the patient is bothered by any thoughts, feelings, images or impulses (obsessions) and if they feel an urge to carry out specific actions/behaviours repeatedly to relieve these (compulsions) Based on a 9-point rating scale ranging from ‘never – constantly’, the clinician asks to rate each obsession on two measures: (1) Persistence-distress (how often it occurs and how much distress [severity/intensity]) (2) Resistance (types of attempts used to get rid of the obsessions [frequency])

Question 79

What are the 2 measures the ADIS-5 is based on? (Ch 3)

Answer 79

(1) Persistence-distress (how often it occurs and how much distress [severity/intensity]) (2) Resistance (types of attempts used to get rid of the obsessions [frequency])

Question 80

Describe behavioural assessments (Ch 3)

Answer 80

Behavioural assessment: The formal process of measuring, directly observing and systematically evaluating, rather than inferring, the patient’s thoughts, feelings and behaviour in the problem situation or context These may be used for patients who are – not old enough, skilled enough or unable to share reliable information and report their problems and experiences Info obtained during the behavioural assessment is added insight into the limited info collected during the clinical encounter/interview Without this info, a clinician’s assessment of the problem and treatment plans would be different

Question 81

Define behavioural assessment (Ch 3)

Answer 81

The formal process of measuring, directly observing and systematically evaluating, rather than inferring, the patient’s thoughts, feelings and behaviour in the problem situation or context

Question 82

What patients are behavioural assessments typically used on? (Ch 3)

Answer 82

These may be used for patients who are – not old enough, skilled enough or unable to share reliable information and report their problems and experiences

Question 83

What are the 3 types of behavioural assessment? (Ch 3)

Answer 83

* Clinical interview - interacting in a clinical room/setting * Observation - going to a workplace, home or local community setting to observe the person directly in specific social contexts * Role-play simulations – observe real life/daily scenarios

Question 84

What are the aims of behavioural assessment? (Ch 3)

Answer 84

* Identify and observe target behaviours (the primary problems of concern) * Determine the factors that influence these target behaviours

Question 85

Why can the behavioural assessment process be difficult? (Ch 3)

Answer 85

This process can be difficult as sources of information may not be reliable or give a comprehensive image of the whole problem as well as the fact that direct observation may not always be possible or practical

Question 86

How is behavioural assessment made easier? What is introduced? Define it and how it works (Ch 3)

Answer 86

Analogue settings/assessments/models – placing patients in simulated conditions or settings that mimic real-life clinical symptoms and situations, through hypnosis or through inducing symptoms of psychopathology into healthy individuals, to study the patient’s characteristics in a controlled manner This process helps determine the behavioural causes which allow for an appropriate and efficient treatment plan to be devised, which ultimately targets and aims to eliminate undesired behaviours These types of observations are useful when developing screenings and treatments

Question 87

What are the ABCs of observation part of the behavioural assessment process? (Ch 3)

Answer 87

The 3 components (ABCs) of observation: A - Antecedent B - Behaviour C – Consequences

Question 88

What is the aim of the ABCs of behavioural assessment? (Ch 3)

Answer 88

Find target behaviours, select and define the primary target behaviour, note each occurrence of this behaviour as well as its antecedent and consequence Aim of ABCs – find patterns of behaviour and then design a treatment plan based on these patterns

Question 89

What are the 2 types of observation? Provide examples (Ch 3)

Answer 89

Formal observation: identifying specific behaviours that are observable and measurable (operational definition) Examples – behavioural observation in a clinical setting, naturalistic observations, checklists and rating scales Informal observation: reports of behaviour based on recollections of the observer which are less observable and measurable Examples – unplanned observations in daily setting, recollections of secondary sources

Question 90

Define operational definition (Ch 3)

Answer 90

Identifying specific behaviours that are observable and measurable which helps clarify behaviour

Question 91

Describe self-monitoring (Ch 3)

Answer 91

Self-monitoring/observation: Action by which patients observe and record their own behaviours as either an assessment of a problem and its change or a treatment procedure that makes them more aware of their response This method helps individuals identify patterns, observe how severe/expansive their problem is and identify which situations/factors influence these occurrences This method is essential for behaviours that occur privately (not observed by anyone but the individual) Clinicians need to trust that this self-report is a reliable reflection of behaviours and that it correlates with other clinical measures and info Checklists & rating scales – assessment tools before and during treatment to monitor progress and behaviour (most common - Brief Psychiatric Rating Scale)

Question 92

What does self-monitoring help with? (Ch 3)

Answer 92

This method helps individuals identify patterns, observe how severe/expansive their problem is and identify which situations/factors influence these occurrences

Question 93

Define self-monitoring (Ch 3)

Answer 93

Action by which patients observe and record their own behaviours as either an assessment of a problem and its change or a treatment procedure that makes them more aware of their response

Question 94

When is self-monitoring most essential? (Ch 3)

Answer 94

This method is essential for behaviours that occur privately (not observed by anyone but the individual) Clinicians need to trust that this self-report is a reliable reflection of behaviours and that it correlates with other clinical measures and info

Question 95

What are some assessment tools used before and during treatment to monitor progress and behaviour? (Ch 3)

Answer 95

Checklists & rating scales such as the Brief Psychiatric Rating Scale

Question 96

Describe how the Brief Psychiatric Rating Scale works (Ch 3)

Answer 96

* Assesses 18 general areas of behavioural concern * Each symptom is rated on a 7-point scale from 0 (not present) to 6 (extremely severe) * Screens for moderate to severe psychotic disorders * Includes somatic concern (preoccupation with physical health, fear of physical illness, hypochondriasis), feelings of guilt (shame, self-blame, remorse for past actions) and grandeur (exaggerated self-opinion, arrogance, conviction of power/abilities)

Question 97

What standards do psychological tests need to meet and what do they assess? (Ch 3)

Answer 97

Psychological tests need to meet strict standards – reliability & validity Utilise tools that assess – cognitive, emotional and behavioural responses that may be associated with a specific disorder as well as long-standing personality traits, intelligence and dysfunction

Question 98

What is something that can negatively influence the reliability of findings/distort observational data? How? And when can it be useful? (Ch 3)

Answer 98

Reactivity Mere presence of another person as well as own self-awareness of behaviour may influence individual’s behaviour or encourage them to alter it Sometimes reactivity can be helpful in eliminating undesired behaviours

Question 99

What do psychological tests assess? (Ch 3)

Answer 99

Cognitive, emotional and behavioural responses that may be associated with a specific disorder as well as long-standing personality traits, intelligence and dysfunction

Question 100

What are the 3 types of psychological tests? (Ch 3)

Answer 100

3 types of psychological tests: (1) Projective tests: Psychoanalytically based measures that present ambiguous stimuli to clients on the assumption that their responses will reveal their unconscious conflicts; these are inferential and lack high reliability and validity (2) Personality inventories/tests: Self-report questionnaires that assess personal traits by asking respondents to identify descriptions that apply to them (3) Intelligence tests

Question 101

Define projective tests (Ch 3)

Answer 101

Psychoanalytically based measures that present ambiguous stimuli to clients on the assumption that their responses will reveal their unconscious conflicts; these are inferential and lack high reliability and validity

Question 102

Define personality inventories/tests (Ch 3)

Answer 102

Self-report questionnaires that assess personal traits by asking respondents to identify descriptions that apply to them

Question 103

Describe projective tests (Ch 3)

Answer 103

* Variety of methods in which ambiguous stimuli, such as inkblots or pictures of people/things, are presented to an individual with the premise that this individual will project their own personality, motivations and unconscious fears onto these stimuli, revealing unconscious thoughts without realising it * Based on psychoanalytic theory (controversial) * Critical of relevancy, reliability and validity as each clinician uses these subjectively (poor for diagnostic testing however valuable in obtaining more info on the individual) * Nonetheless, these are studied/taught and are used often by professionals * Most used - Rorschach inkblot test, Thematic Apperception Test & the sentence-completion method * Rorschach inkblot test - Hermann Rorschach (1920s) * Series of inkblots used initially used to study perceptual processes and then to diagnose disorders * Most recent version includes ten inkblot pictures with ambiguous stimuli which are presented one by one, the patient responding to each with straightforward descriptions of what they see * Test was not systematically completed and is controversial (lack of data, reliability and validity) * John Exner responds to these concerns by developing a standardised version of this test called the Comprehensive System (system of administering and scoring that specifies how these pictures should be presented, what the examiner should say and how responses should be recorded) * Still controversial however (critics question whether research on this system support its use as a valid assessment technique for those with disorders) * Thematic Apperception Test (TAT) - Morgan & Murray (1935) * Series of 31 cards (30 with pictures and 1 blank) however only 20 are typically used * Ask the individual to tell a dramatic story about what they see in the specific picture/card * "This is a test of imagination, one form of intelligence; let your imagination have its way as in a myth, fairy story or allegory" - tester to test taker * Based on the notion that individual will reveal unconscious mental processes * Variations of TAT - Children's Apperception Test (CAT) & Senior Apperception Test (SAT) and tests more inclusive of a variety of ethnic groups (changes in appearance of people and situations in pictures) * Formal scoring system for TAT - Social Cognition and Object Relations Scale * Still lacking in support and consistency

Question 104

What are the 3 most used projective tests? (Ch 3)

Answer 104

Rorschach inkblot test Thematic Apperception Test The sentence-completion method

Question 105

Describe the Rorschach inkblot test (Ch 3)

Answer 105

* Rorschach inkblot test - Hermann Rorschach (1920s) * Series of inkblots used initially used to study perceptual processes and then to diagnose disorders * Most recent version includes ten inkblot pictures with ambiguous stimuli which are presented one by one, the patient responding to each with straightforward descriptions of what they see * Test was not systematically completed and is controversial (lack of data, reliability and validity) * John Exner responds to these concerns by developing a standardised version of this test called the Comprehensive System (system of administering and scoring that specifies how these pictures should be presented, what the examiner should say and how responses should be recorded) * Still controversial however (critics question whether research on this system support its use as a valid assessment technique for those with disorders)

Question 106

Describe the Thematic Apperception Test (TAT) (Ch 3)

Answer 106

* Thematic Apperception Test (TAT) - Morgan & Murray (1935) * Series of 31 cards (30 with pictures and 1 blank) however only 20 are typically used * Ask the individual to tell a dramatic story about what they see in the specific picture/card * "This is a test of imagination, one form of intelligence; let your imagination have its way as in a myth, fairy story or allegory" - tester to test taker * Based on the notion that individual will reveal unconscious mental processes * Variations of TAT - Children's Apperception Test (CAT) & Senior Apperception Test (SAT) and tests more inclusive of a variety of ethnic groups (changes in appearance of people and situations in pictures) * Formal scoring system for TAT - Social Cognition and Object Relations Scale * Still lacking in support and consistency

Question 107

Describe personality inventories/tests (Ch 3)

Answer 107

* Face validity: questions seeming to fit the type of information desired * Personality tests - Paul Meehl (1940s) * What answers predict > content of questions * His position argues that what is necessary from these types of tests is not whether the questions necessarily make sense on the surface but rather what the answers to these questions predict * If people with certain disorders tend to, as a group, answer a variety of questions in a certain way, this pattern may predict who else has this disorder * Most widely used: Minnesota Multiphasic Personality Inventory (MMPI) (1943) * Based on an empirical approach (collection of evaluation data) * Administration of MMPI - individual reads statements and answers either 'true' or 'false' * Some statements from the MMPI: * Cry readily * Often happy for no reason * Am being followed * Fearful of things or people that cannot hurt me * Little room for interpretation of individual responses (like that of projective tests) * Instead, the pattern of responses is reviewed to see if it resembles patterns from groups of people who have specific disorders * Each group is represented on separate standard scales * Aims to find a continuum/spectrum of impairment rather than a yes/no outcome for each individual * Use computer software and additional scales to score and analyse these responses which increases reliability and the validity of each administration * Additional scales used to assess reliability and validity: 1. Lie scale - measures if individual may falsify answers to look good 2. Infrequency scale - measures false claims about problems and if questions are answered randomly) 3. Subtle Defensiveness scale - measures whether person sees themselves in unrealistically positive ways * Problem with MMPI administration - time (tedious) responding to 500+ items/questions, some people may answer in ways that may downplay their problems or be fake * Versions of MMPI - MMPI-2 Revised Form (most recent version) & MMPI-A (for adolescents) that are more gender and culture-ethnic inclusive and include more contemporary issues (e.g. self-esteem issues) * Very high reliability and validity if it follows standardised procedures * Some of this information may not change how patients are treated nor of that treatment is successful Check example of MMPI profile/summary on pages 113 & 114

Question 108

Define face validity (Ch 3)

Answer 108

Questions seeming to fit the type of information desired

Question 109

Who developed personality tests and what was his argument? (Ch 3)

Answer 109

Paul Meehl (1940s) * What answers predict > content of questions * His position argues that what is necessary from these types of tests is not whether the questions necessarily make sense on the surface but rather what the answers to these questions predict * If people with certain disorders tend to, as a group, answer a variety of questions in a certain way, this pattern may predict who else has this disorder

Question 110

What is the most widely used personality inventory/test? (Ch 3)

Answer 110

The Minnesota Multiphasic Personality Inventory (MMPI)

Question 111

Describe the MMPI (Ch 3)

Answer 111

* Based on an empirical approach (collection of evaluation data) * Administration of MMPI - individual reads statements and answers either 'true' or 'false' * Some statements from the MMPI: * Cry readily * Often happy for no reason * Am being followed * Fearful of things or people that cannot hurt me * Little room for interpretation of individual responses (like that of projective tests) * Instead, the pattern of responses is reviewed to see if it resembles patterns from groups of people who have specific disorders * Each group is represented on separate standard scales * Aims to find a continuum/spectrum of impairment rather than a yes/no outcome for each individual * Use computer software and additional scales to score and analyse these responses which increases reliability and the validity of each administration

Question 112

What are some additional scales used to assess reliability and validity in personality tests? (Ch 3)

Answer 112

1. Lie scale - measures if individual may falsify answers to look good 2. Infrequency scale - measures false claims about problems and if questions are answered randomly) 3. Subtle Defensiveness scale - measures whether person sees themselves in unrealistically positive ways

Question 113

What is the problem with MMPI administration? (Ch 3)

Answer 113

time (tedious) responding to 500+ items/questions, some people may answer in ways that may downplay their problems or be fake

Question 114

What are different versions of the MMPI? (Ch 3)

Answer 114

MMPI-2 Revised Form (most recent version) & MMPI-A (for adolescents) that are more gender and culture-ethnic inclusive and include more contemporary issues (e.g. self-esteem issues)

Question 115

Describe intelligence tests (Ch 3)

Answer 115

* Initial purpose of these - to predict who would do well in school (1) Binet & Simon (1904) * Made test to identify those with learning problems that would benefit from further help * Developed tasks needed to succeed in school - tasks of attention, perception, memory, reasoning and verbal comprehension * Removed any tasks that did not differentiate fast from slow learners when taking sample groups * Led to a test that could predict academic success which was revised to 'Stanford-Binet test' by Terman in 1916 * Stanford-Binet test * Provides a score (IQ - Intelligence Quotient) * Intelligence Quotient (IQ): Score on an intelligence test estimating a person's deviation from average test performance * Old tests - initially calculated using a child's mental age divided by the child's chronological age x 100 to get IQ score (critique - formula was too simplistic and not consistent across different age ranges) * Current tests - use a 'deviation IQ' (a person's score is only compared only to scores of others of the same age); IQ score becomes an estimate of how much a child's performance in school will deviate from the average performance of others of the same age (2) David Weschler 3 Weschler tests: * Weschler Adult Intelligence Scale (WAIS-IV) * Weschler Intelligence Scale for Children (WISC-V) * Weschler Preschool and Primary Scale of Intelligence (WPPSI-IV) * All of these use verbal scales (measure vocab, knowledge of facts, short-term memory and verbal reasoning skills) and performance scales (measure psychomotor abilities, non-verbal reasoning and ability to learn new relationships) * IQ and intelligence are not the same - IQ simply measures how one would do in a classical Western education/academic system * People may get low scores for many reasons - e.g. language conflict (presenting test in non-native language) * Need culture and language neutral tests (e.g. Ravens Progressive Matrices) * Intelligence may be more than just the skills tested in these such as the ability to adapt to the environment, generate new ideas and process information efficiently * These tests are typically highly reliable and valid nonetheless

Question 116

What was the initial purpose of intelligence tests? (Ch 3)

Answer 116

to predict who would do well in school

Question 117

Who created the first intelligence tests? (Ch 3)

Answer 117

Binet & Simon (1904)

Question 118

Describe the features of Simon & Binet's intelligence tests (Ch 3)

Answer 118

* Made test to identify those with learning problems that would benefit from further help * Developed tasks needed to succeed in school - tasks of attention, perception, memory, reasoning and verbal comprehension * Removed any tasks that did not differentiate fast from slow learners when taking sample groups * Led to a test that could predict academic success which was revised to 'Stanford-Binet test' by Terman in 1916 * Stanford-Binet test * Provides a score (IQ - Intelligence Quotient) * Intelligence Quotient (IQ): Score on an intelligence test estimating a person's deviation from average test performance * Old tests - initially calculated using a child's mental age divided by the child's chronological age x 100 to get IQ score (critique - formula was too simplistic and not consistent across different age ranges) * Current tests - use a 'deviation IQ' (a person's score is only compared only to scores of others of the same age); IQ score becomes an estimate of how much a child's performance in school will deviate from the average performance of others of the same age

Question 119

What did the first Simon and Binet intelligence test aim to do? (Ch 3)

Answer 119

* Made test to identify those with learning problems that would benefit from further help

Question 120

What were the developmental tasks Simon and Binet believed were needed to succeed in school? (Ch 3)

Answer 120

* Developed tasks needed to succeed in school - tasks of attention, perception, memory, reasoning and verbal comprehension

Question 121

How did Simon and Binet determine what skills to evaluate and what did this lead to? (Ch 3)

Answer 121

* Developed tasks needed to succeed in school - tasks of attention, perception, memory, reasoning and verbal comprehension Removed any tasks that did not differentiate fast from slow learners when taking sample groups * Led to a test that could predict academic success which was revised to 'Stanford-Binet test' by Terman in 1916

Question 122

How does the Stanford-Binet test work? (Ch 3)

Answer 122

* Provides a score (IQ - Intelligence Quotient) * Intelligence Quotient (IQ): Score on an intelligence test estimating a person's deviation from average test performance * Old tests - initially calculated using a child's mental age divided by the child's chronological age x 100 to get IQ score (critique - formula was too simplistic and not consistent across different age ranges) * Current tests - use a 'deviation IQ' (a person's score is only compared only to scores of others of the same age); IQ score becomes an estimate of how much a child's performance in school will deviate from the average performance of others of the same age

Question 123

What are the most used intelligence tests? (Ch 3)

Answer 123

1. Stanford-Binet test 2. Weschler tests

Question 124

What are the 3 Weschler intelligence tests? (Ch 3)

Answer 124

* Weschler Adult Intelligence Scale (WAIS-IV) * Weschler Intelligence Scale for Children (WISC-V) * Weschler Preschool and Primary Scale of Intelligence (WPPSI-IV)

Question 125

How do the Weschler tests work? (Ch 3)

Answer 125

* All of these use verbal scales (measure vocab, knowledge of facts, short-term memory and verbal reasoning skills) and performance scales (measure psychomotor abilities, non-verbal reasoning and ability to learn new relationships) * IQ and intelligence are not the same - IQ simply measures how one would do in a classical Western education/academic system * People may get low scores for many reasons - e.g. language conflict (presenting test in non-native language) * Need culture and language neutral tests (e.g. Ravens Progressive Matrices) * Intelligence may be more than just the skills tested in these such as the ability to adapt to the environment, generate new ideas and process information efficiently * These tests are typically highly reliable and valid nonetheless

Question 126

What scales do the Weschler intelligence tests use? (Ch 3)

Answer 126

* All of these use verbal scales (measure vocab, knowledge of facts, short-term memory and verbal reasoning skills) and performance scales (measure psychomotor abilities, non-verbal reasoning and ability to learn new relationships)

Question 127

Are IQ and intelligence the same? (Ch 3)

Answer 127

* IQ and intelligence are not the same - IQ simply measures how one would do in a classical Western education/academic system * Intelligence may be more than just the skills tested in these such as the ability to adapt to the environment, generate new ideas and process information efficiently

Question 128

What are some reasons people may get low results on IQ test? (Ch 3)

Answer 128

* People may get low scores for many reasons - e.g. language conflict (presenting test in non-native language)

Question 129

What is an example of a culture and language neutral intelligence test? (Ch 3)

Answer 129

Ravens Progressive Matrices

Question 130

Are Weschler intelligence tests reliable and valid? (Ch 3)

Answer 130

Yes, these tests are typically highly reliable and valid

Question 131

Define neuropsychological testing (Ch 3)

Answer 131

Neuropsychological testing: Assessment of brain and nervous system functioning by testing an individual’s performance on behavioural tasks

Question 132

What areas of interest are neuropsychological tests focused on? (Ch 3)

Answer 132

Receptive and expressive language, attention and concentration, memory, motor skills, perceptual abilities, learning and abstraction

Question 133

What are some features and aims of neuropsychological tests? (Ch 3)

Answer 133

Reliable and valid in detecting brain damage/neural system dysfunction, accurate in locating neural dysfunction, widely available and inexpensive Areas of interest - receptive and expressive language, attention and concentration, memory, motor skills, perceptual abilities, learning and abstraction Test – examination of higher functions, performance in each of these areas and the possible existence of brain impairment Assesses brain dysfunction by observing the effects of the dysfunction on the person’s ability to perform certain tasks (see effects and correlates with neuroimaging) Focuses on the functional and structural as well as the anatomical and pathological aspects of the brain

Question 134

What do neuropsychological tests examine? (Ch 3)

Answer 134

Reliable and valid in detecting brain damage/neural system dysfunction, accurate in locating neural dysfunction, widely available and inexpensive Test – examination of higher functions, performance in each of these areas and the possible existence of brain impairment Assesses brain dysfunction by observing the effects of the dysfunction on the person’s ability to perform certain tasks (see effects and correlates with neuroimaging) Focuses on the functional and structural as well as the anatomical and pathological aspects of the brain

Question 135

What are 3 types of neuropsychological tests? (Ch 3)

Answer 135

(1) Bender Visual-Motor Gestalt Test (2) Luria-Nebraska Neuropsychological Battery (3) Halstead-Reitan Neuropsychological Battery

Question 136

What is the most used neuropsychological test? Describe it (Ch 3)

Answer 136

(1) Bender Visual-Motor Gestalt Test * Individual is given a series of cards on which are drawn various lines and shapes * Individual needs to copy what is drawn * Errors on the test are compared with the results of a control group of the same age * If number of errors exceeds a certain figure, brain function is suspected * Provides a simple screening instrument that is easy to administer and can detect possible issues * Nature and location cannot be determined with this test (therefore, less sophisticated)

Question 137

What are 2 advanced tests that detect and locate neural damage and cognitive dysfunction? (Ch 3)

Answer 137

1) Luria-Nebraska Neuropsychological Battery 2) Halstead-Reitan Neuropsychological Battery

Question 138

What are the 3 subtests for the Halstead-Reitan Neuropsychological Battery? (Ch 3)

Answer 138

1. Rhythm Test (compare rhythmic beats to test sound recognition, attention & concentration) 2. Strength of Grip Test (compares grips of left and right hands) 3. Tactile Performance Test (putting wooden blocks on foam board while blindfolded to test learning and memory skills)

Question 139

What do the Luria-Nebraska Neuropsychological Battery and Halstead-Reitan Neuropsychological Battery assess? (Ch 3)

Answer 139

* These assess a variety of skills in children and adolescents using batteries and are around 80% accurate in detecting brain damage (raise issue of false positives and negatives however)

Question 140

Define false positive (Ch 3)

Answer 140

False positive: Assessment error in which pathology is reported (test results are positive) when none is actually present

Question 141

Define false negative (Ch 3)

Answer 141

False negative: Assessment error in which no pathology is reported (test results are negative) when one is actually present

Question 142

Why are false neuropsychological results particularly troublesome? (Ch 3)

Answer 142

failing to find damage may result in the lack of, sometimes urgent, medical diagnoses and treatment

Question 143

In what process are neuropsychological tests used? (Ch 3)

Answer 143

These are not often used in the diagnosing process but rather in the screening process, meaning they are often paired with other assessments that will aid in and increase the likelihood of finding problems that may be present Often not used unless brain damage is suspected as they are tedious

Question 144

What are the 2 strategies to obtain information for diagnosis? Define them (Ch 3)

Answer 144

(1) Idiographic strategy: Close and detailed investigation of an individual emphasising what makes that person unique, which is compared with the nomothetic information (e.g. demographics) (2) Nomothetic strategy: Identification and examination of large groups of people with the same disorder to note similarities and develop general laws, which is then compared with the idiographic information/a general class of problems to which a presenting problem belongs which will help name or classify this problem (e.g. mood disorder)

Question 145

What are the 4 integral aspects of the diagnosis process? Define them (Ch 3)

Answer 145

* Classification: assignment of objects or people to categories on the basis of shared characteristics (nomothetic strategy) * Taxonomy: System of naming and classification in science/classification of entities for scientific purposes (used in scientific context in psychology  nosology) * Nosology: Classification and naming system of disease, medical and psychological phenomena (system of taxonomy used in all health care settings) * Nomenclature: the actual labels or names of disorders that are applied in a nosology/naming system (e.g. mood disorders in psychopathology)

Question 146

Define idiographic strategy (Ch 3)

Answer 146

Close and detailed investigation of an individual emphasising what makes that person unique, which is compared with the nomothetic information (e.g. demographics)

Question 147

Define nomothetic strategy (Ch 3)

Answer 147

Identification and examination of large groups of people with the same disorder to note similarities and develop general laws, which is then compared with the idiographic information/a general class of problems to which a presenting problem belongs which will help name or classify this problem (e.g. mood disorder)

Question 148

Define classification (Ch 3)

Answer 148

Assignment of objects or people to categories on the basis of shared characteristics (nomothetic strategy)

Question 149

Define taxonomy (Ch 3)

Answer 149

System of naming and classification in science/classification of entities for scientific purposes (used in scientific context in psychology  nosology)

Question 150

Define nomenclature (Ch 3)

Answer 150

The actual labels or names of disorders that are applied in a nosology/naming system (e.g. mood disorders in psychopathology)

Question 151

Define nosology (Ch 3)

Answer 151

Classification and naming system of disease, medical and psychological phenomena (system of taxonomy used in all health care settings)

Question 152

What is the most widely used classification system? Describe it (Ch 3)

Answer 152

DSM-5 - developed in the US but used globally; used to identify specific psychological disorders during the diagnostic process

Question 153

What are alternative nosologies to the DSM-5? (Ch 3)

Answer 153

International Classification of Diseases 10th Edition (ICD-10) developed by the WHO

Question 154

Why is classification of disorders controversial? (Ch 3)

Answer 154

Classification is controversial – question ethical implications of classifying human behaviour (objectification) such as the concepts of ‘normal’ and ‘abnormal’ behaviour

Question 155

What are the 3 approaches to classification and diagnosis? (Ch 3)

Answer 155

3 approaches to classification and diagnosis: (1) (Classical/pure) Categorical approach (2) Dimensional approach (3) Prototypical approach

Question 156

Define classical/pure categorical approach to classification (Ch 3)

Answer 156

Classification method founded on the assumption of clear-cut differences between disorders, each with a different known cause

Question 157

Describe the classical/pure categorical approach to classification (Ch 3)

Answer 157

* Distinct and unique categories of disorders that have little/nothing in common with each other * Causes could be psychological, cultural or pathophysiological but there is only one set of these causative factors per disorder that do not overlap with the others * Each one is fundamentally different from the other = one set of defining criteria for each that needs to be met (individual needs to meet all in order to be diagnosed with specific disorder) * In this case, clinician knows cause of disorder * This approach is useful in the medical field as accurate diagnoses are vital however this may not apply to the psychological field as other factors come into play * Therefore, this is not used as a model of classifying psychopathology due to its complexity

Question 158

Define dimensional approach to classification (Ch 3)

Answer 158

Method of categorising characteristics on a continuum rather than on a binary either-or, or all-or-none, basis

Question 159

Describe the dimensional approach to classification (Ch 3)

Answer 159

Dimensional approach: Method of categorising characteristics on a continuum rather than on a binary either-or, or all-or-none, basis Quantify various attributes of a psychological disorder along several dimensions, resulting in a composite score Variety of cognitions, moods and behaviours of which the patient presents which are applied to a scale (e.g. rating from 1-10) This approach is rarely applied as it has been unsatisfactory and difficult to find a consensus on regarding the number of dimensions required to achieve accurate diagnoses

Question 160

Define prototypical approach to classification (Ch 3)

Answer 160

System for categorising disorders using both essential, defining characteristics and a range of variations on other characteristics

Question 161

Describe the prototypical approach to classification (Ch 3)

Answer 161

Prototypical approach: System for categorising disorders using both essential, defining characteristics and a range of variations on other characteristics An alternative to the other approaches that has received increased support over the years Still a categorical approach but with features of the other 2 – identifies certain essential characteristics of an entity to be classified but includes certain non-essential variations that do not change this classification This method still blurs categorical boundaries and some symptoms may apply to more than one disorder however it best fits requirements in current pathological diagnoses and is user friendly Must meet most essential criteria but do not have to meet all criteria in general (context-dependent)

Question 162

Why is reliability important for classification? And what is the most unreliable area of classification as of now? (Ch 3)

Answer 162

Symptoms/disorder needs to be evident/apparent/consistent and readily identifiable across time and clinicians Failure to do so = bias/unreliability (dependent on nosology and clinician) Most unreliable area of classification – personality disorders (enduring and pervasive trait-like sets of inappropriate/undesired behaviours and emotional reactions that characterise a person’s way of interacting with the world) which clinicians cannot come to a diagnostic consensus on

Question 163

What are the 3 types of diagnostic validity? (Ch 3)

Answer 163

1. Construct validity 2. Predictive/criterion validity 3. Content validity

Question 164

Describe construct validity (Ch 3)

Answer 164

Signs and symptoms chosen as criteria for the diagnostic category are consistently associated with each other and what they identify differs from other categories; * This discriminability may be present in the presenting symptoms, course and treatment of the disorder (e.g. someone meeting the criteria for depression should be distinguishable from someone meeting the criteria for social phobia) * This may also predict familial aggregation

Question 165

Define familial aggression (Ch 3)

Answer 165

The extent to which a disorder is found among a patient’s relatives

Question 166

Describe predictive/criterion validity (Ch 3)

Answer 166

Predictive - valid diagnosis will predict what will happen, the likely course and effect of treatment, with prototypical patient and their presenting disorder * Criterion – when the outcome is the criterion by which the usefulness of the diagnostic category is judged

Question 167

Describe content validity (Ch 3)

Answer 167

* If the criteria for a diagnosis of a disorder are created, it should reflect the way most experts in the field see that disorder – the label needs to be accurate

Question 168

What are the 3 sections of the DSM-5? (Ch 3)

Answer 168

First section – introduces the manual and describes how best to use it Second section – presents psychological disorders Third section – descriptions of disorders that need further research before qualifying as official diagnoses

Question 169

Describe how the DSM-5 originated (Ch 3)

Answer 169

Current version – published in 2013 while working on ICD-11 which was published in 2019 Mainly the same however some changes were made - new disorders were introduced and others reclassified as well as structural and organisational changes in the diagnostic manual

Question 170

What are the features of the DSM-5? (Ch 3)

Answer 170

* Use of dimensional axes for rating severity, intensity, frequency and duration of specific disorders in a relatively uniform manner across all disorders * Cross-cutting dimensional symptom measures – not specific to any disorder but evaluate important symptoms that are often present across disorders in almost all patients (e.g. anxiety or poor sleep) * Dimensions are added to categorical diagnoses in order to provide clinicians with additional information for assessment and treatment (e.g. rating levels of anxiety for a bipolar disorder diagnosis) – prototypical approach

Question 171

Describe the DSM-5-TR (Ch 3)

Answer 171

More current nosological system (2022) TR = additional text representing research literature accompanying the diagnostic category (DSM-5) Updated disorders, naming conventions and refined diagnostic criteria for disorders based on scientific advances and fairness principles/considerations Newly added disorders – prolonged grief disorder, unspecified mood disorder, olfactory reference disorder and mild/major neurocognitive disorder Revised texts concern – prevalence, risk and protective factors, culture & sex/gender related features

Question 172

What are the cultural considerations in the DSM-5? (Ch 3)

Answer 172

DSM-5 emphasises levels of stress in the environment and includes a plan for integrating social and cultural influences on diagnosis (cultural formulation) Culture – values, knowledge and practices that individuals derive from membership in different ethnic, religious or other social groups which may affect their experience with psychological disorders Cultural formulation – allows disorder to be described from the perspective of the patient’s personal experience and primary socio-cultural group Despite the important of cultural inclusion, there is no research supporting the use of these plans

Question 173

What are some critiques of the DSM-5? (Ch 3)

Answer 173

* Some diagnostic decisions are still difficult due to blurred boundaries between categories * Individuals are often diagnosed comorbidly which leads to problems in finding definite conclusions about the course, response to treatment and the likelihood of associated problems of a disorder * Reliability is often prioritised and emphasised at the expense of validity which means statements made during assessment may be of little use * Methods of constructing a nosology of mental disorders have a way of perpetuating definitions that have been passed down over decades even if these definitions are flawed * Some systems are subject to misuse which can be dangerous and harmful * Categories are not permanent or static but ever-evolving and dynamic making diagnosis difficult * Argue that not everything needs to fit neatly somewhere and that disorders are interrelated and exist as part of a spectrum

Question 174

Define comorbidity (Ch 3)

Answer 174

Presence of two or more disorders in an individual at the same time

Question 175

Define labelling (Ch 3)

Answer 175

Applying a name to a phenomenon or pattern of behaviour which may lead to the acquirement of negative or false connotations to an individual rather than just their behaviour

Question 176

Define stigma (Ch 3)

Answer 176

Combination of stereotypes, prejudices, discrimination and negative beliefs directed at a specific group that could lead to reduced life opportunities and increased hardship for this group

Question 177

What are some cautions about labelling and stigma of disorders (Ch 3)

Answer 177

Labelling: applying a name to a phenomenon or pattern of behaviour which may lead to the acquirement of negative or false connotations to an individual rather than just their behaviour If a disorder is associated with impairment in functioning, the label becomes negatively associated and leads to a stigma Stigma: combination of stereotypes, prejudices, discrimination and negative beliefs directed at a specific group that could lead to reduced life opportunities and increased hardship for this group Example – those with ID were labelled as ‘morons’, ‘imbeciles’ and ‘idiots’ which initially used as neutral terms became derogatory as time went by and with increased use; led to a change in DSM-5 labelling which sees it as mild, moderate, severe and profound ID now Labels and stigma lead to – association with negative beliefs, low self-esteem and generalisation Stigmatisation is increasing with time

Question 178

What one symptom do anxiety, OCD and trauma related disorders have in common? (Ch 4)

Answer 178

Anxiety

Question 179

Define anxiety (Ch 4)

Answer 179

Mood state characterised by marked negative affect and bodily symptoms of tension in which an individual apprehensively anticipates future danger or misfortune, which may involve feelings, behaviours and physiological responses

Question 180

What are some differences between anxiety and fear? (Ch 4)

Answer 180

Fear: * Normal, natural and instinctual and adaptive response to immediate/present threats in ones environment which enhances ones survival advantage in the face of danger * Accompanied by a strong behavioural bias to escape as well as a surge in arousal * The individual enters a state of physical readiness to avoid harm and pain and to avert danger * Threats include – lack of air, dangerous people, places and animals, social disapproval and uncertainty * Alarm – on par with the level of danger/threat, which decreases as threat lessens Anxiety: * Pathological and future-oriented mood state of worry about distant threats and potential harm or uncertainty * Howard Liddell (1949) – coined anxiety as the ‘shadow of intelligence’ and saw the human ability to conceive and plan for the future as connected to this feeling of impending danger and the desire to prepare for it * Negative feeling state accompanied by apprehensive thoughts and bodily symptoms such as – muscle tension, increased pulse, dry mouth, altered breathing and soothing behaviours * False alarm – fear/anxiety that exceeds the threat and does not lessen even with the absence of a threat * Can be specific and focused on isolated threats even if no real threat is present These 2 are not the same due to different psychological & physiological reactions but can both be linked to panic

Question 181

Describe fear (Ch 4)

Answer 181

* Normal, natural and instinctual and adaptive response to immediate/present threats in ones environment which enhances ones survival advantage in the face of danger * Accompanied by a strong behavioural bias to escape as well as a surge in arousal * The individual enters a state of physical readiness to avoid harm and pain and to avert danger * Threats include – lack of air, dangerous people, places and animals, social disapproval and uncertainty * Alarm – on par with the level of danger/threat, which decreases as threat lessens

Question 182

Describe anxiety (Ch 4)

Answer 182

* Pathological and future-oriented mood state of worry about distant threats and potential harm or uncertainty * Howard Liddell (1949) – coined anxiety as the ‘shadow of intelligence’ and saw the human ability to conceive and plan for the future as connected to this feeling of impending danger and the desire to prepare for it * Negative feeling state accompanied by apprehensive thoughts and bodily symptoms such as – muscle tension, increased pulse, dry mouth, altered breathing and soothing behaviours * False alarm – fear/anxiety that exceeds the threat and does not lessen even with the absence of a threat * Can be specific and focused on isolated threats even if no real threat is present

Question 183

Define panic (Ch 4)

Answer 183

Sudden, overwhelming fright or terror

Question 184

Define panic attack (Ch 4)

Answer 184

Abrupt experience of intense fear or discomfort accompanied by a number of physical symptoms such as breathing changes, dizziness, tremors, chills or heart palpitations

Question 185

Describe panic (Ch 4)

Answer 185

Came from Greek god (Pan); non-specific, can occur across a range of normal situations, physical conditions and mental disorders not limited to panic disorder (PD); not confined to specific situations however can be expected (cued) and unexpected (uncued); panic attacks are not a disorder but occur across a range of conditions/disorders

Question 186

What are the 2 types of panic attacks? Describe them (Ch 4)

Answer 186

Expected (cued) panic attack – experiencing a panic attack in which you know you are afraid of the thing/situation you are about to encounter however you do not have a panic attack in any other situation; more common in specific phobias Unexpected (uncued) panic attack – experiencing a panic attack out of the blue without a clear trigger/threat or identifiable cause; more common in PD (recurrent panic attacks)

Question 187

What are some symptoms of panic attacks? (Ch 4)

Answer 187

* Heart palpitations, pounding heart or accelerated heart rate * Sweating/chills/heat sensations * Trembling/shaking * Sensations of shortness of breath/smothering/feeling of choking * Chest pain/discomfort * Nausea/abdominal distress * Dizziness/unsteadiness/light-headedness/faintness * Paraesthesias (numbness/tingling sensation) * Derealisation (feelings of unreality)/depresonalisation (detachment from oneself) * Fearing of losing control/going crazy * Fear of dying

Question 188

What are some examples of pathological responses to archetypal threats? Describe them (Ch 4)

Answer 188

1. Panic: * Linked to both fear and anxiety * Most intense expression of fear – strongest panic is smothering (lack of air) 2. Specific phobias & social phobia: * May form from excessive fear and anxiety * Can be instinctual such as fear of spiders or social such as fear of social rejection – social phobia/anxiety 3. Other disorders: * OCD – E.g. threat of contamination/disorderly environments/doubt about potential danger * Generalised anxiety disorder: A vague sense of apprehension, without specific focus, that does not go away - E.g. Threat of uncertainty about the future

Question 189

Are there causes for anxiety disorders? (Ch 4)

Answer 189

There is no singular, one-dimensional cause for emotional reactions but rather many interrelating factors/contributors

Question 190

What are three contributors to anxiety and related disorders? (Ch 4)

Answer 190

1. Biological contributors 2. Psychological contributors 3. Social contributors

Question 191

Describe biological contributors to anxiety disorders (Ch 4)

Answer 191

1) Biological Contributors * Inherited tendency to be tense, uptight and anxious and to panic due to genetics * However, the genetic components that contribute to anxiety and panic may differ * No single gene is a cause for either of these but rather a collection of genes in several areas on chromosomes (meaning they manifest in certain situations) * Genetic vulnerability is not enough to ascertain panic or anxiety problems or disorders – other factors such as stress or environment can trigger these genes

Question 192

How does the brain and anxiety work regarding biological contributors? (Ch 4)

Answer 192

The brain & anxiety: * Anxiety is associated with specific neural systems (anatomical and functional) * Many neurotransmitters are indirectly involved in anxiety pathogenesis (development) – dopamine, serotonin, nor adrenaline and gamma-aminobutyric acid (GABA) * Corticotropin-releasing factor (CBF)  central to expression of anxiety and onset of anxiety through the triggering of groups of genes that increase the likelihood of this system being turned on  does this through – activating the hypothalamic-pituitary-adrenocortical (HPO) axis part of the CBF system  affects brain structures such as - the hippocampus and the amygdala of the limbic system, the brain stem locus coeruleus and the prefrontal cortex  interacts with serotonergic, noradrenergic and GABAergic systems * Area of brain associated with anxiety – limbic system (hippocampus and amygdala) * Limbic system - acts a mediator between the brain steam and cortex * Brain stem – monitors and senses changes in bodily functions and relays info about potential threats via the limbic system to the cortex * Cortex - integration (creating experience/perception)

Question 193

What are 2 circuits/systems that regulate threat responses? (Ch 4)

Answer 193

1. Behavioural Inhibition System (BIS) circuit 2. Fight/Flight System (FFS) circuit

Question 194

Define Behavioural Inhibition System (BIS) (Ch 4)

Answer 194

Brain circuit in the limbic system that responds to threat signals by inhibiting activity and causing anxiety

Question 195

Describe how the BIS circuit regulates threat responses (Ch 4)

Answer 195

1. Behavioural Inhibition System (BIS) circuit * Behavioural Inhibition System: Brain circuit in the limbic system that responds to threat signals by inhibiting activity and causing anxiety * Jeffrey Gray – identified circuit (BIS) in limbic system involved in anxiety in animals that may apply to humans too (septal & hippocampal area  frontal cortex) * Behavioural Inhibition System (BIS) system receives strong amygdalar inputs and is activated by signals from the brain stem of unexpected events such as major changes in bodily functioning that may signal danger * Danger signals arise from brain stem and descend from the cortex to the septal-hippocampal system * This causes the tendency to freeze, experience anxiety and apprehensively assess the situation to confirm if danger is present or not

Question 196

Define Fight/Flight System (FFS) (Ch 4)

Answer 196

Brain circuit in animals that, when stimulated, causes an immediate alarm and escape response resembling human panic, also known as fight, flight and freeze

Question 197

Describe how the FFS circuit regulates threat responses? (Ch 4)

Answer 197

* Fight/flight System: Brain circuit in animals that, when stimulated, causes an immediate alarm and escape response resembling human panic, also known as fight, flight and freeze * Fight/flight system (FFS) – originates in the brain and travels through several midbrain structures (amygdala, hypothalamus and central grey matter) * When stimulated this circuit produces an immediate alarm-and-escape response similar to that in humans * Activated partly by abnormalities in serotoninergic transmission * The activation of the network involving the prefrontal cortex and the amygdala while performing certain tasks can predict responses to CBT

Question 198

What can change the sensitivity of BIS and FFS systems and thus affect the likelihood of anxiety/anxiety disorders? (Ch 4)

Answer 198

Factors in the environment can change the sensitivity of these systems and thus affect the likelihood of anxiety/anxiety disorders

Question 199

What 3 factors contribute to smoking addiction? (Ch 4)

Answer 199

 Anxiety sensitivity - the general tendency to fear bodily sensations  Distress tolerance – the amount of distress a person can tolerate)  Anhedonia – the inability to feel pleasure

Question 200

What is some information collected through brain-imaging about those with anxiety disorders? And what treatment helps with this? (Ch 4)

Answer 200

* The limbic system (including the amygdala) is overly responsive to stimulation/new information (abnormal bottom-up processing) * The cortex is deficient in down-regulating the hyperexcitable amygdala (abnormal top-down processing) Treatment – CBT

Question 201

What is some information collected through brain-imaging about those with panic disorder (PD)? (Ch 4)

Answer 201

* Altered sensitivity of brainstem chemoreceptors is indirectly involved in PD * Panic attacks can be brought about through the delivering of lactic acid in a needle * Lactic acid mimics the biochemical effects of smothering which thus leads to a panic attack

Question 202

What are some problems that induce panic attacks? (Ch 4)

Answer 202

Smothering, phobias and bodily problems

Question 203

How does smothering induce panic attacks? (Ch 4)

Answer 203

 Carbon dioxide pressure increases in the body  Chemoreceptors in the brain stem sense this increase  Systems are triggered to counteract this  These systems induce panic * Phobias – similar process ^^ (e.g. agoraphobia which has a greater occurrence of disequilibrium/unbalanced symptoms) * Bodily problems – heart attacks (often indistinguishable from panic attacks), blood clots, pneumonia, hyperthyroidism, gastrointestinal disease, movement disorders, focal seizures, migraines, medications, substance abuse and alcohol use

Question 204

Describe psychological contributor views of anxiety disorders (Ch 4)

Answer 204

Psychoanalytic view – believed it was caused by a psychic reaction to danger due to the resurgence of dangerous/fearful childhood situations and emotions Behavioural view – product of early classical conditioning, modelling and other forms of learning Current view – combination of psychological factors Personality traits – anxiety sensitivity (tendency to respond fearfully to anxiety symptoms)

Question 205

Describe the psychological contributors of anxiety (Ch 4)

Answer 205

Anxiety: * Views of ability to control life and situations starts in childhood and continues throughout life * This can range from total confidence to extreme uncertainty in one’s own ability to control/deal with future events) * Uncontrollability may develop as a result of environmental, social and personality factors such as upbringing Poor conditions and parenting - ultimately lead to fear and anxiety due to negative views of control (e.g. neglect or overprotectiveness) Good conditions and parenting – healthy coping mechanisms due to positive views of control (e.g. security, safety, protection, love)

Question 206

Describe the psychological contributors of panic (Ch 4)

Answer 206

Panic: * Conditioning and cognition (conditioned/learnt response) * Initial strong fear response to stress (false alarm) or danger (true alarm)  response becomes associated with internal (heart rate/respiration associated with panic attack) & external cues (places/situations associated with panic attack)  these become conditioned stimuli that provoke the fear response  same response to future situations in which danger is not present * Cues/triggers may not be acknowledged as they may be unconscious

Question 207

What are the psychological factors that contribute to vulnerability to anxiety & panic? (Ch 4)

Answer 207

Personality traits and upbringing - sense of control and anxiety sensitivity

Question 208

Describe social contributors to anxiety disorders (Ch 4)

Answer 208

Stressful social and interpersonal events trigger biological and psychological vulnerabilities to anxiety Examples – socioeconomic status, marriage, divorce, dating, breakups, work difficulties, friendship difficulties and physical injuries/illness Poorer social livelihood = increased vulnerability to anxiety How anxiety is viewed, interpreted and treated is dependent on cultural factors

Question 209

What is the main theory of the development of anxiety? (Ch 4)

Answer 209

The triple vulnerability theory

Question 210

What are the three vulnerabilities of the triple vulnerability theory? (Ch 4)

Answer 210

1. First vulnerability (diathesis) – generalised biological vulnerability 2. Second vulnerability (diathesis) – generalised psychological vulnerability 3. Third vulnerability (diathesis) – specific psychological vulnerability

Question 211

Describe the three vulnerabilities of the triple vulnerability theory (Ch 4)

Answer 211

* Generalised biological vulnerability – inherited tendency to be anxious, uptight or highly strung (e.g. irritable/driven disposition) * Generalised psychological vulnerability – grew up with general negative beliefs that world was dangerous and out of one’s control leading to poor coping skills and anxiety as a result of early experiences (e.g. low self-esteem/inability to cope) * Specific psychological vulnerability – learn from early experiences, through learning and teaching, that certain situations/objects are filled with danger even if they are not (e.g. developing fears that parents project onto child such as anxiety about health) Social factors trigger these vulnerabilities and anxiety increases the likelihood of panic

Question 212

Define comorbidity (Ch 4)

Answer 212

Presence of two or more disorders in an individual at the same time

Question 213

Describe the comorbidity of anxiety and related disorders (Ch 4)

Answer 213

Comorbidity: Presence of two or more disorders in an individual at the same time There are high rates of comorbidity amongst anxiety and related disorders – emphasises the shared features, symptoms and vulnerabilities of anxiety and panic These disorders only differ in what triggers the anxiety as well as the pattern of panic attacks Therefore, a single treatment was made that targets a variety of these disorders and cooccurring ones Argument – is a single unified protocol (UP) that can treat various disorders as effective as single disorder protocols (SDP) that focus merely on one disorder; research shows that patients were more likely to complete UP treatment and that both of these treatments seemed to have the same effect for posttreatment and follow-up; UP is more time savvy Studies on comorbidity show:  55% of patients with a principal anxiety/depression diagnosis had at least one additional anxiety/depressive disorder at the time of assessment (76% for separately occurring disorders throughout life)  Most common additional diagnosis for anxiety disorder – major depression (50% of cases)  Additional diagnosis of anxiety increases likelihood of relapsing for substance abuse patients

Question 214

What do studies on comorbidity of anxiety and other disorders show? (Ch 4)

Answer 214

 55% of patients with a principal anxiety/depression diagnosis had at least one additional anxiety/depressive disorder at the time of assessment (76% for separately occurring disorders throughout life)  Most common additional diagnosis for anxiety disorder – major depression (50% of cases)  Additional diagnosis of anxiety increases likelihood of relapsing for substance abuse patients

Question 215

What are the rates of comorbidity amongst anxiety and related disorders? (Ch 4)

Answer 215

There are high rates of comorbidity amongst anxiety and related disorders – emphasises the shared features, symptoms and vulnerabilities of anxiety and panic

Question 216

What is the difference between anxiety and related disorders? (Ch 4)

Answer 216

These disorders only differ in what triggers the anxiety as well as the pattern of panic attacks Therefore, a single treatment was made that targets a variety of these disorders and cooccurring ones

Question 217

What is the argument regarding the treatment of anxiety and related disorders? (Ch 4)

Answer 217

Argument – is a single unified protocol (UP) that can treat various disorders as effective as single disorder protocols (SDP) that focus merely on one disorder; research shows that patients were more likely to complete UP treatment and that both of these treatments seemed to have the same effect for posttreatment and follow-up; UP is more time savvy

Question 218

What do studies on comorbidity between anxiety disorders and physical disorders show? (Ch 4)

Answer 218

 Strong correlation and presence of anxiety along with physical conditions  Includes – thyroid disease, respiratory disease, gastrointestinal disease, arthritis, migraines and allergic conditions  The anxiety disorder often begins before the physical disorder  Comorbidity of these causes greater morbidity and a poorer quality of life  Panic attacks often occur with certain medications  Individuals with physical conditions are not any more likely to have psych disorders however

Question 219

What do studies regarding the link between anxiety disorders and suicide show? (Ch 4)

Answer 219

Studies show:  20% of patients with PD had attempted suicide (attempts associated with PD)  Risk of someone with PD attempting suicide is comparable with someone with depression  Having anxiety disorders increase thoughts about suicide and suicidal attempts  Strong correlation between suicide and mood/anxiety disorders

Question 220

Describe Generalised Anxiety Disorder (GAD) (Ch 4)

Answer 220

* DSM-5 criteria - difficulty controlling excessive anxiety, worry and apprehensive expectations must be present on most days for a period of at least 6 months * Characteristic that distinguishes GAD from other anxiety disorders - worry about minor, everyday life events (major events also become a focus) * Adults - worry about misfortune for children, family health, work responsibilities, etc * Children - worry about academic competence, social performance, family matters, etc * Physical symptoms differ from panic: * Panic - autonomic arousal such as increased heart rate, palpitations, etc) * GAD - muscle tension, headaches, fatigue, poor concentration/attention and sleeping difficulties Insomnia - difficulty sleeping due to rumination which worsens anxiety * Main feature of GAD --> chronically tense

Question 221

What are the types of anxiety disorders? (Ch 4)

Answer 221

* Generalised Anxiety Disorder (GAD) * Panic Disorder and Agoraphobia * Specific Phobia * Social Anxiety Disorder (SAD/Social Phobia) 2 new disorders – separation anxiety disorder and selective mutism

Question 222

Define Generalised Anxiety Disorder (GAD) (Ch 4)

Answer 222

Anxiety disorder characterised by intense, uncontrollable, unfocused, chronic and continuous worry that is distressing and unproductive, accompanied by physical symptoms such as tenseness, irritability and restlessness

Question 223

Describe GAD (clinical description)

Answer 223

* DSM-5 criteria - difficulty controlling excessive anxiety, worry and apprehensive expectations must be present on most days for a period of at least 6 months * Characteristic that distinguishes GAD from other anxiety disorders - worry about minor, everyday life events (major events also become a focus) * Adults - worry about misfortune for children, family health, work responsibilities, etc * Children - worry about academic competence, social performance, family matters, etc * Physical symptoms differ from panic: * Panic - autonomic arousal such as increased heart rate, palpitations, etc) * GAD - muscle tension, headaches, fatigue, poor concentration/attention and sleeping difficulties Insomnia - difficulty sleeping due to rumination which worsens anxiety * Main feature of GAD --> chronically tense

Question 224

What is a characteristic that distinguishes GAD from other anxiety disorders?

Answer 224

worry about minor, everyday life events (major events also become a focus)

Question 225

How do the physical symptoms of panic and GAD differ? (Ch 4)

Answer 225

* Panic - autonomic arousal such as increased heart rate, palpitations, etc) * GAD - muscle tension, headaches, fatigue, poor concentration/attention and sleeping difficulties

Question 226

What do adults and children with GAD worry about?

Answer 226

* Adults - worry about misfortune for children, family health, work responsibilities, etc * Children - worry about academic competence, social performance, family matters, etc

Question 227

Describe the causes of Generalised Anxiety Disorder (GAD) (Ch 4)

Answer 227

* Generalised biological vulnerability & generalised psychological vulnerability (inherit anxious tendencies rather than just GAD itself and sense of uncontrollability) * High levels of anxiety sensitivity - tendency to become distressed in response to arousal-related sensations, which are believed to have harmful consequences * Those who were generally anxious were thought to not be specific enough, thus not diagnosed * Differences between GAD and other anxiety disorders: * Physiological responsivity - do not respond as strongly to stressors compared to others like PD * Low response for physiological measures - heart rate, blood pressure or respiration rate * Autonomic restriction - low cardiac vagal tone (nerve in charge of heart activity) leading to autonomic inflexibility (inability to adjust CNS in response to stressors) as heart is less responsive to certain tasks * Causes: * High sensitivity to threat in general leading to heightened awareness of these threats (may have arisen from generalised psychological vulnerability) * Heightened awareness (especially if threat is personal) seems to be automatic and unconscious * Mental processes of GAD: * Autonomic restrictors - peripheral autonomic arousal is restricted * However, intense cognitive processing is present as seen in brain imaging of the frontal lobes * This suggests that frantic and intense processes and worry are present without images of what is causing this mental state (suggests that this is the reason for autonomic restriction) - avoidance * This process is so energy consuming, none is put into generating images of threats that would give the intense fear responses (negative affect/autonomic activity) like that of other anxiety disorders

Question 228

What are the 3 differences regarding the causes of GAD and other anxiety disorders?

Answer 228

* Differences between GAD and other anxiety disorders: * Physiological responsivity - do not respond as strongly to stressors compared to others like PD * Low response for physiological measures - heart rate, blood pressure or respiration rate * Autonomic restriction - low cardiac vagal tone (nerve in charge of heart activity) leading to autonomic inflexibility (inability to adjust CNS in response to stressors) as heart is less responsive to certain tasks

Question 229

What are the specific causes of GAD?

Answer 229

* High sensitivity to threat in general leading to heightened awareness of these threats (may have arisen from generalised psychological vulnerability) * Heightened awareness (especially if threat is personal) seems to be automatic and unconscious

Question 230

What is the mental process of GAD?

Answer 230

* Mental processes of GAD: * Autonomic restrictors - peripheral autonomic arousal is restricted * However, intense cognitive processing is present as seen in brain imaging of the frontal lobes * This suggests that frantic and intense processes and worry are present without images of what is causing this mental state (suggests that this is the reason for autonomic restriction) - avoidance * This process is so energy consuming, none is put into generating images of threats that would give the intense fear responses (negative affect/autonomic activity) like that of other anxiety disorders

Question 231

Describe the management/treatment of Generalised Anxiety Disorder (GAD) (Ch 4)

Answer 231

* Treatment - therapeutic and pharmacological are most effective * Pharmacological treatment (2 approaches) * First approach - acute symptomatic relief can be achieved with time limited use of anxiolytic agents an beta-antagonists which are lower-acting and lower-potency agents which reduces dependence on these; benzodiazepines like these can have negative side effects (e.g. delirium) so use is limited\ * Second approach - long-term management in which anti-depressants are useful; effective with newer and older agents * Psychological/therapeutic treatments * More effective in long term than ^^ * Treatments have been designed to help people with GAD process threatening images and the negative affect that comes with these instead of avoiding them and these feelings * Along with this, they help teach patients how to relax deeply to combat tension * CBT is efficient as the patient learns how to use CT and other coping techniques to counteract and control worry; this was more effective than stress education over a 6 month period as well as adaptations to these treatments * More potent types of both treatments are needed leading to the introduction of a new psychological treatment - procedures, along with CT, aimed at encouraging acceptance and tolerance rather than avoidance of distressing thoughts and feelings * Patients tend to have metacognitions - cognitions (beliefs) about cognitions (worrying) - newer therapy is aimed at increasing tolerance to uncertainty about the future as well as changing beliefs about worrying * Children: * There is strong evidence that psychological treatments help children with GAD - CBT and antidepressants (Zoloft) combination were very effective compared to placebo pills * Those with impairing anxiety, greater caregiver strain and a principal diagnosis of social anxiety had less favourable outcomes however * Mindfulness-based therapies are rising in use and showing positive results, as well as in adults * Best approach - exclusion of physical causes/contributors to anxiety

Question 232

What are the most effective treatments for GAD?

Answer 232

* Treatment - therapeutic and pharmacological are most effective

Question 233

What are the 2 pharmacological treatment approaches for GAD?

Answer 233

* Pharmacological treatment (2 approaches) * First approach - acute symptomatic relief can be achieved with time limited use of anxiolytic agents an beta-antagonists which are lower-acting and lower-potency agents which reduces dependence on these; benzodiazepines like these can have negative side effects (e.g. delirium) so use is limited\ * Second approach - long-term management in which anti-depressants are useful; effective with newer and older agents

Question 234

Describe psychological/therapeutic treatments for GAD

Answer 234

* More effective in long term than ^^ * Treatments have been designed to help people with GAD process threatening images and the negative affect that comes with these instead of avoiding them and these feelings * Along with this, they help teach patients how to relax deeply to combat tension * CBT is efficient as the patient learns how to use CT and other coping techniques to counteract and control worry; this was more effective than stress education over a 6 month period as well as adaptations to these treatments * More potent types of both treatments are needed leading to the introduction of a new psychological treatment - procedures, along with CT, aimed at encouraging acceptance and tolerance rather than avoidance of distressing thoughts and feelings * Patients tend to have metacognitions - cognitions (beliefs) about cognitions (worrying) - newer therapy is aimed at increasing tolerance to uncertainty about the future as well as changing beliefs about worrying

Question 235

Describe psychological treatments for children with GAD

Answer 235

* Children: * There is strong evidence that psychological treatments help children with GAD - CBT and antidepressants (Zoloft) combination were very effective compared to placebo pills * Those with impairing anxiety, greater caregiver strain and a principal diagnosis of social anxiety had less favourable outcomes however * Mindfulness-based therapies are rising in use and showing positive results, as well as in adults * Best approach - exclusion of physical causes/contributors to anxiety

Question 236

What are the diagnostic criteria for GAD? (Ch 4)

Answer 236

Diagnostic criteria for GAD: * Excessive anxiety and worry occurring often for at least 6 months about a number of events or activities * Difficulty controlling worry * Associated with 3+ of these symptoms – restlessness/on edge, easily fatigued, difficulty concentrating, irritability, muscle tension and sleep disturbance * Anxiety, worry or physical symptoms cause distress/impairment in areas of functioning * Disturbance is not attributable to substance use or a medical condition * Not better explained by another mental disorder

Question 237

Describe the integrated model of GAD (Ch 4)

Answer 237

Integrated model of GAD Generalised biological vulnerability + generalised psychological vulnerability  stress (due to life events) Stress  Anxious apprehension (muscle tension/hypervigilance) Anxious apprehension  Worry process (failed attempt to cope and problem solve) Worry process  intense cognitive process  inadequate problem-solving skills  GAD AND Worry process  avoidance of imagery  restricted autonomic response  GAD

Question 238

Define Panic Disorder (PD) (Ch 4)

Answer 238

Recurrent unexpected panic attacks accompanied by concern about future attacks and/or a lifestyle change to avoid future attacks

Question 239

Define agoraphobia (Ch 4)

Answer 239

Anxiety disorder characterised by anxiety about being in places/situations from which escape might be difficult in the event of panic symptoms or other unpleasant physical symptom

Question 240

Define anticipatory anxiety (Ch 4)

Answer 240

Anxiety about experiencing anxiety/panic and the avoidance of situations that may lead to this

Question 241

Describe PD and agoraphobia (Ch 4)

Answer 241

* Agoraphobia is often accompanied by panic symptoms or PD * Very interrelated however some people experience PD without having agoraphobia and vice versa (most of the time they cooccur however); some also just experience panic attacks without having either * PD: * Criteria for PD - must experience an unexpected panic attack and develop anxiety over the possibility of having another/avoid situations due to implications that come with the panic attack (see each attack as impending death/doom) * Agoraphobia: * Origins - coined by Westphal in 1871; means 'fear of the marketplace' * Most avoidant behaviour is a result of severe, unexpected panic attacks (want to be in a safe and secure place) * Anxiety diminishes if individual believes they are in a safe location and with safe people, even if nothing can be done is something bad did occur * A rapid escape plan is always thought of before leaving the home * Can become independent to panic attacks - individual who has not had a panic attack for years may still have strong agoraphobic avoidance or tendencies * In fact, many have never had any panic attacks or fear associated with them (around 50% of those with the disorder) * These individuals may have other forms of unexpected distress/complication - e.g. loss of bladder control, dizziness * Agoraphobic avoidance seems to be determined by the extent to which one thinks/expects they may have another panic attack rather than how many/how severe past attacks were * Agoraphobia is thus a coping mechanism for unexpected panic attacks * Other methods for coping with panic attacks - substance and alcohol abuse and intense dread endurance through goal making * Both of these also often display interoceptive avoidance (avoidance of internal physical sensations) * This involves these individuals from removing themselves from situations/activities that may produce physiological arousal that resembles the start of a panic attack (e.g. exercising)

Question 242

Describe the causes of PD & agoraphobia (Ch 4)

Answer 242

* Biological, psychological and social factors * Biological/psychological - panic attacks and PD * Social - evidence supports the notion that agoraphobia often develops after an individual has unexpected panic attacks, however whether it develops and how severe it becomes is socially and culturally dependent Triple vulnerability theory: Generalised biological vulnerability - stronger tendency to have an emergency alarm reaction (unexpected attack) when confronted with stressful events (and sometimes positive events); associations become associated with internal and external cues that were present during panic attack; next time these arise (e.g. exercise), first response becomes distress; learnt alarms - cues become associated with a number of different internal and external stimuli through learning Generalised psychological vulnerability Specific psychological vulnerability (SPV) - tendency to believe that unexpected bodily sensations are dangerous, learnt through childhood * 8-12% of people have occasional panic attacks but only 5% develop anticipatory anxiety for future (criteria for PD) * Those who do not develop this seem to attribute the attack to events rather than themselves * Clark theories on cognitive processes in PD - emphasises SPV ^^ in those with PD as interpreting normal physical sensation in a negative/catastrophic way; anxiety that arises during these events, in turn, produces more physical sensations because of the SNS which are perceived as even more dangerous - leads to a vicious cycle * Hypothesis - PD and agoraphobia develop from psychodynamic causes; this suggests early object loss/separation anxiety may predispose someone to develop PD and agoraphobia as an adult (little evidence supports this however) * Those with agoraphobia tend to have dependent personality tendencies

Question 243

What are some things and situations often avoided by those with agoraphobia? (Ch 4)

Answer 243

* Shopping malls/shops/supermarkets/restaurants/movies * Being far from home/ staying at home alone * Transportation/wide streets * Tunnels/ lifts/escalators * Waiting in line * Crowds * Walking in intense heat/cold * Exercise related activities – running up stairs, aerobics, lifting heavy objects, dancing, standing quickly, sports, sexual relations * Getting involved in heated debates/getting angry * Showering with doors and windows closed * Drinking caffeine

Question 244

Describe the management/treatment of PD & agoraphobia (Ch 4)

Answer 244

Medication: * focused on serotonergic, noradrenergic and GABAergic are most effective * Preferred and most used medication for PD - SSRIs and high potency benzodiazepines which provide acute relief by halting attacks (these lead to high dependence so should be avoided for long-term use) * 60% success rate in stopping panic however 20% become non-compliant with high rates of relapse Psychological Intervention: * Quite effective for PD and agoraphobia * Exposure Therapy (ET) - reducing agoraphobic avoidance by using strategies/conditions in which the patient faces feared situations and learn that there is no threat/nothing to fear; this is convinced through focus on the emotional experience and reality testing the situation; sometimes accompanied by therapist/sometimes therapist helps structure own exercises (least to most difficult) with many anxiety-reducing coping mechanisms such as relaxation techniques, this combination is especially helpful for those with agoraphobia (with/without PD) helping around 70% of patients * Panic Control Therapy (PCT) - directly treat PD; involves exposing patients with PD to the cluster of interoceptive (physical) sensations that remind them of their panic attacks; patients may also be asked to exercise to bring up these sensations and other methods; quite effective however there is relapse; this has led to adding booster sessions after therapy to prevent this (decrease relapse rates compared to therapy without booster sessions); these are relatively new treatments and not yet available to every patient due to the advanced training that is required to administer these * Cognitive Therapy (CT) - identify unconscious attitudes and perceptions concerning the dangerousness of the feared yet objectively harmless situations Combined treatment: * Patients tend to already be taking medication * CBT alone seems to be better than combined treatment however antidepressants taken before therapy lead to earlier improvement * CBT added to those who already take medication resulted in significant further improvement compared to those without prior medication (stepped care approach - starting with one treatment and adding another may be better than combined treatments from the beginning) * Seems to be no advantage to combining treatments and psychological treatments seem to perform better in the long run, this should be offered initially followed by antidepressant treatment for patients who did not respond best to initial treatment or for those who do not have access to psychological treatment

Question 245

What are the diagnostic criteria for panic disorder (PD)? (Ch 4)

Answer 245

* Recurrent unexpected panic attacks * At least one attack is followed by one+ month of one or both of these symptoms – persistent concern/worry about additional panic attacks and their consequences or significant maladaptive change in behaviour related to the attacks (avoidance behaviours) * Disturbance is not attributable to the physiological effects of a substance/medical condition * Not better explained by another mental disorder

Question 246

What are the diagnostic criteria for agoraphobia? (Ch 4)

Answer 246

* Marked fear/anxiety about 2 or more of the following situations:  Using public transportation  Being in open spaces  Being in enclosed places  Standing in line/being in a crowd  Being outside the home alone * Fears/avoids situations due to thoughts that escape may be difficult or help may not be available in the event of developing panic-like or embarrassing symptoms * Agoraphobic situations almost always provoke fear/anxiety * Agoraphobic situations are actively avoided, require presence of companion or are endured with intense fear/anxiety * Fear/anxiety is not proportionate to actual danger posed * Fear, anxiety or avoidance causes severe distress/impairment in areas of functioning * Not better explained by another mental disorder

Question 247

Describe the model of the causes of PD (with & without agoraphobia) (Ch 4)

Answer 247

Generalised biological vulnerability + generalised psychological vulnerability  stress (due to life events) Stress  False Alarm False alarm  Association with somatic sensations (interoceptive cues such as increased heart rate) Association with somatic sensations  Learnt Alarm Learnt Alarm  Specific psychological vulnerability (unexplained physical sensations are dangerous) Specific psychological vulnerability  Anxious apprehension (focused on somatic sensations) Anxious apprehension  PD AND/OR Anxious apprehension  Development of agoraphobia (determined by socio-cultural factors)  PD & agoraphobia

Question 248

Define Specific phobia (Ch 4)

Answer 248

Unreasonable/irrational fear of a specific object/situation that markedly interferes with daily life functioning

Question 249

Describe Specific Phobia (clinical description)

Answer 249

* Early versions of DSM-5 - 'simple' phobia * Specific fears of a variety of objects/situations is common amongst the population leading to trivialisation of serious disorders like SP which can be disabling (know fear is disproportionate to the threat but go to great lengths to avoid) * Major characteristic of phobias - marked fear and anxiety about a specific object/situation * Most people suffering from phobia tend to have more than 1 type of phobia

Question 250

Describe SP and its subtypes (Ch 4)

Answer 250

* Early versions of DSM-5 - 'simple' phobia * Specific fears of a variety of objects/situations is common amongst the population leading to trivialisation of serious disorders like SP which can be disabling (know fear is disproportionate to the threat but go to great lengths to avoid) * Major characteristic of phobias - marked fear and anxiety about a specific object/situation * Most people suffering from phobia tend to have more than 1 type of phobia * 4 major subtypes of specific phobia: * Blood-injection-injury phobia * Situational phobia - e.g. planes, lifts, enclosed spaces * Natural environment phobia - e.g. heights, storms, water * Animal phobia * Other phobia - do not fit into any of these ^^; e.g. situations leading to choking, vomiting, contracting illness & loud sounds Blood-injection-injury phobia: Unreasonable fear and avoidance of exposure to blood, injury or the possibility of an injection, leading to physical symptoms such as fainting or a drop in blood pressure * Difference between this type and other phobias - physiological reaction and most inheritable than any other phobia * Why it runs so strongly in families - inherit a strong vasovagal response to blood, injury or injections which lead to fainting * This phobia seems to form based on the response to these objects rather than the objects themselves * Average age of onset - 9 years old Situational phobia: Anxiety involving enclosed places or public transportation (e.g. claustrophobia or flying) * Experts first believed situational phobia was similar to PD & agoraphobia as * they tend to emerge mid-teens to mid-20s (similar time frame) * Extent to which they run in families (inheritability) is similar (30% have the same or similar phobia as relatives) * Main difference between these --> people with situational never experience panic attacks outside the context of their phobic object/situation while those with PD can experience unexpected, uncued panic attacks at any time Natural environment phobia: Fear of situations or events in nature, especially heights, storms and water * These fears seem to cluster together (high likelihood they cooccur) * Mild or moderate fear can stem from the need to survive in these somewhat dangerous objects/situations * We may be genetically predisposed (sensitivity) to be afraid of these (adaptive means) * Average age of onset - 7 years old * Have to be persistent, last for more than 6 months and interfere with functioning to be phobias Animal phobia: Unreasonable, enduring fear of animals or insects that usually develop in early life * Common fear however only becomes a phobia if it persists and interferes * Can even lead to avoidance of leaving the house * Age of onset - 7 years old

Question 251

What are the 4 major subtypes of specific phobia?

Answer 251

* 4 major subtypes of specific phobia: * Blood-injection-injury phobia * Situational phobia - e.g. planes, lifts, enclosed spaces * Natural environment phobia - e.g. heights, storms, water * Animal phobia * Other phobia - do not fit into any of these ^^; e.g. situations leading to choking, vomiting, contracting illness & loud sounds

Question 252

Define blood-injection-injury phobia

Answer 252

Unreasonable fear and avoidance of exposure to blood, injury or the possibility of an injection, leading to physical symptoms such as fainting or a drop in blood pressure

Question 253

Describe blood-injection-injury phobia

Answer 253

Blood-injection-injury phobia: Unreasonable fear and avoidance of exposure to blood, injury or the possibility of an injection, leading to physical symptoms such as fainting or a drop in blood pressure * Difference between this type and other phobias - physiological reaction and most inheritable than any other phobia * Why it runs so strongly in families - inherit a strong vasovagal response to blood, injury or injections which lead to fainting * This phobia seems to form based on the response to these objects rather than the objects themselves * Average age of onset - 9 years old

Question 254

Define situational phobia

Answer 254

Anxiety involving enclosed places or public transportation (e.g. claustrophobia or flying)

Question 255

Describe situational phobia

Answer 255

Situational phobia: Anxiety involving enclosed places or public transportation (e.g. claustrophobia or flying) * Experts first believed situational phobia was similar to PD & agoraphobia as * they tend to emerge mid-teens to mid-20s (similar time frame) * Extent to which they run in families (inheritability) is similar (30% have the same or similar phobia as relatives) * Main difference between these --> people with situational never experience panic attacks outside the context of their phobic object/situation while those with PD can experience unexpected, uncued panic attacks at any time

Question 256

Define natural environment phobia

Answer 256

Fear of situations or events in nature, especially heights, storms and water

Question 257

Describe natural environment phobia

Answer 257

Natural environment phobia: Fear of situations or events in nature, especially heights, storms and water * These fears seem to cluster together (high likelihood they cooccur) * Mild or moderate fear can stem from the need to survive in these somewhat dangerous objects/situations * We may be genetically predisposed (sensitivity) to be afraid of these (adaptive means) * Average age of onset - 7 years old * Have to be persistent, last for more than 6 months and interfere with functioning to be phobias

Question 258

Define animal phobia

Answer 258

Unreasonable, enduring fear of animals or insects that usually develop in early life

Question 259

Describe animal phobia

Answer 259

Animal phobia: Unreasonable, enduring fear of animals or insects that usually develop in early life * Common fear however only becomes a phobia if it persists and interferes * Can even lead to avoidance of leaving the house * Age of onset - 7 years old

Question 260

Describe the 3 general causes of SP

Answer 260

* 3 general causes: * Biological factors - Inherited tendency & susceptibility to anxiety (may be caused by genes, epigenetic effects, modelling or combination) * Psychological factors - direct experience * Social - vicarious experience & information transmission (unacceptable for males to have fears in some cultures thus most reported phobias are from women; men may overcome fears through exposure or endure them quietly; intensity of reported fear seems to be based on gender roles rather than biological sex)

Question 261

Describe the 3 specific causes of SP

Answer 261

3 specific causes: * Experience - direct experience - directly experiencing a traumatic event that leads to phobia; where real danger/pain results and raises a true alarm (e.g. choking/drowning experience); vicarious experience - experiencing a false alarm (panic attack) or observing someone else experience severe fear (vicarious); information transmission - fear conditioning through repeatedly being told about danger * Inherited tendency - general psychological vulnerability * Susceptibility to anxiety - general psychological vulnerability * Many do not develop it from direct experience (true alarm) but from panic attacks (false alarm) * Vicarious experience is also a common cause (emotions are contagious and repeated exposure can have negative effects) * Traumatic experience is not enough to develop phobia, needs to be accompanied by anxiety about experiencing another future traumatic event or false alarm as well as the avoidance of situations in which this may occur * Difference between those with normal fear & those with phobia --> anxiety and general psychological vulnerability

Question 262

Describe the causes of SP (Ch 4)

Answer 262

* 3 general causes: * Biological factors - Inherited tendency & susceptibility to anxiety (may be caused by genes, epigenetic effects, modelling or combination) * Psychological factors - direct experience * Social - vicarious experience & information transmission (unacceptable for males to have fears in some cultures thus most reported phobias are from women; men may overcome fears through exposure or endure them quietly; intensity of reported fear seems to be based on gender roles rather than biological sex) 3 specific causes: * Experience - direct experience - directly experiencing a traumatic event that leads to phobia; where real danger/pain results and raises a true alarm (e.g. choking/drowning experience); vicarious experience - experiencing a false alarm (panic attack) or observing someone else experience severe fear (vicarious); information transmission - fear conditioning through repeatedly being told about danger * Inherited tendency - general psychological vulnerability * Susceptibility to anxiety - general psychological vulnerability * Many do not develop it from direct experience (true alarm) but from panic attacks (false alarm) * Vicarious experience is also a common cause (emotions are contagious and repeated exposure can have negative effects) * Traumatic experience is not enough to develop phobia, needs to be accompanied by anxiety about experiencing another future traumatic event or false alarm as well as the avoidance of situations in which this may occur * Difference between those with normal fear & those with phobia --> anxiety and general psychological vulnerability

Question 263

Describe the management/treatment of SP (Ch 4)

Answer 263

* Structured and consistent exposure-based approaches - should be accompanied by therapeutic supervision rather than alone as individuals may take on too much too soon and worsen the issue which is counterproductive * If individual experiences panic attacks in process, therapists can guide them with PD treatments like programmes * For blood-injection-injury phobia gradual exposure and exercises are necessary to avoid fainting - e.g. tensing muscles so blood pressure does not drop; some of these phobias can be treated in a single session - patient then practices alone at home while checking in with therapist; phobia often disappears as well as internal response * Brain-imaging shows changes in brain functioning (neural activity); responsiveness in these areas is diminished while prefrontal cortical areas showed increased use indicating rational thinking; brain is 'rewired' * Some pharmacological treatment is effective in reducing distress but does not directly address phobias, just aid in therapy

Question 264

What are the diagnostic criteria for specific phobia (including subtypes)? (Ch 4)

Answer 264

* Marked fear/anxiety about a specific object/situation * Phobic object/situation almost always provokes immediate fear/anxiety * Phobic object/situation is actively avoided/endured with intense fear/anxiety * Fear/anxiety is not proportionate to actual danger posed * Fear/anxiety or avoidance is persistent, typically lasting for 6+ months * Fear, anxiety or avoidance causes severe distress/impairment in areas of functioning * Not better explained by another mental disorder

Question 265

Describe the model of ways specific phobia may develop (Ch 4)

Answer 265

1. Generalised biological vulnerability  Stress  False Alarm  Learnt Alarm  Generalised psychological vulnerability  Specific Phobia 2. Generalised biological vulnerability  Direct experience  True Alarm  Learnt Alarm  Generalised psychological vulnerability  Specific Phobia 3. Generalised biological vulnerability  Vicarious experience  True Alarm  Learnt Alarm  Generalised psychological vulnerability  Specific Phobia 4. Specific psychological vulnerability (specific object/situation is dangerous)  Generalised psychological vulnerability  Specific Phobia

Question 266

Define Social Anxiety Disorder (SAD) (Ch 4)

Answer 266

Extreme, enduring and irrational fear and avoidance of social or performance situations

Question 267

Describe SAD (Ch 4)

Answer 267

* SAD subtypes: * Social anxiety * Performance anxiety: * usually have no difficulty with social interaction but find it extremely difficult performing tasks in front of others * Feelings of shame and embarrassment arise which are worsened by possibility of others seeing this * Common type of performance anxiety - public speaking, eating in restaurant, writing in front of others, stage fright * Anxiety provoking physical reactions - blushing, sweating and trembling/shaking * Main feature of this type - anxiety is only present when others are present and only diminished when gone

Question 268

What are the 2 subtypes of SAD?

Answer 268

* Social anxiety * Performance anxiety:

Question 269

Describe performance anxiety

Answer 269

* usually have no difficulty with social interaction but find it extremely difficult performing tasks in front of others * Feelings of shame and embarrassment arise which are worsened by possibility of others seeing this * Common type of performance anxiety - public speaking, eating in restaurant, writing in front of others, stage fright

Question 270

What are some physical reactions that occur during SAD?

Answer 270

* Anxiety provoking physical reactions - blushing, sweating and trembling/shaking

Question 271

What is the main feature of SAD?

Answer 271

* Main feature of this type - anxiety is only present when others are present and only diminished when gone

Question 272

Describe the causes of SAD (Ch 4)

Answer 272

* Biological, Psychological and Social: * Prepared by evolution to fear certain animals and dangerous situations; including us social animals - hostile/angry = danger (attacking or killing) which leads to avoidance; those who avoided may be more likely to survive (survival adaptation) * Biased to fear, angry, critical and rejecting people because of the need to belong which increases chance of survival * Studies - we learn more quickly to fear angry expressions that other expressions and this fear diminishes more slowly than other types of learning; SAD seem to be more likely to remember more critical expressions than 'normal' individuals and seem to react to angry faces with greater activation of the limbic system (emotional) and less cortical (rational) control; most threatening area of face - eyes * Temperamental traits such as shyness/emotional inhibition = excessive behavioural inhibition leads to increased risk of developing phobic behaviour (similar causes to PD and specific phobia) * 3 pathways - generalised biological vulnerability, generalised psychological vulnerability and specific psychological vulnerability * Generalised biological vulnerability: 1. Biological tendency to be socially inhibited and/or develop anxiety; belief that stressful events are potentially uncontrollable increases vulnerability; anxiety/self-focused attention may be present without a false alarm when stressed which could lead to disrupted performance 2. If a false alarm (panic attack) occurs under stress in a social situation, it can become associated with that situation due to conditioned social cues - individual thus becomes anxious about further false alarms in future similar situations 3. Individual may experience an actual social trauma resulting in a true alarm, leading anxiety to develop, through conditioning, for future social situations (this experience could go back to childhood - 92% of adults with SAD experienced childhood social trauma) * Specific psychological vulnerability: 1. Must have the belief that social evaluation in particular can be dangerous creating a vulnerability to develop social anxiety 2. Some are predisposed to focus on anxiety during social events, according to evidence 3. Studies - parents of SAD individuals are more socially fearful/concerned with others opinions than those with PD (genetic component); relatives of them also have a greater risk of developing this; also an overlap of SAD with avoidant personality disorder (very similar with similar causes)

Question 273

What are the 3 pathways that cause SAD?

Answer 273

* 3 pathways - generalised biological vulnerability, generalised psychological vulnerability and specific psychological vulnerability * Generalised biological vulnerability: 1. Biological tendency to be socially inhibited and/or develop anxiety; belief that stressful events are potentially uncontrollable increases vulnerability; anxiety/self-focused attention may be present without a false alarm when stressed which could lead to disrupted performance 2. If a false alarm (panic attack) occurs under stress in a social situation, it can become associated with that situation due to conditioned social cues - individual thus becomes anxious about further false alarms in future similar situations 3. Individual may experience an actual social trauma resulting in a true alarm, leading anxiety to develop, through conditioning, for future social situations (this experience could go back to childhood - 92% of adults with SAD experienced childhood social trauma) * Specific psychological vulnerability: 1. Must have the belief that social evaluation in particular can be dangerous creating a vulnerability to develop social anxiety 2. Some are predisposed to focus on anxiety during social events, according to evidence 3. Studies - parents of SAD individuals are more with socially fearful/concerned with others opinions than those with PD (genetic component); relatives of them also have a greater risk of developing this; also an overlap of SAD with avoidant personality disorder (very similar with similar causes)

Question 274

Describe the management/treatment of SAD (Ch 4)

Answer 274

* Why is SAD maintained - presence of repeated exposure of social cues leads to avoidant behaviour that reduces chances of rejection; this avoidance prevents individuals from evaluating negative beliefs about embarrassment from interaction * CT - emphasises real life experiences during therapy to disprove automatic perceptions of danger (effective for 84% after 1 year follow-up); this treatment is superior to secondary treatment - interpersonal psychotherapy (IPT) - immediately after and 1 year follow-up even in specialised centres for treatment) * Other approaches - such as social mishap exposures target specific negative beliefs by confronting them with actual consequences of social mishaps/embarrassing events (had a 82% completion rate and 73% response rate maintained over 6 months) * Brain imaging before treatment can predict responses to CBT treatments (extent to which the reduce anxiety symptoms in SAD) * CBT effectiveness - leads to changes in emotional processing in brain which reduces anxiety symptoms in SAD, improve functioning in social settings * Family and individual treatments - both are effective however family-based ones seem to outperform individual ones when parents also have an anxiety disorder (individuals with parent component tend to be more diagnosis free following treatment and helps prevent onset of disorders in children with anxious parents) * Pharmacological - not much evidence to support effectiveness of medication like beta-antagonists/SSRIs; only medication vs medication + therapy = medication + therapy is more effective however this combination is no more effective than just CBT * Current studies however show that adding d-cycloserine to CBT enhances the effects of treatment as it speeds up therapy but does not increase a full course of CBT

Question 275

Explain why SAD is maintained

Answer 275

* Why is SAD maintained - presence of repeated exposure of social cues leads to avoidant behaviour that reduces chances of rejection; this avoidance prevents individuals from evaluating negative beliefs about embarrassment from interaction

Question 276

What psychological treatments help with SAD?

Answer 276

* CT - emphasises real life experiences during therapy to disprove automatic perceptions of danger (effective for 84% after 1 year follow-up); this treatment is superior to secondary treatment - interpersonal psychotherapy (IPT) - immediately after and 1 year follow-up even in specialised centres for treatment) * Other approaches - such as social mishap exposures target specific negative beliefs by confronting them with actual consequences of social mishaps/embarrassing events (had a 82% completion rate and 73% response rate maintained over 6 months) * Brain imaging before treatment can predict responses to CBT treatments (extent to which the reduce anxiety symptoms in SAD) * CBT effectiveness - leads to changes in emotional processing in brain which reduces anxiety symptoms in SAD, improve functioning in social settings * Family and individual treatments - both are effective however family-based ones seem to outperform individual ones when parents also have an anxiety disorder (individuals with parent component tend to be more diagnosis free following treatment and helps prevent onset of disorders in children with anxious parents)

Question 277

What pharmacological treatments help with SAD?

Answer 277

* Pharmacological - not much evidence to support effectiveness of medication like beta-antagonists/SSRIs; only medication vs medication + therapy = medication + therapy is more effective however this combination is no more effective than just CBT * Current studies however show that adding d-cycloserine to CBT enhances the effects of treatment as it speeds up therapy but does not increase a full course of CBT

Question 278

What are the diagnostic criteria for SAD? (Ch 4)

Answer 278

Diagnostic criteria for SAD: * Marked fear about one or more social situations in which the individual is exposed to possible scrutiny from others, including social interactions, being observed or performing in front of others (must occur in peer and adult setting for children) * Fear that one will act in a way, or show anxiety symptoms, that will be negatively evaluated * The social situations almost always provoke fear/anxiety * Social situation are actively avoided/endured with intense fear/anxiety * Fear/anxiety is not proportionate to actual danger posed * Fear/anxiety or avoidance is persistent, typically lasting for 6+ months * Fear, anxiety or avoidance causes severe distress/impairment in areas of functioning * Not attributable to effects of substance use/medical condition * Not better explained by another mental disorder

Question 279

Describe the model of ways SAD may develop (Ch 4)

Answer 279

Model of ways SAD may develop: Generalised biological vulnerability  Stressors  Direct experience  True Alarm  Learn Alarm  Anxious Apprehension  Specific psychological vulnerability  SAD Generalised biological vulnerability  Stressors  Direct experience  False Alarm  Learnt Alarm  Anxious Apprehension  Specific psychological vulnerability  SAD Generalised biological vulnerability  Stressors  True Alarm  Learnt Alarm  Anxious Apprehension  Specific psychological vulnerability  SAD Generalised biological vulnerability  Stressors  No Alarm  Anxious Apprehension  Specific psychological vulnerability  SAD Generalised psychological vulnerability  Stressors  No Alarm  Anxious Apprehension  Specific psychological vulnerability  SAD Generalised psychological vulnerability  Stressors  False Alarm  Learnt Alarm  Anxious Apprehension  Specific psychological vulnerability  SAD Generalised psychological vulnerability  Stressors  Direct experience  True Alarm  Learnt Alarm  Anxious Apprehension  Specific psychological vulnerability  SAD Generalised psychological vulnerability  Stressors  True Alarm  Learnt Alarm  Anxious Apprehension  Specific psychological vulnerability  SAD

Question 280

Define selective mutism: (Ch 4)

Answer 280

Developmental disorder characterised by the individual's consistent failure to speak in specific social situations despite speaking in other situations/lack of speaking in one or more settings in which speaking is socially expected

Question 281

Describe selective mutism (Ch 4)

Answer 281

* Driven by social anxiety - strong evidence to support this hypothesis as there are high rates of comorbidity of SM and anxiety disorders, especially SAD (studies show nearly 100% comorbidity) * Not due to lack of knowledge of speech, physical difficulties or another disorder in which speaking may be impaired such as ASD * Occurs in some settings and not in others * Diagnostic criteria: lack of speech must occur for 1+ months and cannot be limited to the first month of school * Around 0.5% of children have it, girls more affected than boys

Question 282

Describe the causes of selective mutism (Ch 4)

Answer 282

* Social anxiety * Lack of speech in SM rather than other socially anxious behaviours is seemingly due to, according to evidence, well-meaning parents enabling this behaviour by being more ready to intervene and talk for them

Question 283

Describe the management/treatment of selective mutism (Ch 4)

Answer 283

Same cognitive behavioural principles used to treat social anxiety in children but with a greater emphasis on speech

Question 284

What are the types of trauma and stressor-related disorders? (Ch 4)

Answer 284

* Trauma and Stress Related Disorders * Post-Traumatic Stress Disorder (PTSD) * Prolonged Grief Disorder

Question 285

Describe trauma and stressor-related disorders? (Ch 4)

Answer 285

Formerly separate groups but are now combined – all based on stressful/traumatic life events Include – attachment disorders (inadequate/abusive child-rearing practices), adjustment disorders (persistent anxiety and depression following a life stressor), PTSD and acute stress disorder (severe reactions to trauma) Investigators conclude that these disorders do not fit as neatly with other classes as previously assumed as these all share an instigating stressful event followed by intense emotional responses A wide range of emotions – rage, horror, guilt and shame, fear and anxiety – may be involved in their onset, especially for PTSD

Question 286

Define Post-Traumatic Stress Disorder (Ch 4)

Answer 286

Enduring and distressing emotional disorder that follows exposure to severe helplessness or a fear-inducing threat in which the victim relives the trauma, avoids stimuli associated with it, develops a numbing of responsiveness and an increased vigilance and arousal

Question 287

Describe PTSD (Ch 4)

Answer 287

* Exposure to a traumatic event during which an individual experiences or witnesses death or threatened death, actual or threatened serious injury or actual or threatened sexual violation * Also includes indirect exposure such as learning that it happened to a close one or through repeated exposure to details of a traumatic event through information transmission * Characteristics and criteria: * victim re-experiences the event through disturbing memories * difficulty sleeping along with disturbing and intrusive dreams and nightmares * avoids any cues associated with it * restricts or numbs emotional responsiveness (which may impact relationships) * sometimes unable to remember certain aspects of event * becomes chronically over-aroused, easily startled, irritable, easily provoked and quick to anger * reckless or destructive behaviour due to arousal and reactivity * need at least one + months of symptoms following the traumatic event * Flashback - memories that are autonomous with a specific vivid quality and accompanied by strong emotion * Subtype & other types - dissociative PTSD (do not necessarily re-experience phenomena or hyper-arousal but have less arousal accompanied by dissociative feelings of unreality, detachment, depersonalisation and derealisation); these individuals seem to respond somewhat differently to treatment compared to typical PTSD; PTSD with delayed onset - individuals show few or no symptoms immediately after or for months or years following event to then develop full-blown PTSD later on (not yet clear why) * To account for the symptoms immediately following event - acute stress disorder was introduced * Acute stress disorder - evolves into PTSD if disturbance persists (occurs to around 50% of individuals however 52% of those with PTSD did not meet criteria for acute stress disorder), differs from PTSD in that dissociative symptoms are more prominent * Other similar descriptions - war fatigue and shell shock bossies (South African)

Question 288

What are the characteristics and criteria of PTSD?

Answer 288

* Characteristics and criteria: * victim re-experiences the event through disturbing memories * difficulty sleeping along with disturbing and intrusive dreams and nightmares * avoids any cues associated with it * restricts or numbs emotional responsiveness (which may impact relationships) * sometimes unable to remember certain aspects of event * becomes chronically over-aroused, easily startled, irritable, easily provoked and quick to anger * reckless or destructive behaviour due to arousal and reactivity * need at least one + months of symptoms following the traumatic event * Flashback - memories that are autonomous with a specific vivid quality and accompanied by strong emotion

Question 289

What are the subtypes and other types of PTSD?

Answer 289

* Subtype & other types - dissociative PTSD (do not necessarily re-experience phenomena or hyper-arousal but have less arousal accompanied by dissociative feelings of unreality, detachment, depersonalisation and derealisation); these individuals seem to respond somewhat differently to treatment compared to typical PTSD; * PTSD with delayed onset - individuals show few or no symptoms immediately after or for months or years following event to then develop full-blown PTSD later on (not yet clear why) * To account for the symptoms immediately following event - acute stress disorder was introduced

Question 290

Define acute stress disorder

Answer 290

evolves into PTSD if disturbance persists (occurs to around 50% of individuals however 52% of those with PTSD did not meet criteria for acute stress disorder), differs from PTSD in that dissociative symptoms are more prominent * Other similar descriptions - war fatigue and shell shock bossies (South African)

Question 291

Describe the causes of PTSD (Ch 4)

Answer 291

* Relates to the precipitating event - experiencing trauma and developing a disorder as a result of it * Not all people who experience a traumatising event develop PTSD however * Likelihood of actually developing it depends on 4 things ---> biological, psychological and social factors AND intensity of the event * Man-made disasters are more prone to cause PTSD than natural disasters * Those who develop PTSD have generalised biological vulnerability and generalised psychological vulnerability during the event (greater vulnerability = greater chance it will develop) * Generalised biological vulnerability --> family history of anxiety leads to predisposition/personality; little to no evidence that single genes are the cause however (note: the presence of the short allele of the serotonin transporter gene correlates with increased risk of depression and acute stress symptoms) * Characteristics and factors that increase risk for PTSD development - tendency to be anxious (externalising problems) and minimal education (due to increased exposure to traumatic events) * Characteristics and factors that decrease risk for PTSD development - higher intelligence * Thus, existing vulnerabilities may determine the kind of environment and experiences people have Generalised psychological vulnerability --> early experiences with unpredictable/uncontrollable events * High levels of trauma - vulnerabilities did not matter much; high % still developed PTSD because of intensity of event * Mild levels of trauma - vulnerabilities matter much more as they determine response * Types of early experiences that lead to a sense of uncontrollability/danger - family instability * Biomarkers (biological individual characteristics) that increase likelihood of PTSD development - emotional reactivity to stressors and strong physiological symptoms (shortness of breath, tingling, sweating, etc) and anxiety Social factors --> strong and supportive group of close ones lead to a decrease in likelihood of developing PTSD (similar cross-culturally as the reaction to trauma is similar across cultures) * Why - as social animals, a strong & caring support group affects biological and psychological responses to stress * Changes in brain - reduce cortical secretion and HPA activity in children during stress; neurobiological systems alter the CRF responses and HPA axis activity (common symptom of PTSD) may be directly related to changes in brain structure and function (e.g. damage to the hippocampus as this area is involved in regulation of the HPA axis and in memory encoding); thus hippocampal pathology which is decreased in volume correlates with PTSD and increased arousal/deficiencies in memory * Alarm reaction (panic attack) is similar in PD and PTSD but in PD the alarm is false, in PTSD the initial alarm is true (danger is present); if this alarm is intense/severe enough, a learnt/conditioned response may develop which leads to a similar/the same reaction when stimuli that remind the individual of the event are present ; anxiety about potential future uncontrollable emotional experiences may form (e.g. flashbacks); anxiety development depends on vulnerabilities * Dissociation may play a role - causes lesions of neural networks and may produce flashbacks, restriction and dissociative symptoms

Question 292

Describe the management/treatment of PTSD (Ch 4)

Answer 292

* Most effective approach - patient should face the original trauma, process the intense emotions and develop coping procedures * Psychoanalytic therapy - catharsis (reliving emotional trauma to relieve emotional suffering); important to arrange exposure in a way that is therapeutic rather than reinforcing trauma; this can be especially difficult as many patients have repressed memories and the emotions associated with it * Traumatic events are difficult to recreate, best strategy for this --> imaginal exposure - content of the trauma and emotions associated with it are worked through systematically by getting individuals to repeatedly and vividly imagine a situation, or activity to reduce intense negative emotions; this narrative that is created between victim and therapist is reviewed extensively in therapy * Effects - exposure practices may be strengthened by strategically timing the exposure treatment with sleep (due to extinction learning - the process by which a previously learned behaviour or conditioned response weakens and eventually disappears when it is no longer reinforced or presented with the conditioned stimulus - which occurs during sleep and the reduced anxiety that comes with quality sleep * CBT - utilised as part of ^^ treatment to address negative assumptions/beliefs about the trauma such as blaming oneself or feeling guilt/shame * Preventing development - using early, structured interventions as soon after traumatic event as possible * These psychoanalytic approaches seem to be more effective than medication * Nonetheless, pharmacological treatment can also be effective - antidepressants (SSRIs) are helpful as they relieve severe anxiety and panic attacks as well as depressive symptoms; mood stabilising agents may reduce flashbacks and irritability; beta-antagonists may diminish risk of developing PTSD symptoms

Question 293

What are the diagnostic criteria for PTSD (Ch 4)

Answer 293

Diagnostic criteria for PTSD: * Exposure to actual/threatened death, serious injury or sexual violence in one/more of the following ways:  Directly experiencing traumatic event  Witnessing, in person, the event as it occurred to others  Learning that the event occurred to a close one (in actual/threatened cases, event must have been violent/accidental)  Experiencing repeated/extreme exposure to aversive details of traumatic event * Presence of one or more of the following symptoms, after the event has occurred:  Recurrent, involuntary and intrusive distressing memories of the traumatic event  Recurrent distressing dreams in which the content and/or affect of the dream are related to the traumatic event  Dissociative reactions (e.g. flashbacks) in which the individual feels or acts as if the traumatic event is recurring (complete loss of awareness = most extreme)  Intense/prolonged distress at exposure to internal or external cues that symbolise or resemble as aspect of the traumatic event  Marked physiological reactions to internal/external cues that symbolise or resemble as aspect of the traumatic event * Persistent avoidance of stimuli associated with traumatic event as evidenced by:  Avoidance of or effort to avoid distressing memories, thoughts, feelings or conversations about or closely associated to traumatic event  Avoidance of or effort to avoid external reminders that arouse distressing memories, thoughts, feelings or conversations about or closely associated to traumatic event * Negative alterations in cognitions and mood associated with traumatic event, beginning or worsening after traumatic event, as evidenced by 2 or more of the following:  Inability to remember an important aspect of the traumatic event typically due to dissociative amnesia and not other factors like brain injury  Persistent and exaggerated negative beliefs/expectations about oneself, others or the world  Persistent distorted cognitions about the cause or consequences of the traumatic event that lead individual to blame themselves  Persistent negative emotional state  Markedly diminished interest/participation in significant activities  Feelings of detachment from others  Persistent inability to experience positive emotions * Marked alterations in arousal and reactivity associated with traumatic event as evidenced by 2 or more of the following:  Irritable behaviour and angry outbursts typically expressed as verbal/physical aggression towards people or objects  Reckless/self-destructive behaviour  Hypervigilance  Exaggerated startle response  Problems with concentration  Sleep disturbance * Duration of the disturbance is more than one month * Disturbance causes extreme distress/impairment in areas of functioning * Not attributable to substance use/medical condition * Not better explained by another disorder

Question 294

Describe the model of the causes of PTSD (Ch 4)

Answer 294

Model of the causes of PTSD: Generalised biological vulnerability  experience of trauma  true alarm  learnt alarm  anxious apprehension  avoidance/numbing of emotional response  moderated by social support and ability to cope  PTSD Generalised psychological vulnerability  experience of trauma  true alarm  learnt alarm  anxious apprehension  avoidance/numbing of emotional response  moderated by social support and ability to cope  PTSD

Question 295

Define Prolonged Grief Disorder (Ch 4)

Answer 295

Disorder in which a bereaved person experiences intense longing for and preoccupation with the deceased and a range of other symptoms that make it difficult to move on with life even after a year or more has passed (6+ months for children)

Question 296

Describe PGD (Ch 4)

Answer 296

* Acute grief - changes in emotion, thoughts and behaviours * Most cases - feelings of grief diminish over time and loss becomes integrated into lives * For some, the process of adaptation is prolonged and may intensify with the passage of time instead of diminishing * Estimated to occur in 9.8% to 11% of adults experiencing grief (many experiencing it after covid) * Intense grief can produce a traumatic reaction Disorders included in PGD: * Adjustment disorders: anxious or depressive reactions to life stress that are generally milder than acute stress disorder or PTSD but still cause impairment; life stress may affect - academic performance and cause discipline and prosocial behaviour problems; stressful events would not be considered traumatic but individual still finds it difficult to cope; if symptoms persist after 6 months of removing stressors, disorder would be considered chronic; this diagnosis is often used for those that do not have an identifiable life stressor leading to little research * Attachment disorders: disturbed and developmentally inappropriate maladaptive behaviours in children, onset before 5 years of age, in which child is unwilling to form normal attachment relationships with care-giving adults due to inadequate/abusive child-rearing practices (may be due to constant changes of primary caregiver or neglect in the home; failure to meet child's basic emotional needs; these disorders are seen as pathological reactions to early extreme stress 2 types of attachment disorders: * Reactive attachment disorder: Attachment disorder in which a child with disturbed behaviour neither seeks out a caregiver nor responds to offers of help from one, fearfulness and sadness are evident; lack responsiveness, have limited positive affect and additional emotional reactivity * Disinhibited social engagement disorder: Condition in which a child shows no inhibitions whatsoever in approaching adults; may engage in inappropriately intimate behaviour by showing a willingness to immediately accompany an unfamiliar adult figure somewhere without checking in with a caregiver first (may be due to early, persistent and harsh punishment)

Question 297

What are the 2 disorders included in PGD? Describe them

Answer 297

Disorders included in PGD: * Adjustment disorders: anxious or depressive reactions to life stress that are generally milder than acute stress disorder or PTSD but still cause impairment; life stress may affect - academic performance and cause discipline and prosocial behaviour problems; stressful events would not be considered traumatic but individual still finds it difficult to cope; if symptoms persist after 6 months of removing stressors, disorder would be considered chronic; this diagnosis is often used for those that do not have an identifiable life stressor leading to little research * Attachment disorders: disturbed and developmentally inappropriate maladaptive behaviours in children, onset before 5 years of age, in which child is unwilling to form normal attachment relationships with care-giving adults due to inadequate/abusive child-rearing practices (may be due to constant changes of primary caregiver or neglect in the home; failure to meet child's basic emotional needs; these disorders are seen as pathological reactions to early extreme stress

Question 298

What are the 2 types of attachment disorders in PGD?

Answer 298

2 types of attachment disorders: * Reactive attachment disorder: Attachment disorder in which a child with disturbed behaviour neither seeks out a caregiver nor responds to offers of help from one, fearfulness and sadness are evident; lack responsiveness, have limited positive affect and additional emotional reactivity * Disinhibited social engagement disorder: Condition in which a child shows no inhibitions whatsoever in approaching adults; may engage in inappropriately intimate behaviour by showing a willingness to immediately accompany an unfamiliar adult figure somewhere without checking in with a caregiver first (may be due to early, persistent and harsh punishment)

Question 299

Describe the causes of PGD (Ch 4)

Answer 299

* Biological, psychological and social factors - increase likelihood of grief progressing to PGD (vulnerabilities similar to other disorders)

Question 300

Describe the management/treatment of PGD (Ch 4)

Answer 300

Treatments similar to PTSD but adapted for prolonged grief

Question 301

What are the diagnostic criteria for PGD? (Ch 4)

Answer 301

Diagnostic criteria for PGD: * Death, at least 12 months ago, of a person who was close to the bereaved individual (6 months for children) * Since death, development of a persistent grief response characterised by one or both of the following symptoms which have been present most days to a significant degree:  Intense longing for the deceased person  Preoccupation with thoughts/memories of the deceased person * Since death, at least 3 of the following symptoms have been present most days to a significant degree:  Identity disruption (feeling as if a part of oneself has died) since the death  Marked sense of disbelief about the death  Avoidance of reminders that the person is dead  Intense emotional pain related to the death  Difficulty reintegrating into one’s relationships and activities after death  Emotional numbness as a result of the death  Feeling that life is meaningless as a result of the death  Intense loneliness as a result of the death * Disturbance causes significant distress/impairment in areas of functioning * Duration and severity of the bereavement reaction exceed expected social, cultural or religious norms for their context * Symptoms are not better explained by substance use, medical condition or another disorder

Question 302

Define Somatic Symptom Disorder (Ch 6)

Answer 302

Disorder involving extreme and long-lasting focus on multiple physical symptoms, for which no medical cause is evident, associated with distress and maladaptive use of health care resources. Formerly known as ‘somatisation disorder’ and has incorporated the formerly separate diagnostic entity of pain disorder which was historically known as ‘Briquet’s syndrome’

Question 303

List the defining features of the Somatic Symptom group in the DSM-5

Answer 303

Defining features of the Somatic Symptom group in the DSM-5: * Disproportionate and extreme beliefs and focus on physical/bodily symptoms that impair daily functioning * Disproportionate response lasts  6+ months * Exaggerate possible causes/consequences of objectively minor somatic symptoms * Become very anxious and constantly scan information about an illness * Avoid situations/behaviours they believe are related to illness * Emotional distress/impairment in response to symptoms is excessive and may worsen conditions if they are present

Question 304

Define Dissociative Disorder (Ch 6)

Answer 304

Disorder in which individuals feel detached from themselves or their surroundings in which their reality, experience and identity may disintegrate; dissociation involves the failure of integration of the mental modules that constitute the totality of human experience

Question 305

List the defining features of the Dissociative group in the DSM-5 (Ch 6)

Answer 305

* Feeling removed from oneself and surroundings * Feeling alienated from a body part or setting in which they feel unreal * Sense of dreaming/unreality * Sensory experiences are altered/detached from consciousness or identity * Loss of personality/self-identity

Question 306

What were SSD and DD both combined and categorised as? (Ch 6)

Answer 306

These 2 groups of disorders are strongly linked and share common features (not well understood) Were both combined and categorised as  ‘hysterical neurosis’

Question 307

Describe how the term 'hysterical neurosis' came about

Answer 307

Hysterical neurosis - thought to primarily occur in women due to their biology but later referred to more general physical symptoms without a known organic cause/condition or histrionic behaviour (also associated with women) Conversion hysteria – Freud suggested this condition where unexplained physical symptoms indicated the conversion of unconscious emotional conflicts into a more acceptable form; term ‘conversion’ remains but without theoretical implications however term ‘hysterical’ is not used anymore Neurosis – suggests a specific cause for certain disorders; neurotic disorders resulted from underlying anxiety caused by unconscious conflicts and the implementation of ego defence mechanisms; this term was removed as it was too vague, implied a specific but unproven cause and could be applied to almost all non-psychotic disorders

Question 308

What are the five basic somatic symptom and related disorders? (Ch 6)

Answer 308

1. Somatic symptom disorder 2. Illness anxiety disorder 3. Psychological factors affecting medical condition 4. Conversion disorder 5. Factitious disorder All of these share the feature of the individual being concerned with the functioning of their bodies

Question 309

Describe how SSD came about (Ch 6)

Answer 309

Briquet (1859) – patients with long lists of physical complaints yet no medical basis/cause would return just with variations despite no diagnosis; initially called ‘Briquet’s syndrome’ and later ‘somatisation disorder’ and later ‘SSD’ in DSM-5

Question 310

What is the main feature of SSD? (Ch 6)

Answer 310

Main feature  person’s belief that they are suffering or will develop a serious illness/disease based on the misinterpretation of the symptom ‘picture/image’ they have which causes extreme anxiety/worry/distress

Question 311

What are the features of SSD? (Ch 6)

Answer 311

Features of SSD  severe impairment, suffered in past from symptoms, do not feel urgency to take action but continually feel weak and ill, avoid exercising/activities that worsen symptoms, entire life revolves around symptoms, views that symptoms are linked to one’s identity (poor image of oneself without symptoms), psychological factors exacerbate the pain whether is a reason for it or not, anxiety and distress compound the severity and impairment

Question 312

Describe the 'sick role' in relation to SSD (Ch 6)

Answer 312

‘Sick role’ – introduced by Parsons (1950s) which suggests that a person who has fallen ill is not only physically ill but has adopted a social role of being sick with its rights and obligations based on the social norms (rights – sick person is not responsible for sickness and is exempt from certain social responsibilities & sick person has an obligation to try to get well and cooperate with treatment efforts)

Question 313

What are the diagnostic criteria for SSD? (Ch 6)

Answer 313

Diagnostic criteria for SSD: * One or more somatic symptoms are distressing and/or result in significant disruption of daily life * Excessive thoughts, feelings and behaviours related to the somatic symptoms or associated health concerns as manifested by at least one of the following:  Disproportionate and persistent thoughts about the seriousness of one’s symptoms  High levels of health-related anxiety  Excessive time and energy devoted to these symptoms or health concerns * Although any one symptom may not be continuously present, the state of being symptomatic is persistent for around 6 months * Specify if:  Predominantly involves pain (previously pain disorder)  Persistent – severe symptoms, marked impairment and long duration (6 months)  Mild (only one symptom); moderate (2+ symptoms) or severe (2+ symptoms along with multiple somatic symptoms or one severe symptom)

Question 314

What is the target of treatment for SSD? (Ch 6)

Answer 314

Target of treatment  target psychological experiences and behaviours focused on somatic symptoms Important note – pain is real for these patients, whether there are clear physical reasons or not

Question 315

Define Illness anxiety disorder (Ch 6)

Answer 315

A somatic symptom disorder characterised by severe anxiety or belief in having a disease process without any evident physical cause in which the occurrence of actual somatic/bodily symptoms is not prominent

Question 316

What was IAD previously known as? (Ch 6)

Answer 316

Previously known as hypochondriasis

Question 317

What are the features of IAD? (Ch 6)

Answer 317

Features of IAD  symptoms are either not experienced at present time or are very mild; severe anxiety is focused on the possibility of having/developing a serious disease (difference between this an SSD – SSD would involve having severe symptoms along with anxiety/distress), little complaint about having somatic symptoms despite having serious anxiety; concern with idea of being sick rather than actual physical symptoms (threat feels real nonetheless)

Question 318

What are the diagnostic criteria for IAD? (Ch 6)

Answer 318

Diagnostic criteria for IAD: * Preoccupation with having/acquiring a serious illness * Somatic symptoms are not present (mild if present) * Preoccupation is excessive or disproportionate if another medical condition is present or if there is a high risk for developing one * High level of anxiety about health and individual is easily alarmed about personal health status * Individual performs excessive health related behaviours (repeatedly checking body for signs of illness) or exhibits maladaptive avoidance (avoiding doctor’s appointments) * Illness preoccupation has been present for at least 6 months but the specific illness that is feared may change over that period of time * The illness-related preoccupation is not better explained by another mental disorder * Specify if the individual is care seeking or care avoidant in type

Question 319

Describe SSD and IAD (Ch 6)

Answer 319

* Defining feature - anxiety/fear of serious disease - concern with idea rather than actual physical symptoms * Features of IAD: * Anxiety and disease conviction (mistaken and persistent belief one has a disease despite reassurance and evidence they do not) * Preoccupation is with bodily/somatic sensations and symptoms, misinterpreting them as indicative of a serious illness * Focus on bodily functions such as heart rate/perspiration or symptoms such as a cough, aches or fatigue * Can be general (ache/fatigue) or specific * Any symptom can be basis for concern - whether its minor or not * Go to doctors often and only a mental health professional after medical condition has been ruled out * Reassurance from doctors is short term, doubt/worry that something may be missed, leading to repeated visits Differences between SSD and PD: PD: * Typically fear immediate symptom related catastrophes that may occur during panic attacks, lessening between attacks * Continue to believe attacks will kill them but learn quickly to stop going to doctor's appointments after evidence is denies this * Focus on 10-15 symptoms associated with panic attacks SSD: * Typically fear and focus on long-term process of illness and disease * Continue to seek opinions of doctors in an attempt to rule out or confirm disease * More likely to demand unnecessary medical treatments * Remain unconvinced despite assurance * Concerns range much wider than symptoms just associated with panic attacks * IAD + SSD - share features with mood and anxiety disorders, especially PD (correlation between anxiety and somatic symptoms) * These ^^ are often comorbid (anxiety and mood disorders are usually additions to SSD/IAD)

Question 320

What is the defining feature of SSD and IAD?

Answer 320

* Defining feature - anxiety/fear of serious disease - concern with idea rather than actual physical symptoms

Question 321

What are the features of IAD?

Answer 321

* Features of IAD: * Anxiety and disease conviction (mistaken and persistent belief one has a disease despite reassurance and evidence they do not) * Preoccupation is with bodily/somatic sensations and symptoms, misinterpreting them as indicative of a serious illness * Focus on bodily functions such as heart rate/perspiration or symptoms such as a cough, aches or fatigue * Can be general (ache/fatigue) or specific * Any symptom can be basis for concern - whether its minor or not * Go to doctors often and only a mental health professional after medical condition has been ruled out * Reassurance from doctors is short term, doubt/worry that something may be missed, leading to repeated visits

Question 322

What are the differences between SSD and PD?

Answer 322

* Defining feature - anxiety/fear of serious disease - concern with idea rather than actual physical symptoms * Features of IAD: * Anxiety and disease conviction (mistaken and persistent belief one has a disease despite reassurance and evidence they do not) * Preoccupation is with bodily/somatic sensations and symptoms, misinterpreting them as indicative of a serious illness * Focus on bodily functions such as heart rate/perspiration or symptoms such as a cough, aches or fatigue * Can be general (ache/fatigue) or specific * Any symptom can be basis for concern - whether its minor or not * Go to doctors often and only a mental health professional after medical condition has been ruled out * Reassurance from doctors is short term, doubt/worry that something may be missed, leading to repeated visits Differences between SSD and PD: PD: * Typically fear immediate symptom related catastrophes that may occur during panic attacks, lessening between attacks * Continue to believe attacks will kill them but learn quickly to stop going to doctor's appointments after evidence is denies this * Focus on 10-15 symptoms associated with panic attacks SSD: * Typically fear and focus on long-term process of illness and disease * Continue to seek opinions of doctors in an attempt to rule out or confirm disease * More likely to demand unnecessary medical treatments * Remain unconvinced despite assurance * Concerns range much wider than symptoms just associated with panic attacks * IAD + SSD - share features with mood and anxiety disorders, especially PD (correlation between anxiety and somatic symptoms) * These ^^ are often comorbid (anxiety and mood disorders are usually additions to SSD/IAD)

Question 323

Describe the causes of SSD and IAD (Ch 6)

Answer 323

* Cognition/perception problems with emotional contributions: * Cycle of SSD: * Faulty interpretation of physical signs and sensations as evidence of physical illness * Focus on oneself increases arousal and make physical sensations feel more intense than they are, leading to increased anxiety * Increased anxiety - produces additional physical symptoms; process begins again * Studies - use of Stroop test showed that individuals with SSD & IAD show enhanced perceptual sensitivity to illness cues and tend to interpret ambiguous stimuli as threatening leading to quickly becoming aware of any sign of possible illness; would rather be prepared than regret not checking, thus many doctor visits; have a restrictive idea that health = symptom free; show consistent cognitive errors about meaning/consequences of somatic symptoms * What causes pattern of somatic sensitivity/distorted belief: * Biological factors - inherited through genetics (may be non-specific) * Psychological - tendency to view life events as unpredictable and uncontrollable, leading to caution and worry * Why does this anxiety focus on physical sensations and illness: * Possible individuals have learnt through upbringing to focus their anxiety on specific physical conditions/illness, like anxiety with PD Factors that contribute to SSD & IAD: * These seem to develop in the context of a stressful life event (correlation between stress and somatic symptoms) * Individuals who develop these disorders tend to have had a disproportionate incidence of disease in family when they were young (carry strong memories of illness that could become focus of anxiety) * Social influence - if illness is a major issue in families, individual learns that an ill person often gets a lot of attention (benefits of sick role - less responsibilities and more attention; positive consequences of sick role are called a secondary gain) * Studies - show strong link between SSD/IAD and antisocial personality disorder (ASPD) characterised by vandalism, persistent lying, theft, irresponsibility and physical aggression (insensitive to signals of punishment, negative consequences of behaviour & guilt); occurs primarily in males while SSD is primarily in females * Shared features ^^ --> begin early in life, tend to run in families (genetically or through upbringing), typically run a chronic course, predominate among lower socioeconomic class, difficult to treat and associated with marital conflict, substance and alcohol abuse and suicidal attempts * Similar causes ^^ -->neuropsychological vulnerability & neurobiologically based disinhibition syndrome characterised by impulsive behaviour - many behaviours/traits of these reflect the impulsive characteristic of short-term gain at the expense of long-term problems (symptomatic gains lead to attention and then decrease until social isolation occurs); SSD individuals tend to be more impulsive and pleasure seeking than other disorders * Why do these disorders manifest differently then? - social and cultural factors such as gender roles - degree of dependence and aggression; males are seen as more aggressive and less dependent and therefore associated with, females are seen as more dependent and less aggressive and therefore associated with SSD

Question 324

Explain the cycle of SSD

Answer 324

* Cycle of SSD: * Faulty interpretation of physical signs and sensations as evidence of physical illness * Focus on oneself increases arousal and make physical sensations feel more intense than they are, leading to increased anxiety * Increased anxiety - produces additional physical symptoms; process begins again

Question 325

Describe the factors that contribute to SSD and IAD

Answer 325

Factors that contribute to SSD & IAD: * These seem to develop in the context of a stressful life event (correlation between stress and somatic symptoms) * Individuals who develop these disorders tend to have had a disproportionate incidence of disease in family when they were young (carry strong memories of illness that could become focus of anxiety) * Social influence - if illness is a major issue in families, individual learns that an ill person often gets a lot of attention (benefits of sick role - less responsibilities and more attention; positive consequences of sick role are called a secondary gain) * Studies - show strong link between SSD/IAD and antisocial personality disorder (ASPD) characterised by vandalism, persistent lying, theft, irresponsibility and physical aggression (insensitive to signals of punishment, negative consequences of behaviour & guilt); occurs primarily in males while SSD is primarily in females * Shared features ^^ --> begin early in life, tend to run in families (genetically or through upbringing), typically run a chronic course, predominate among lower socioeconomic class, difficult to treat and associated with marital conflict, substance and alcohol abuse and suicidal attempts * Similar causes ^^ -->neuropsychological vulnerability & neurobiologically based disinhibition syndrome characterised by impulsive behaviour - many behaviours/traits of these reflect the impulsive characteristic of short-term gain at the expense of long-term problems (symptomatic gains lead to attention and then decrease until social isolation occurs); SSD individuals tend to be more impulsive and pleasure seeking than other disorders * Why do these disorders manifest differently then? - social and cultural factors such as gender roles - degree of dependence and aggression; males are seen as more aggressive and less dependent and therefore associated with, females are seen as more dependent and less aggressive and therefore associated with SSD

Question 326

Describe the management/treatment of SSD and IAD (Ch 6)

Answer 326

* Little knowledge on treatment * Targets of therapy --> providing reassurance, reducing stress and reducing frequency of help-seeking behaviours * To limit doctor visits - gatekeeper physician is assigned to each patient to screen all physical complaints and authorise visits to doctors * To reduce stress and reassurance needs - methods of interacting with others for support are encouraged in order to develop healthy social and personal adjustment without relying on being 'sick" (CBT may be most helpful for this) Check page 227 for other treatments

Question 327

Define conversion disorder (Ch 6)

Answer 327

Physical malfunctioning, such as blindness or paralysis, suggesting neurological impairment but with no organic pathology to account for it

Question 328

What is another name for conversion disorder? (Ch 6)

Answer 328

Functional Neurological Symptom Disorder

Question 329

Describe conversion disorder (Ch 6)

Answer 329

Conversion disorder: Physical malfunctioning, such as blindness or paralysis, suggesting neurological impairment but with no organic pathology to account for it * Was combined with somatisation disorder and referred to as hysteria, conversion reaction or dissociation reaction * Hysteria/conversion was seen as a disturbance in selective attention (somatic in DSM-5 & dissociative in ICD-11) * Freud - anxiety from unconscious conflicts was somehow 'converted' into physical symptoms * FNSD - used by neurologists for conversion diagnoses and because patients prefer the term * Functional - refers to a symptom without an organic cause * Symptoms can be divided into 4 faculties of influence: (check page 230 for symptoms) * Motor symptoms * Sensory symptoms * Pseudo-seizure symptoms * Mixed symptoms * These symptoms are not characterised by other typical neurological and anatomical conditions * Practitioners should be aware of the possibility of this condition * Symptoms of this disorder do not follow typical patterns expected from ^^ problems and may be inconsistent or contradictory Closely related disorders to conversion disorders: * Malingering: Intentionally deceitful presentation of physical or psychological symptoms or dysfunction for gain, in the presence of an external, identifiable motivation such as avoiding prosecution or to gain undue monetary reward * Difficult to differentiate between conversion disorder and malingering as the distinguishing sign (la belle indifference) is not consistent however do not need to distinguish these for a diagnosis unless it is obviously fake through definite evidence * Factors that can help distinguish ^^ --> CD symptoms are often caused by stress in the form of physical injuries; those with CD seem to be unaware of the ability to function normally even though they are able to (e.g. those with CD blindness will avoid objects in their visual field but still complain that they cannot see anything) - may help distinguish between conversion reactions and organic physical disorders (doing something when they feel they cannot); however it is important to not misdiagnose an actual neurological condition with CD (as this happens in 4% of cases); thus medical causes need to be considered and ruled out before diagnosing CD * Some conversion symptoms involve movements that are perceived as involuntary but what makes movements voluntary/involuntary? - use fMRI scans to compare brain activity during movements and during a voluntary (malingered) movement and showed differences in brain activity * Check page 231 for distinctions between these * La belle indifference: lack of distress in the presence of apparently serious symptoms, sometimes encountered in conversion disorder * The unconcerned attitude towards illness is not always the case as some conversion disorder individuals experience distress * Neurological disorders - those involving sensory or motor symptoms such as brain tumours, basal ganglia disease or MS can be considered for alternative diagnoses * SSD may have a similar presentation to CD (difference = need to be compatible symptoms for SSD, whereas CD does not) * Factitious disorder: intentionally deceitful production of physical or psychological symptoms or dysfunction in the absence of an external motivation but to assume the sick role * Previously known as Munchausen's syndrome - named after Baron Munchausen who was a patient with this description * no identifiable secondary gain but there is a primary gain to resolve intrapsychic tension (sick role) * To diagnose this, interview should include extensive obtaining of information and outside source data * Common among people who: * Received extensive medical treatment as children * Carry a grudge against the medical profession * Have worked in medically related fields where substantial knowledge of illnesses may have been gained These individuals often have no social support, few relationships and little family support * Characteristic of FD --> pseudologia fantastica (limited info is mixed with extensive and colourful fantasies about life stories such as pathological lying) * Factitious disorder imposed on another/Munchausen syndrome by proxy - when a close one/family member or someone else purposely makes another sick (form of abuse) through using extreme tactics to create the appearance of illness or to actual make person ill; person is often successful in alluding suspicion * Procedures to assess possibility of FD imposed on another --> trial separation of the two individuals or video surveillance of the individual while in hospital (almost all perpetrators and victims are mothers with child - often due to mothers history of maltreatment and other psychiatric disorders)

Question 330

What 4 faculties can the symptoms of conversion disorder be divided into?

Answer 330

* Symptoms can be divided into 4 faculties of influence: (check page 230 for symptoms) * Motor symptoms * Sensory symptoms * Pseudo-seizure symptoms * Mixed symptoms * These symptoms are not characterised by other typical neurological and anatomical conditions * Practitioners should be aware of the possibility of this condition * Symptoms of this disorder do not follow typical patterns expected from ^^ problems and may be inconsistent or contradictory

Question 331

What 2 other closely related disorders to conversion disorder are there? Describe them

Answer 331

Closely related disorders to conversion disorders: * Malingering: Intentionally deceitful presentation of physical or psychological symptoms or dysfunction for gain, in the presence of an external, identifiable motivation such as avoiding prosecution or to gain undue monetary reward * Difficult to differentiate between conversion disorder and malingering as the distinguishing sign (la belle indifference) is not consistent however do not need to distinguish these for a diagnosis unless it is obviously fake through definite evidence * Factors that can help distinguish ^^ --> CD symptoms are often caused by stress in the form of physical injuries; those with CD seem to be unaware of the ability to function normally even though they are able to (e.g. those with CD blindness will avoid objects in their visual field but still complain that they cannot see anything) - may help distinguish between conversion reactions and organic physical disorders (doing something when they feel they cannot); however it is important to not misdiagnose an actual neurological condition with CD (as this happens in 4% of cases); thus medical causes need to be considered and ruled out before diagnosing CD * Some conversion symptoms involve movements that are perceived as involuntary but what makes movements voluntary/involuntary? - use fMRI scans to compare brain activity during movements and during a voluntary (malingered) movement and showed differences in brain activity * Check page 231 for distinctions between these * La belle indifference: lack of distress in the presence of apparently serious symptoms, sometimes encountered in conversion disorder * The unconcerned attitude towards illness is not always the case as some conversion disorder individuals experience distress * Neurological disorders - those involving sensory or motor symptoms such as brain tumours, basal ganglia disease or MS can be considered for alternative diagnoses * SSD may have a similar presentation to CD (difference = need to be compatible symptoms for SSD, whereas CD does not) * Factitious disorder: intentionally deceitful production of physical or psychological symptoms or dysfunction in the absence of an external motivation but to assume the sick role * Previously known as Munchausen's syndrome - named after Baron Munchausen who was a patient with this description * no identifiable secondary gain but there is a primary gain to resolve intrapsychic tension (sick role) * To diagnose this, interview should include extensive obtaining of information and outside source data * Common among people who: * Received extensive medical treatment as children * Carry a grudge against the medical profession * Have worked in medically related fields where substantial knowledge of illnesses may have been gained These individuals often have no social support, few relationships and little family support * Characteristic of FD --> pseudologia fantastica (limited info is mixed with extensive and colourful fantasies about life stories such as pathological lying) * Factitious disorder imposed on another/Munchausen syndrome by proxy - when a close one/family member or someone else purposely makes another sick (form of abuse) through using extreme tactics to create the appearance of illness or to actual make person ill; person is often successful in alluding suspicion * Procedures to assess possibility of FD imposed on another --> trial separation of the two individuals or video surveillance of the individual while in hospital (almost all perpetrators and victims are mothers with child - often due to mothers history of maltreatment and other psychiatric disorders)

Question 332

Define malingering

Answer 332

Intentionally deceitful presentation of physical or psychological symptoms or dysfunction for gain, in the presence of an external, identifiable motivation such as avoiding prosecution or to gain undue monetary reward

Question 333

Define la belle indifference

Answer 333

lack of distress in the presence of apparently serious symptoms, sometimes encountered in conversion disorder

Question 334

Describe malingering

Answer 334

* Malingering: Intentionally deceitful presentation of physical or psychological symptoms or dysfunction for gain, in the presence of an external, identifiable motivation such as avoiding prosecution or to gain undue monetary reward * Difficult to differentiate between conversion disorder and malingering as the distinguishing sign (la belle indifference) is not consistent however do not need to distinguish these for a diagnosis unless it is obviously fake through definite evidence * Factors that can help distinguish ^^ --> CD symptoms are often caused by stress in the form of physical injuries; those with CD seem to be unaware of the ability to function normally even though they are able to (e.g. those with CD blindness will avoid objects in their visual field but still complain that they cannot see anything) - may help distinguish between conversion reactions and organic physical disorders (doing something when they feel they cannot); however it is important to not misdiagnose an actual neurological condition with CD (as this happens in 4% of cases); thus medical causes need to be considered and ruled out before diagnosing CD * Some conversion symptoms involve movements that are perceived as involuntary but what makes movements voluntary/involuntary? - use fMRI scans to compare brain activity during movements and during a voluntary (malingered) movement and showed differences in brain activity * Check page 231 for distinctions between these * La belle indifference: lack of distress in the presence of apparently serious symptoms, sometimes encountered in conversion disorder * The unconcerned attitude towards illness is not always the case as some conversion disorder individuals experience distress * Neurological disorders - those involving sensory or motor symptoms such as brain tumours, basal ganglia disease or MS can be considered for alternative diagnoses * SSD may have a similar presentation to CD (difference = need to be compatible symptoms for SSD, whereas CD does not)

Question 335

Define factitious disorder

Answer 335

intentionally deceitful production of physical or psychological symptoms or dysfunction in the absence of an external motivation but to assume the sick role

Question 336

Describe factitious disorder

Answer 336

* Factitious disorder: intentionally deceitful production of physical or psychological symptoms or dysfunction in the absence of an external motivation but to assume the sick role * Previously known as Munchausen's syndrome - named after Baron Munchausen who was a patient with this description * no identifiable secondary gain but there is a primary gain to resolve intrapsychic tension (sick role) * To diagnose this, interview should include extensive obtaining of information and outside source data * Common among people who: * Received extensive medical treatment as children * Carry a grudge against the medical profession * Have worked in medically related fields where substantial knowledge of illnesses may have been gained These individuals often have no social support, few relationships and little family support * Characteristic of FD --> pseudologia fantastica (limited info is mixed with extensive and colourful fantasies about life stories such as pathological lying) * Factitious disorder imposed on another/Munchausen syndrome by proxy - when a close one/family member or someone else purposely makes another sick (form of abuse) through using extreme tactics to create the appearance of illness or to actual make person ill; person is often successful in alluding suspicion * Procedures to assess possibility of FD imposed on another --> trial separation of the two individuals or video surveillance of the individual while in hospital (almost all perpetrators and victims are mothers with child - often due to mothers history of maltreatment and other psychiatric disorders)

Question 337

Describe the causes of conversion disorder (Ch 6)

Answer 337

* Freud's 4 basic processes in CD development: * Individual experiences a traumatic event (unconscious conflict) * Person represses conflict (which is seen as unacceptable), making it unconscious * Anxiety continues to increase, threatens to emerge into consciousness and the person converts it into physical symptoms to relieve the pressure of having to deal with the conflict directly (reduction of anxiety = primary gain that maintains C symptom) * Individual receives greatly increased attention and sympathy from loved ones and may be able to avoid difficult tasks or situations (attention/avoidance = secondary gain) * Primary gain refers to la belle indifference - Freud thought that because symptoms reflected an unconscious attempt to resolve a conflict, the patient would not be upset by them but there is little empirical evidence to support this, people do get upset with symptoms most of the time showing emotional problems Social & cultural influences - less educated and lower socioeconomic status (little knowledge about medical illness); prior experience of real physical problems among family members tends to influence the later choice of specific conversion symptoms (adopt symptoms they are familiar with); incidence of these disorders have decreased however due to increased knowledge of real causes of physical problems Marked biological vulnerability - correlation between CD and brain structures

Question 338

Describe the management/treatment of conversion disorder (Ch 6)

Answer 338

* No specific psychiatric therapy is effective * Check page 235 for considerations when treating FD patients

Question 339

What are the diagnostic criteria for factitious disorders? (Ch 6)

Answer 339

* Falsification of physical or psychological signs or symptoms or induction of injury/distress associated with identified deception * The individual presents themselves to others as ill, impaired or injured * The deceptive behaviour is evident even in the absence of obvious external rewards * The behaviour is not better accounted for by another mental disorder such as delusional belief system or acute psychosis * Specify if it is – single or recurrent episodes

Question 340

What are the diagnostic criteria for conversion disorder? (Ch 6)

Answer 340

* One or more symptoms of altered voluntary motor or sensory function * Clinical findings provide evidence of incompatibility between the symptom and recognised neurological or medical conditions * The symptom or deficit is not better explained by another medical or mental disorder * The symptom or deficit causes clinically significant distress or impairment in social, occupational or other important areas of functioning or warrants medical evaluation

Question 341

Define mood (Ch 7)

Answer 341

Enduring period of emotionality

Question 342

What are the features of depression? (Ch 7)

Answer 342

* Outside boundaries of normal experience due to intensity and duration * Substantial interference with ability to function in different areas * Number of psychological and physical symptoms accompany the depressed feelings

Question 343

What are the origins of depression and mania? (Ch 7)

Answer 343

 Melancholia (black bile – melancholy produced through excessive amounts of this in body) & mania (yellow bile – mania (increased energy) produced through excessive amounts of this in body)  Falret – introduced term, ‘folie circulaire’ (circular madness) to the concept of bipolar mood disturbance and distinct from the unipolar (singular/phase episodes) nature of depression alone; placed emphasis on the occurrence of both depression and mania in patients  Kraepelin – introduced first systematised approach to schizophrenia and distinguished this disorder from ‘manic-depressive illness’  View of manic-depressive illness in 20th century – a recurrent, biphasic disturbance of mood characterised by distinct episodes of depression, mania or both (each can be varying degrees of intensity)

Question 344

What are the current views of depression and mania? (Ch 7)

Answer 344

 Separate from unipolar depression  Nomenclature (naming) of mood disorders is complicated and contradictory  Term ‘bipolar disorder’ describes course of mood disorders but not emotional quality much  Mood disorders is the umbrella heading for disorders including depressive and affective disorders since the 1980s in the DSM published by the APA (due to gross deviations in mood); these focused on mood rather than affect (except affective disorders)  The fundamental experiences of depression, mania or both contribute to all the mood disorders (along with the distinct and defining nature and symptoms of each disorder)  DSM-5 has separated depressive disorders from bipolar disorders (own categories) in order to recognise similarities between BP and psychotic disorders such as schizophrenia and to show its position between depressive disorders and psychotic disorders in the manual

Question 345

Define mood disorders (Ch 7)

Answer 345

Group of disorders involving severe and enduring disturbances in emotionality ranging from elation to severe depression

Question 346

What are the two fundamental mood states in mood disorders? (Ch 7)

Answer 346

Depression and mania

Question 347

Describe depression (Ch 7)

Answer 347

Most commonly diagnosed mood disturbance – major depressive episode Major depressive episode: Morbid or pathological expression of depression, that occurs for most of the day most days of the week for at least 2 weeks, including symptoms such as depressed mood, anhedonia, feelings of guilt and worthlessness, disturbances to sleep and appetite, poor concentration, indecision, fatigue, loss of energy and interest and thoughts around death and suicide Anhedonia: Inability to experience pleasure, associated with some mood and schizophrenic disorders Central indicators of a full episode  Physical changes (somatic/vegetative symptoms) and behavioural/emotional shutdown Symptoms of manic-depressive episodes:  Depressed mood  Anhedonia  Feelings of guilt and worthlessness  Disturbances to sleep and appetite  Poor concentration  Indecision  Fatigue  Loss of energy and interest  Thoughts around death and suicide Features of manic-depressive episodes: * Extremely depressed mood state (pathological expression of depression) * Occurs for most of the day, most days of the week for at least 2 weeks * Includes symptoms ^^ * Includes physical changes and behavioural/emotional shutdown * Dysfunctional reward processing/anhedonia (abnormalities in the brain's ability to process and respond to rewarding stimuli, impacting motivation, pleasure and learning from rewards) – more characteristic of MDE than just the symptoms of sadness/distress * High negative affect AND low positive affect * Duration of an untreated episode  around 4 to 9 months Criteria for major depressive episode: Five/more of the following symptoms have been present during the same 2-week period & represent a change from previous functioning in which at least one is either  depressed mood/loss of interest 1. Depressed mood most of the day, nearly everyday either by subjective report or objective observation (children may show as irritable mood) 2. Markedly diminished interest pleasure in almost all activities most of the day, everyday 3. Significant weight loss/gain or decreased/increased appetite nearly everyday 4. Insomnia/hypersomnia nearly everyday 5. Psychomotor agitation/retardation nearly everyday 6. Fatigue/loss of energy nearly everyday 7. Feelings of worthlessness/excessive inappropriate guilt nearly every day (may be delusional) 8. Diminished ability to think/concentrate as well as indecisiveness nearly every day 9. Recurrent thoughts of death, recurrent suicidal ideation with(out) a plan or a suicide attempt Symptoms cause significant distress/impairment in functioning and not result of sub abuse/conditions

Question 348

What is the most commonly diagnosed mood disturbance? (Ch 7)

Answer 348

Major depressive episode

Question 349

Define major depressive disorder (Ch 7)

Answer 349

Morbid or pathological expression of depression, that occurs for most of the day most days of the week for at least 2 weeks, including symptoms such as depressed mood, anhedonia, feelings of guilt and worthlessness, disturbances to sleep and appetite, poor concentration, indecision, fatigue, loss of energy and interest and thoughts around death and suicide

Question 350

Define anhedonia (Ch 7)

Answer 350

Inability to experience pleasure, associated with some mood and schizophrenic disorders

Question 351

What are central indicators of a full depressive episode? (Ch 7)

Answer 351

 Physical changes (somatic/vegetative symptoms) and behavioural/emotional shutdown

Question 352

What are some symptoms of major depressive episodes? (Ch 7)

Answer 352

 Depressed mood  Anhedonia  Feelings of guilt and worthlessness  Disturbances to sleep and appetite  Poor concentration  Indecision  Fatigue  Loss of energy and interest  Thoughts around death and suicide

Question 353

What are some features of depressive episodes? (Ch 7)

Answer 353

* Extremely depressed mood state (pathological expression of depression) * Occurs for most of the day, most days of the week for at least 2 weeks * Includes symptoms ^^ * Includes physical changes and behavioural/emotional shutdown * Dysfunctional reward processing/anhedonia (abnormalities in the brain's ability to process and respond to rewarding stimuli, impacting motivation, pleasure and learning from rewards) – more characteristic of MDE than just the symptoms of sadness/distress * High negative affect AND low positive affect * Duration of an untreated episode  around 4 to 9 months

Question 354

What are the criteria for major depressive disorder? (Ch 7)

Answer 354

Five/more of the following symptoms have been present during the same 2-week period & represent a change from previous functioning in which at least one is either  depressed mood/loss of interest 1. Depressed mood most of the day, nearly everyday either by subjective report or objective observation (children may show as irritable mood) 2. Markedly diminished interest pleasure in almost all activities most of the day, everyday 3. Significant weight loss/gain or decreased/increased appetite nearly everyday 4. Insomnia/hypersomnia nearly everyday 5. Psychomotor agitation/retardation nearly everyday 6. Fatigue/loss of energy nearly everyday 7. Feelings of worthlessness/excessive inappropriate guilt nearly every day (may be delusional) 8. Diminished ability to think/concentrate as well as indecisiveness nearly every day 9. Recurrent thoughts of death, recurrent suicidal ideation with(out) a plan or a suicide attempt Symptoms cause significant distress/impairment in functioning and not result of sub abuse/conditions

Question 355

Define mania (Ch 7)

Answer 355

Period of abnormally excessive elation, euphoria or irritability lasting around one week and associated with increased goal-directed activity, inflated self-esteem, decreased needs for sleep and rapid thinking and communication, often accompanied by psychotic features

Question 356

Define manic episode (Ch 7)

Answer 356

Period of abnormally elevated or irritable mood that may include inflated self-esteem, decreased need for sleep, pressured speech/talk, flight of ideas, agitation or self-destructive behaviour, and may be accompanied by psychotic symptoms

Question 357

Describe mania (Ch 7)

Answer 357

Mania: Period of abnormally excessive elation, euphoria or irritability lasting around one week and associated with increased goal-directed activity, inflated self-esteem, decreased needs for sleep and rapid thinking and communication, often accompanied by psychotic features Manic episode: Period of abnormally elevated or irritable mood that may include inflated self-esteem, decreased ned for sleep, pressured speech/talk, flight of ideas, agitation or self-destructive behaviour, and may be accompanied by psychotic symptoms Symptoms of mania:  Excessive elation, euphoria  irritability & dysphoria  Hyperactivity  Increased goal-directed activity/grandiose plan-making  Inflated self-esteem  Decreased need for sleep  Rapid, incoherent and disorganised thinking and communication Features of manic episodes: * Extremely manic mood state (pathological expression of mania) * Elation/euphoria often leads to irritability/dysphoria (discontented feeling state) * Occurs for most of the day, most days of the week for at least one week * Includes symptoms ^^ * High positive affect AND low negative affect * Duration of an untreated episode  around 3 to 4 months * Hospitalisation could occur if destructive behaviour arises * Occurrence of a single manic episode = bipolar 1 disorder (irrespective of earlier episodes) * Occurrence of hypomanic episode (less severe symptoms, less impairment) * Occurrence of frequent hypomanic episodes = bipolar 2 Hypomanic episode: Reduced form of mania, with similar but less severe symptoms and less disruption, occurring for at least 4 days without the occurrence of psychotic symptoms or the need for hospitalisation; these define bipolar 2 & cyclothymic disorders but may also occur during B1 episodes Bipolar 1 disorder: The occurrence of one manic or mixed manic episode, often recurrent or alternating with major depressive episodes Bipolar 2 disorder: Occurrence of hypomanic episodes, frequently alternating with major depressive episodes in which there is a greater tendency of recurrent cycles of mood disturbance Cyclothymic disorder: Chronic (at least 2 years) mood disorder characterised by alternating mood elevation and depression levels that are not as severe as manic or major depressive episodes Criteria for manic episodes: * Distinct period of abnormally and persistently elevated, expansive mood and increased goal directed activity/energy lasting at least one week and present most of the day nearly everyday (any duration if hospitalisation is necessary) * 3 or more of the following symptoms are present to a significant degree during period of mood disturbance:  Inflated self-esteem/grandiosity  Decreased need for sleep  More talkative than usual/pressure to keep talking  Flight of ideas or subjective experience that thoughts are racing  Distractibility as reported or observed  Increase in goal-directed activity or psychomotor agitation  Excessive involvement in activities that have a high potential for painful consequences * Mood disturbance is sufficiently severe to caused marked impairment in areas of functioning or to necessitate hospitalisation to prevent harm to oneself/others/psychotic features * Episode is not attributable to physiological effects of substance use or another medical condition

Question 358

What are the symptoms of mania? (Ch 7)

Answer 358

 Excessive elation, euphoria  irritability & dysphoria  Hyperactivity  Increased goal-directed activity/grandiose plan-making  Inflated self-esteem  Decreased need for sleep  Rapid, incoherent and disorganised thinking and communication

Question 359

What are the features of manic episodes? (Ch 7)

Answer 359

* Extremely manic mood state (pathological expression of mania) * Elation/euphoria often leads to irritability/dysphoria (discontented feeling state) * Occurs for most of the day, most days of the week for at least one week * Includes symptoms ^^ * High positive affect AND low negative affect * Duration of an untreated episode  around 3 to 4 months * Hospitalisation could occur if destructive behaviour arises * Occurrence of a single manic episode = bipolar 1 disorder (irrespective of earlier episodes) * Occurrence of hypomanic episode (less severe symptoms, less impairment) * Occurrence of frequent hypomanic episodes = bipolar 2

Question 360

Define hypomanic episode (Ch 7)

Answer 360

Reduced form of mania, with similar but less severe symptoms and less disruption, occurring for at least 4 days without the occurrence of psychotic symptoms or the need for hospitalisation; these define bipolar 2 & cyclothymic disorders but may also occur during B1 episodes

Question 361

Define bipolar 1 disorder (Ch 7)

Answer 361

The occurrence of one manic or mixed manic episode, often recurrent or alternating with major depressive episodes

Question 362

Define bipolar 2 disorder (Ch 7)

Answer 362

Occurrence of hypomanic episodes, frequently alternating with major depressive episodes in which there is a greater tendency of recurrent cycles of mood disturbance

Question 363

Define cyclothymic disorder (Ch 7)

Answer 363

Chronic (at least 2 years) mood disorder characterised by alternating mood elevation and depression levels that are not as severe as manic or major depressive episodes

Question 364

What are the criteria for manic episodes? (Ch 7)

Answer 364

Criteria for manic episodes: * Distinct period of abnormally and persistently elevated, expansive mood and increased goal directed activity/energy lasting at least one week and present most of the day nearly everyday (any duration if hospitalisation is necessary) * 3 or more of the following symptoms are present to a significant degree during period of mood disturbance:  Inflated self-esteem/grandiosity  Decreased need for sleep  More talkative than usual/pressure to keep talking  Flight of ideas or subjective experience that thoughts are racing  Distractibility as reported or observed  Increase in goal-directed activity or psychomotor agitation  Excessive involvement in activities that have a high potential for painful consequences * Mood disturbance is sufficiently severe to caused marked impairment in areas of functioning or to necessitate hospitalisation to prevent harm to oneself/others/psychotic features * Episode is not attributable to physiological effects of substance use or another medical condition

Question 365

Define unipolar mood disorder (Ch 7)

Answer 365

Mood disorder characterised by depression or mania but not both

Question 366

Describe the architecture of mood disorders (Ch 7)

Answer 366

Unipolar mood disorder: mood disorder characterised by depression or mania but not both Most cases involve depression, mania alone is rare as those who have it eventually develop depressive episodes; nonetheless manic episodes occur most frequently in adolescents Depression and mania may not be on the same spectrum as widely believed nor may they be on complete opposite ends of this spectrum – they are often independent though related Individuals can also experience both symptoms in either depressive/manic episodes, just at different levels of intensity – mixed features (e.g. depressive episodes may have some manic symptoms); need to specify whether its predominantly depressive or manic however and if enough symptoms of the opposite polarity are present to meet mixed features criteria (polarity exists if one polarity occurs 2/3 of individuals lifetime) Mixed features: Condition in which the individual experiences both elation and depression/anxiety at the same time; also known as dysphoric manic episode or mixed manic episode Studies – show manic episodes involve dysphoria more often than thought and it can be severe; many bipolar episode cases involved mixed features (2/3 in some) and led to increased impairment Views – newer models seen bipolar disorder as an evolving condition, proceeding through different ‘risk’ phases with mild symptoms to a more chronic and severe state later on Diagnosis is dependent on – course/pattern of episodes (recurrence/relapse/remission/alternations); this importance placed on remissive and recurrence patterns makes treatment of mood disorders different to other disorders (preventing future episodes) Aim of long-term management/treatment  prevent future episodes

Question 367

Define mixed features (Ch 7)

Answer 367

Condition in which the individual experiences both elation and depression/anxiety at the same time; also known as dysphoric manic episode or mixed manic episode

Question 368

What are the differences between the disorders under the depressive disorder category? (Ch 7)

Answer 368

Frequency and intensity in which symptoms occur, course of the symptoms and likelihood that they will become chronic/non-chronic

Question 369

What are the 2 main factors that describe mood disorders? (Ch 7)

Answer 369

Severity and chronicity

Question 370

What are the 3 main types of depressive disorders?

Answer 370

1. MDD 2. PDD 3. Double Depression

Question 371

Define Major Depressive Disorder (MDD) (Ch 7)

Answer 371

Mood disorder involving a single (one) or recurrent (more than one episode separated by at least 2 months without depression) major depressive episodes

Question 372

Define recurrent (Ch 7)

Answer 372

Occurring repeatedly or often; 2 or more major depressive episodes occur and are separated by at least 2 months in which the individual is not depressed

Question 373

What are the features of MDD? (Ch 7)

Answer 373

 One or more major depressive episodes (2-month intervals = recurrent)  Occurrence of a major depressive episode in the absence of mania/hypomania during the course of the condition  Some experience recurrence, which is important for predicting the future course and treatment of the disorder (risk of recurrence is rise from 20% year after to 40% 2 years after)  Unipolar depression is often a chronic condition that improves and worsens over time but seldom disappears  Median number and duration of episodes  4-7 and 4-5 months

Question 374

What are the diagnostic criteria for major depressive disorder? (Ch 7)

Answer 374

Diagnostic criteria for major depressive disorder: * At least one major depressive episode * At least one major depressive episode is not better explained or superimposed by another disorder * There has never been a manic episode/hypomanic episode (does not apply if substance abuse/another medical condition is the reason) * Specify if it is a single or recurrent episode (mild, moderate or severe) with:  Psychotic, mixed, melancholic or atypical features  Anxious distress  Catatonia  Peri-partum onset  Seasonal pattern  In partial/full remission

Question 375

Define persistent depressive disorder (Ch 7)

Answer 375

Mood disorder involving persistently depressed mood, with low self-esteem, withdrawal, pessimism and despair and present for at least 2 years with no absence of symptoms for more than 2 months

Question 376

What are the symptoms of PDD? (Ch 7)

Answer 376

Symptoms of PDD:  Persistently depressed mood  Low-self esteem  Withdrawal  Pessimism  Despair

Question 377

What are the features of PDD? (Ch 7)

Answer 377

 Also known as dysthymia  Depression remains unchanged over long periods  Present for at least 2 years with no absence of symptoms for more than 2 months  Symptoms ^^ - few  Differs from MDD – in number of symptoms, chronicity and course (more severe)  Severe – higher comorbidity with other disorders, less responsive to treatment and slower rate of improvement over time  Chronicity of PDD is a defining feature – not only differs in time with other disorders but in course (family history and cognitive style) despite similar symptoms  Around 22% of patients suffering from PDD experience a major depressive episode (double depression)  Specified whether an MDE is part of the course (state if individuals in this episode or not)  3 types of dysthymia/PDD  no MDE (pure dysthymic syndrome), presence of an MDE over a 2-year period (with persistent major depressive episode) and double depression (with intermittent major depressive episode)

Question 378

What are the diagnostic criteria for PDD? (Ch 7)

Answer 378

* Depressed mood for most of the day, for more days than not as indicated through self-report or observation by others, for at least 2 years (manifests as irritability in children) * Presence, while depressed, of 2+ of the following symptoms:  Poor appetite/overeating  Insomnia/hypersomnia  Low energy/fatigue  Low self-esteem  Poor concentration/indecisiveness  Feelings of hopelessness * During the 2-year period (one for minors) of the disturbance, the individual has never been without the symptoms more than 2 months at a time * Criteria for MDD may be continuously present for 2 years * Never been a manic or hypomanic episode and criteria for cyclothymic disorder are not met * Disturbance is not better explained by substance use or another medical condition/disorder * Symptoms cause significant distress in areas of functioning * Specify if:  Severity (mild, moderate, severe)  With anxious distress/with atypical features  Partial/full remission  Early/late onset  With pure dysthymic syndrome/persistent major depressive episodes/with intermittent major depressive episodes

Question 379

Define double depression (Ch 7)

Answer 379

Severe mood disorder typified by major depressive episodes superimposed over a background of persistent depressive disorder of dysthymia; also called persistent depressive disorder with intermittent major depressive episodes

Question 380

Describe double depression (Ch 7)

Answer 380

Double depression: severe mood disorder typified by major depressive episodes superimposed over a background of persistent depressive disorder of dysthymia; also called persistent depressive disorder with intermittent major depressive episodes Typical course of DD^^ - few depressive symptoms develop first  one/more MDE occur later  reverting back to underlying pattern of depression once these are over (identification of this pattern is important as it is associated with more psychopathology Double depression is more difficult to treat than either MDD or PDD

Question 381

What are the additional defining criteria for depressive disorders? (Ch 7)

Answer 381

Specific features (specifiers) - may or may not accompany a disorder and are helpful in determining the likely course and the most effective treatment for the disorder

Question 382

What are the three main specifiers for mood disorders? (Ch 7)

Answer 382

Severity of episode (mild, moderate and severe)

Question 383

What are the eight specifiers to describe depressive disorders? (Ch 7)

Answer 383

1. Psychotic features specifier (mood congruent/mood incongruent) 2. Anxious distress specifier (mild, moderate and severe) 3. Mixed features specifier 4. Melancholic features specifier 5. Atypical features specifier 6. Catatonic features specifier 7. Peri-partum onset specifier 8. Seasonal pattern specifier These may only apply to MDD or both MDD and PDD

Question 384

Describe the psychotic features specifier (Ch 7)

Answer 384

1. Psychotic features specifier * May experience psychotics symptoms  hallucinations and/or delusions * Hallucinations: Psychotic symptoms of perceptual disturbance in which things are seen, heard or otherwise sensed although they are not actually present * Delusion: Psychotics symptom involving disorder of thought content and presence of strong beliefs that are misrepresentations of reality * Types of delusions:  Somatic/physical delusions (belief something is medically, physically or biologically wrong)  Nihilistic delusions (belief that part of body or the world around oneself does not exist or has been destroyed)  Delusions of grandeur (false beliefs about one's own importance, power, wealth or abilities)  Bizarre delusions (false beliefs that are implausible and not grounded in ordinary life or cultural experiences) * These hallucinations and delusions are mood congruent * Mood congruent - match or agreement between a person's current mood and their thoughts, emotions and behaviours * Mood incongruent - situation in which an individual’s thoughts, emotions and behaviours do not align with their mood * Depressive episodes may transform into a psychotic disorder if they are accompanied by psychotic features (this is rare however) * Patients with psychotic features  poor response to treatment, greater impairment and fewer weeks with minimal symptoms compared to non-psychotic patients * Psychotic episodes accompanied by mood symptoms predict a more favourable outcome than those without

Question 385

Define hallucinations

Answer 385

Psychotic symptoms of perceptual disturbance in which things are seen, heard or otherwise sensed although they are not actually present

Question 386

Define delusions

Answer 386

Psychotics symptom involving disorder of thought content and presence of strong beliefs that are misrepresentations of reality

Question 387

What are the 4 types of delusions under the psychotic features specifier?

Answer 387

* Types of delusions:  Somatic/physical delusions (belief something is medically, physically or biologically wrong)  Nihilistic delusions (belief that part of body or the world around oneself does not exist or has been destroyed)  Delusions of grandeur (false beliefs about one's own importance, power, wealth or abilities)  Bizarre delusions (false beliefs that are implausible and not grounded in ordinary life or cultural experiences)

Question 388

Differentiate between mood congruent and mood incongruent

Answer 388

* Mood congruent - match or agreement between a person's current mood and their thoughts, emotions and behaviours * Mood incongruent - situation in which an individual’s thoughts, emotions and behaviours do not align with their mood

Question 389

Describe the anxious distress specifier (Ch 7)

Answer 389

2. Anxious distress specifier * Presence and severity of accompanying anxiety whether it is just anxiety symptoms or comorbidity with an anxiety disorder define this specifier * Most important new specifier for mood disorders as its presence  indicates a more severe condition, makes suicidal thoughts and suicide more likely and predicts a poorer outcome for treatment; also warns of possible bipolar disorder if present during a depressive episode

Question 390

Describe the mixed features specifier (Ch 7)

Answer 390

3. Mixed features specifier * Mainly for depressive episodes that have several symptoms of mania present * Applies to MDE in both MDD and PDD

Question 391

Describe the melancholic features specifier (Ch 7)

Answer 391

4. Melancholic features specifier * Only applies if full criteria for an MDE have been met (whether in PDD or not) * Include severe somatic symptoms  marked diurnal variation in mood, early morning waking, weight loss, loss of sex drive, excessive/inappropriate guilt and anhedonia * Melancholic depression appears most in elderly and responds more predictably to somatic treatments, antidepressant medication and ECT

Question 392

Describe the catatonic features specifier (Ch 7)

Answer 392

5. Catatonic features specifier * Applies to MDE whether in PDD or not and manic episodes (rare) * Catatonia: Gross disturbance in motor behaviour, ranging from marked absence of movement to frenzied excitability * Catatonia is encountered in mood disorders, psychotic disorders and neurological disorders as well as neuroleptic malignant syndrome (severe, often lethal, complication of antipsychotic use characterised by high fever, delirium and organ failure) * Common presentation of catatonia  grossly decreased movements with insensibility but may present with excitability or both * Common feature or catatonia  catalepsy * Catalepsy: manifestation of catatonia in which there is a disturbance in motor behaviour characterised by absence of movement and the maintenance of uncomfortable and rigid posture despite external stimulus (sometimes decreased sensitivity to pain and waxy flexibility) * Waxy flexibility - ability to maintain imposed postures for extended periods without discomfort * More associated with schizophrenia at first but some studies show it may be more common in depression * This response may be a result of reduced responsiveness to the environment due to an impending doom feeling state * Catatonia may indicate the possibility of bipolar disorder and responds well to ECT

Question 393

Define catalepsy

Answer 393

manifestation of catatonia in which there is a disturbance in motor behaviour characterised by absence of movement and the maintenance of uncomfortable and rigid posture despite external stimulus (sometimes decreased sensitivity to pain and waxy flexibility)

Question 393

Define catatonia

Answer 393

Gross disturbance in motor behaviour, ranging from marked absence of movement to frenzied excitability

Question 394

Describe the atypical features specifier (Ch 7)

Answer 394

6. Atypical features specifier * Atypical – symptoms deviating from those typical of depression (common) * Applies to MDE whether in PDD or not * Individuals with this specifier oversleep and overeat during their depression and gain weight (leading to higher chance of diabetes) * Can react with interest to some things (atypical), despite experiencing anxiety * Depression with atypical features  associated with women and earlier age of onset * This group have  more severe symptoms, more suicide attempts and higher rate of comorbid disorders including alcohol abuse

Question 395

Describe the peri-partum onset specifier (Ch 7)

Answer 395

7. Peri-partum onset specifier * Period just before, during and just after birth (up to 6 months after) * Can apply to both MDE and ME (manic episodes) * Around 13%-19% of women meet the criteria for peripartum depression * Higher incidence of depression after than during pregnancy (many having serious thoughts of harming themselves) * Psychotic-depressive episodes are common during peripartum period (and sometimes lead to infanticide) * Infanticide and psychosis/mood disorders = close association * This affects mothers (40%) and fathers (10%) one year after birth * Thus, CBT and interpersonal (family) therapy are most effective * Many mothers do not understand why they are feeling this way * Studies show hormones may be different for these mothers following birth and pregnancy (though no strong evidence) * No difference in mood disorders with mothers or any other individual with this disorder * More minor reactions to birth – baby blues (occur in 40-80% of new mothers) and include temporary mood swings (specifier does not apply to this state)

Question 396

Describe the seasonal pattern specifier (Ch 7)

Answer 396

8. Seasonal pattern specifier * Applies to recurrent MDD and bipolar disorders * Accompanies episodes that occur during certain seasons * Episodes must have occurred for at least 2 years with no evidence of non-seasonal MDE occurring that period of time * Also called seasonal affective disorder (SAD) * Seasonal Affective Disorder (SAD): mood disorder involving a cycling of episodes, corresponding to the seasons of the year, typically with depression occurring during the winter

Question 397

Define Seasonal Affective Disorder

Answer 397

mood disorder involving a cycling of episodes, corresponding to the seasons of the year, typically with depression occurring during the winter

Question 398

What are two other types of depressive disorders added to the DSM-5? (Ch 7)

Answer 398

1. Premenstrual dysphoric disorder (PMDD) 2. Disruptive mood dysregulation disorder

Question 399

Describe Premenstrual dysphoric disorder (PMDD) (Ch 7)

Answer 399

1. Premenstrual dysphoric disorder (PMDD) Premenstrual dysphoric disorder: Condition characterised by mood disturbances, typically lability and uncomfortable physical symptoms associated with the menses (female periods) Smal group of women (2% to 5%) – suffer from severe emotional reactions during the premenstrual period Many were worried this diagnosis would be stigmatising however this diagnosis was essential to differentiate them from 20% to 40% of women who experience PMS (no impaired functioning) Combination of physical symptoms, severe mood swings and anxiety Disorder of mood instead of a physical disorder due to evidence and allows women to receive specific, effective and appropriate treatment Diagnostic criteria for PMDD: * In majority of menstrual cycles, at least 5 symptoms must be present in final week before onset of menses, start to improve within a few days after the onset and become minimal/absent in the week following menses * One+ of following symptoms must be present:  Marked affective lability (mood swings)  Marked irritability/anger/increased interpersonal conflicts  Marked depressed mood, feelings of hopelessness or self-depreciating thoughts  Marked anxiety, tension and/or feelings of being on edge * One or more of the following symptoms must be present (to make 5 when combined with ^)  Decreased interest in usually activities  Subjective difficulty in concentration  Lethargy, easily fatigued or lack of energy  Marked change in appetite (overeating)  Insomnia/hypersomnia  Sense of being overwhelmed/out of control  Physical symptoms such as breast tenderness/swelling/joint or muscle pain/sensation of bloating * Symptoms cause significant distress/interference in life functioning * Disturbance is not merely an exacerbation of symptoms of another disorder * First criteria should be confirmed by prospective daily ratings during at least 2 symptomatic cycles * Symptoms are not attributable to substance use/another medical condition

Question 400

Define Premenstrual dysphoric disorder (Ch 7)

Answer 400

Premenstrual dysphoric disorder: Condition characterised by mood disturbances, typically lability and uncomfortable physical symptoms associated with the menses (female periods)

Question 401

What are the diagnostic criteria for PMDD? (Ch 7)

Answer 401

Diagnostic criteria for PMDD: * In majority of menstrual cycles, at least 5 symptoms must be present in final week before onset of menses, start to improve within a few days after the onset and become minimal/absent in the week following menses * One+ of following symptoms must be present:  Marked affective lability (mood swings)  Marked irritability/anger/increased interpersonal conflicts  Marked depressed mood, feelings of hopelessness or self-depreciating thoughts  Marked anxiety, tension and/or feelings of being on edge * One or more of the following symptoms must be present (to make 5 when combined with ^)  Decreased interest in usually activities  Subjective difficulty in concentration  Lethargy, easily fatigued or lack of energy  Marked change in appetite (overeating)  Insomnia/hypersomnia  Sense of being overwhelmed/out of control  Physical symptoms such as breast tenderness/swelling/joint or muscle pain/sensation of bloating * Symptoms cause significant distress/interference in life functioning * Disturbance is not merely an exacerbation of symptoms of another disorder * First criteria should be confirmed by prospective daily ratings during at least 2 symptomatic cycles * Symptoms are not attributable to substance use/another medical condition

Question 402

Describe disruptive mood dysregulation disorder (Ch 7)

Answer 402

2. Disruptive mood dysregulation disorder Disruptive mood dysregulation disorder: Condition in which a child has chronic negative moods such as anger and irritability without any accompanying mania Similar to bipolar – falls under ‘bipolar disorder not otherwise specified (NOS)’ category (mainly in children) Include symptoms such as  chronic irritability, anger, aggression, hyperarousal and frequent temper tantrums that are not limited to an occasional episode Studies - no evidence of periods of distinct mania/hypomania which is a requirement for diagnosis of bipolar disorder, no evidence of bipolar in families; these children are at increased risk for additional depressive and anxiety disorders rather than manic episodes; irritability is associated with distress in child and reflects chronic negative affect and disruption of family life Children are being misdiagnosed when meeting criteria for more classic diagnostic categories such as BD or ADHD and these treatments may pose more risk for these individuals Treatments are yet to be made Diagnostic criteria for disruptive mood dysregulation disorder: * Severe recurrent temper outburst manifested verbally and/or behaviourally that are grossly out of proportion in intensity/duration to the situation or provocation * Temper outbursts are inconsistent with developmental level * Temper outbursts occur, on average, 3+ times per week * Mood between temper outbursts is persistently irritable/angry most of the day, nearly every day and is observable by others * First 4 criteria have been present for 12 or more months in which individual has had no period lasting 3+ consecutive months without all the symptoms throughout that time * Diagnosis should not be made for the first time before age 6 or after 18 years * Age of onset is before 10 years, by history or observation * Has never been a distinct period lasting more than one day during which the full symptom criteria, except duration for a manic/hypomanic episode have been met * Behaviours do not occur exclusively during an episode of MDD and are not better explained by another mental disorder * Symptoms are not attributable to the physiological effects of substance use or medical condition

Question 403

Define disruptive mood dysregulation disorder: (Ch 7)

Answer 403

Condition in which a child has chronic negative moods such as anger and irritability without any accompanying mania

Question 404

What are the diagnostic criteria for disruptive mood dysregulation disorder? (Ch 7)

Answer 404

Diagnostic criteria for disruptive mood dysregulation disorder: * Severe recurrent temper outburst manifested verbally and/or behaviourally that are grossly out of proportion in intensity/duration to the situation or provocation * Temper outbursts are inconsistent with developmental level * Temper outbursts occur, on average, 3+ times per week * Mood between temper outbursts is persistently irritable/angry most of the day, nearly every day and is observable by others * First 4 criteria have been present for 12 or more months in which individual has had no period lasting 3+ consecutive months without all the symptoms throughout that time * Diagnosis should not be made for the first time before age 6 or after 18 years * Age of onset is before 10 years, by history or observation * Has never been a distinct period lasting more than one day during which the full symptom criteria, except duration for a manic/hypomanic episode have been met * Behaviours do not occur exclusively during an episode of MDD and are not better explained by another mental disorder * Symptoms are not attributable to the physiological effects of substance use or medical condition

Question 405

What was the original term for the group called bipolar disorders? (Ch 7)

Answer 405

Manic-depressive illness (Kraepelin)

Question 406

What are the features of bipolar disorders? (Ch 7)

Answer 406

Features of bipolar disorders: * Defining feature of BD  occurrence of mania/hypomania with a tendency to recur with depressive episodes in an unending cycle of emotional highs and lows (causes much distress and dysfunction) * Manic episodes may occur only once or repeatedly (recurrent) like that of depressive disorders * Recurrence of mania followed by MDE * Expansive and irritable affect * Goal-directed activity * Need little sleep * Rapid communication with evidence of incoherence * Delusions of grandeur * Hypomanic episodes

Question 407

Describe bipolar disorders (Ch 7)

Answer 407

Original term for this group  manic-depressive illness (Kraepelin) Features of bipolar disorders: * Defining feature of BD  occurrence of mania/hypomania with a tendency to recur with depressive episodes in an unending cycle of emotional highs and lows (causes much distress and dysfunction) * Manic episodes may occur only once or repeatedly (recurrent) like that of depressive disorders * Recurrence of mania followed by MDE * Expansive and irritable affect * Goal-directed activity * Need little sleep * Rapid communication with evidence of incoherence * Delusions of grandeur * Hypomanic episodes Bipolar 1 and 2 have the same criteria except bipolar one individual’s experience full manic episodes while bipolar two individual’s experience less severe hypomanic episodes Manic and hypomanic episodes are differentiated by  symptomatic-free period of 2 months between episodes Problems  patients often deny they are unwell during episodes and the euphoria experienced during mania may be so addictive that patients purposely do not take medication during periods of distress in order to feel that high again (difficult for therapists) Cyclothymic disorder – a milder but more chronic spiritual type of BD similar to PDD in that it is a chronic alternation of mood elevation and depression that does not reach the severity of manic/MD episodes; individuals with this tend to be in one mood state or the other for years with few periods of neutral mood and tend to alternate between depressive and hypomanic states; these fluctuating mood states are enough to cause impairment in functioning; this pattern must last for 2 years to get this diagnosis Clanging/clang associations: a disturbance in communication characterised by repetition of sounds or repetitive phonetic associations, encountered in mania and disorganised psychosis Diagnostic criteria for cyclothymic disorder: * Over 2 years, numerous periods with hypomanic symptoms that do not meet criteria for a hypomanic episode and numerous periods with depressive symptoms that do not meet the criteria for an MDE * During the 2-year period, these ^ symptoms have been present for at least half the time and the individual has not been without symptoms for more than 2 months * Criteria for a major depressive, manic or hypomanic episode have never been met * Symptoms in first criteria are not better explained by a psychotic disorder such as schizophrenia * Symptoms are not attributable to the physiological effects of substance use or another medical condition * Symptoms cause significant distress and impairment in areas of functioning

Question 408

Define clanging/clang associations (Ch 7)

Answer 408

a disturbance in communication characterised by repetition of sounds or repetitive phonetic associations, encountered in mania and disorganised psychosis

Question 409

What are the diagnostic criteria for cyclothymic disorder? (Ch 7)

Answer 409

Diagnostic criteria for cyclothymic disorder: * Over 2 years, numerous periods with hypomanic symptoms that do not meet criteria for a hypomanic episode and numerous periods with depressive symptoms that do not meet the criteria for an MDE * During the 2-year period, these ^ symptoms have been present for at least half the time and the individual has not been without symptoms for more than 2 months * Criteria for a major depressive, manic or hypomanic episode have never been met * Symptoms in first criteria are not better explained by a psychotic disorder such as schizophrenia * Symptoms are not attributable to the physiological effects of substance use or another medical condition * Symptoms cause significant distress and impairment in areas of functioning

Question 410

What specifiers apply to bipolar disorders? (Ch 7)

Answer 410

All of the specifiers for depressive disorder apply to BD, especially the:  Catatonic features specifier – applies to MDE and rarely a manic episode  Psychotic features specifier – may apply to manic episodes during which delusions of grandeur commonly appear  Anxious distress specifier – present in BD as it is in depressive disorders  Mixed features specifier – major depressive/manic episodes that has some symptoms from the opposite polarity  Seasonal pattern specifier – depressed during winter and manic during summer  Peri-partum specifier – manic episodes may occur around this period Need to determine if they have had depressive/manic episodes in the past and if they have fully recovered between these past episodes as well as determine if cyclothymia preceded the onset of BD (as it predicts a decreased chance of a full inter-episode recovery)

Question 411

What is a specifier unique to BD 1 and 2? (Ch 7)

Answer 411

Rapid-cycling specifier

Question 412

Describe the rapid-cycling specifier (Ch 7)

Answer 412

Rapid-cycling specifier: * More characteristic of bipolar 2 * Some patients move quickly in and out of depressive/manic episodes * Those with at least 4 depressive/manic episodes in a year have this (rapid-cycling pattern) * This is a severe variety of BD that does not respond well to treatments * Studies – higher probability of suicide and more severe episodes and symptoms * Anticonvulsants and mood stabilisers may be more effective than antidepressants * 20%-50% of BD patients experience rapid cycling * 60%-90% being female – higher rate than any other form of BD * Most cases – rapid cycling increases in frequency over time and can reach severe states in which patients cycle through depression and mania without any breaks * This is called rapid switching/rapid mood switching (treatment resistant form of BD) * Other terms for extreme cycling – ultra-rapid/ultra-radian cycling * One precipitant/cause of rapid cycling  antidepressant medication * Frequency is considerably higher than those who do not take them (especially older meds) * Rapid-cycling does not seem to be permanent (only 3%-5% continue after 5 years) * Ultra-rapid cycling may seem similar to a mixed manic state but they are not

Question 413

What are the diagnostic criteria for bipolar 2 disorder? (Ch 7)

Answer 413

Diagnostic criteria for bipolar 2 disorder: * Criteria have been met for at least one MDE and at least one hypomanic episode (criteria identical to manic episode but few distinctions  (1) minimum duration is 4 days, (2) it is not severe enough to cause marked social/occupational impairment/hospitalisation though it does represent a change in functioning and (3) there are no psychotic symptoms * There has never been a manic episode * At least one hypomanic episode and at least one MDE are not better explained by another psychotic disorder such as schizophrenia * The symptoms of depression/unpredictability caused by frequent alternation between periods of depression and hypomania cause significant distress/impairment in areas of functioning * Specify:  If current/most recent episode is hypomanic – or if they are in partial/full remission if BD2  Pattern of mood disorders is rapid-cycling/seasonal specifiers  Specify if with – anxious distress, mixed features, rapid cycling, peri-partum or seasonal pattern  Current/most recent episode is depressed - or if they are in partial/full remission if BD2  Specify if with – anxious distress, mixed features, rapid cycling, melancholic features, atypical features, mood-congruent psychotic features, mood-incongruent psychotic features, catatonia, peri-partum or seasonal pattern  Specify severity if full criteria for mood episode are currently met – full/partial remission and if it is mild, moderate or severe

Question 414

What are the causes of mood disorders? (Ch 7)

Answer 414

Three causes  biological, psychological and social factors Equifinality  same outcome resulting from possibly different causes (many reasons for mood disorders) Integrative theory  interaction of these 3^ and the strong relationship between depression and anxiety

Question 415

What are the psychological causes of mood disorders? (Ch 7)

Answer 415

stressful life events, learnt helplessness, negative cognitive styles, psychological (cognitive) vulnerability

Question 416

Describe stressful life events in relation to the psychological causes of mood disorders (Ch 7)

Answer 416

1. Stressful Life Events * Stress and trauma – largely related to onset of mood disorders * Reflected through psychopathology – genetic and psychological vulnerabilities * Stress and trauma activate/trigger this vulnerability (diathesis) * Note: most people who experience stressful events do no develop mood disorders (50% - 80% do not whereas 20%-50% do) * Therefore  genetic and psychological vulnerability (and especially combo of both) lead to development of mood disorders

Question 417

Describe the relationship between stress and depression (Ch 7)

Answer 417

Stress and Depression * George W. Brown (1989) studied life events and developed approach * Believed a stressful event occurred that led to depression * His approach to studying life events - context of the event and the meaning it has for the individual is most important, not necessarily the nature of the event itself * E.g. some may take it worse than others when losing a job (very subjective) * This methodology is unfinished and difficult to carry out as it can be biased * Bias is inherent in remembering events (current moods distort memories) * Investigators believe the only way to study life events is to follow people prospectively * Prospectively  researchers follow a group of individuals over time, collecting data from the present into the future, to observe how they develop or respond to depression and intervention * This more accurately determines the precise nature of events and their relation to the subsequent psychopathology * Studies – show marked link between severe/traumatic life events with depression, most individuals have the severe events precede the depression however some have melancholic/psychotic features in the absence of stressors/events, the occurrence of severe life stress during the latest episode of depression for those with recurrent depression leads to a poor response in treatment, longer time taken before remission and a greater likelihood of recurrence * Despite these points some events are more likely to lead to depression  Breakup of a relationship (adolescents and adults) * Most potent stressful life events that lead to depression: humiliation, loss, social rejection * Gene-environment correlation model  inheriting of specific genes increases probability that we will experience stressful life events (e.g. certain personality characteristics lead to seeking out difficult relationship which leads to depression) * In other words, individuals who are genetically vulnerable to depression are exposing themselves to adverse life events where bad outcomes are common * Reciprocal model  stress triggers depression and depressed individuals are drawn towards stressful events * Both genetics and environment play a role  their impact just differs throughout life (genetics earlier on and environment later on)

Question 418

Describe the relationship between stress and bipolar disorder (Ch 7)

Answer 418

Stress and Bipolar Disorder * Strong link between stressful events and bipolar disorder * Issues relevant to causes of BD: (1) Typical adverse life events trigger depression while more positive stressful life events seem to trigger mania  E.g. breakup for depression and difficulties encountered while striving to achieve goals for mania  These are triggered in individuals with certain vulnerabilities (2) Stress seems to initially and only trigger depression and mania but as BD progresses, these episodes seem to develop a life of their own, not necessarily caused by stress (psychopathological process takes over and ensures the disorder continues) (3) Sleep deprivation and childbirth may precipitate mania in their own right * Thus stressful life events precipitate relapse but also maintain the disorder, preventing recovery

Question 419

Describe learnt helplessness in relation to the causes of mood disorders (Ch 7)

Answer 419

Learnt helplessness: Martin Seligman’s theory that people become anxious and depressed when they make an attribution that they have no control the stress in their lives, whether they do or not * Seligman’s argument  anxiety is often the first response to a stressful situation; depression follows this due to the hopelessness felt when trying to deal/cope with these events * The depressive attributional style is: (1) Internal  individual attributes negative events to personal failings (2) Stable  even after a negative event passes, the attribution of the expectation for negative situations to occur again remains (3) Global  attributions extend across a variety of issues * Is learnt helplessness a cause of depression or a by-product of becoming depressed? – a cause (exists before depression) but can also be a by-product as they are interrelated * Studies: negative attributional style did not predict later symptoms of depression in young children but rather stressful events; this changes as they grow * Process = stressful/negative events in early childhood  stress with age  negative cognitive/attributional styles develop  predicts depressive symptoms in reaction to these stressful events  increased vulnerability to depressive episodes when further stressful events occur * Result = negative cognitive styles precede and are a risk factor for depression * For someone with a non-specific genetic vulnerability to depression, stressful events activate a sense that life events are uncontrollable * This negative attributional style are not specific to just depression and occur with anxiety too * This may indicate that a psychological (cognitive) vulnerability is no more specific for mood disorders than a genetic vulnerability (both may underlie multiple disorders) * Hopelessness thus seems to be more important than attributions – attributions are important only to the extent that they contribute to a sense of hopelessness

Question 420

Define learnt helplessness (Ch 7)

Answer 420

Martin Seligman’s theory that people become anxious and depressed when they make an attribution that they have no control the stress in their lives, whether they do or not

Question 421

What 3 components characterise the depressive attributional style? (Ch 7)

Answer 421

(1) Internal  individual attributes negative events to personal failings (2) Stable  even after a negative event passes, the attribution of the expectation for negative situations to occur again remains (3) Global  attributions extend across a variety of issues

Question 422

Describe negative cognitive styles in relation to the causes of mood disorders (Ch 7)

Answer 422

3. Negative Cognitive Styles * Beck  depression may result from a tendency to interpret everyday events in a negative way (worst case scenario/catastrophic thinking) * Cognitive errors characteristic of negative thinking styles:  Arbitrary inference  emphasis of the negative events rather than the positive of a situation; infer negative information about themselves and their situation in the case of arbitrary situations  Overgeneralisation  individuals create broad and general conclusions from a single negative event or a few instances, applying them to all future situations * Leads to depressive cognitive triad * Depressive cognitive triad: Thinking errors in depressed individuals negatively focused in three areas: themselves, their immediate world and their future * Depressive cognitive triad of negative thinking: (1) Think negatively about oneself (2) Think negatively about one’s immediate world (3) Think negatively about their future * Children may develop a deep- seated negative schema after a series of negative events in childhood * Negative schema  an enduring negative cognitive belief system about some aspect of life * Types of negative schemas:  Self-blame schema – blame oneself for every bad thing that happens  Self-evaluation schema – belief that one cannot do anything correctly * These cognitive errors and negative schemas are automatic and unconscious according to Beck * Evidence supports cognitive based theories of mood disorders, especially depression, as negative thinking is way more prominent in depressed than non-depressed individuals in each dimension of the cognitive triad ^^ * Where do depressive cognitions emerge from – distorted and automatic methods of processing info * Identifying these cognitive errors and underlying schemas is most effective for treatment * BD individuals also exhibit this thinking style but are further characterised by ambitious striving for goals, perfectionism and self-criticism in addition

Question 423

What are 2 cognitive errors characteristic of negative thinking styles? (Ch 7)

Answer 423

 Arbitrary inference  emphasis of the negative events rather than the positive of a situation; infer negative information about themselves and their situation in the case of arbitrary situations  Overgeneralisation  individuals create broad and general conclusions from a single negative event or a few instances, applying them to all future situations

Question 424

Define depressive cognitive triad (Ch 7)

Answer 424

Thinking errors in depressed individuals negatively focused in three areas: themselves, their immediate world and their future

Question 425

What are the 3 components of the depressive cognitive triad? (Ch 7)

Answer 425

Depressive cognitive triad of negative thinking: (1) Think negatively about oneself (2) Think negatively about one’s immediate world (3) Think negatively about their future

Question 426

What are the 2 types of negative schemas? (Ch 7)

Answer 426

* Types of negative schemas:  Self-blame schema – blame oneself for every bad thing that happens  Self-evaluation schema – belief that one cannot do anything correctly

Question 427

Describe cognitive vulnerability for depression and the integration of psychological factors in relation to the causes of mood disorders (Ch 7)

Answer 427

4. Cognitive Vulnerability for Depression: An Integration * Some people may have a negative outlook – dysfunctional attitudes (Beck) and others explain things negatively – hopeless attributes (Seligman) however these have a basic premise that overlaps (negative thinking) * Cognitive vulnerabilities predispose some to view events negatively putting them at risk of depression, according to evidence * Studies – dysfunctional attitudes correlate with depression, negative cognitive styles indicate a vulnerability to later depression, parents thinking styles can influence children’s and cognitive vulnerability to depression can be contagious

Question 428

What are the most prominent socio-cultural factors for onset/maintenance of depression (+mental health in general)? (Ch 7)

Answer 428

 Marital relationships  Gender  Social support

Question 429

Describe marital relationships as a socio-cultural factor for the onset/maintenance of depression (+mental health in general) (Ch 7)

Answer 429

 Marital relations * Interpersonal stress influences mood disorders – marital dissatisfaction is especially related to BD * Those who got divorced – 21% of women and 17% of men experienced severe depression (much higher than those still married) * Only men faced a heightened risk of developing a mood disorder for the first time immediately after divorce (seems that remaining married is more important to men than women) * Personality and failures play strong causal role in major depression for women than for men * Women more affected by  divorce, social support, marital satisfaction, parental warmth and neuroticism * Men more affected by  childhood sexual abuse, conduct disorder, drug abuse, prior history of major depression and stressful life events (financial/legal/occupational issues) * Marital relations may be affected by depression and chronic depressive symptoms due to constant negativity/pessimism and contagiousness of these – reciprocal relationship * Conflict has different effects on men and women  depression causes men to disrupt the relationship whereas disruption problems in the relationship cause depression for women (different causal direction) * Thus, mood disorders and disturbed relationships can be treated at the same time to be most effective and to prevent future relapse * Individuals with BD are less likely to get married and are more likely to get divorced

Question 430

Describe gender as a socio-cultural factor for the onset/maintenance of depression (+mental health in general) (Ch 7)

Answer 430

 Gender - Mood disorders in women * BD  evenly divided between men and women * Depression 70% are women, 30% are men (consistent cross-culturally) * Anxiety, GAD and specific phobias have a similar ratio to depression * Why women have greater rates of mood disorders:  Cultural gender roles - perceptions of uncontrollability are influenced by independence, mastery and assertiveness (masculine role) compared to dependence, sensitivity and passivity (feminine role)  Culturally induced dependence and passivity = women at higher risk of emotional disorders as they increase feelings of uncontrollability and helplessness  Parenting styles lead to development of early psychological vulnerability to later depression/anxiety (especially styles that smother/prevent initiative)  Emergence during puberty in girls  stress from changes in life as well as those who mature physically earlier than others develop more distress  Women’s greater emphasis on relationships and the dissatisfaction/disruption that may come with them = risk for mood disorders  Response style - more rumination and self-blame for depression, predicts later development of depression when under stress (whereas men tend to ignore feelings and do other activities (activities - actually a successful treatment for depression)  Disadvantages  discrimination, poverty, sexism, sexual harassment and abuse as well as less respect and power = stressful life events that could lead to depression  Single, divorced or widowed

Question 431

Describe social support as a socio-cultural factor for the onset/maintenance of depression (+mental health in general) (Ch 7)

Answer 431

3. Social Support * Important in reducing risk for mood disorders * Strong predictor of onset of depressive symptoms at a later time * Strong factor in speeding up recovery from depressive episodes, though not with manic episodes * Those living alone compared to living with others = 80% higher risk for depression * Many of those with depression do not have a close one to confide in * Led to a therapeutic approach for emotional disorders  interpersonal psychotherapy

Question 432

Describe the integrated theory/model of causes of mood disorders (Ch 7)

Answer 432

Biological, psychological and social influences: * Depression and anxiety share common genetically determined biological vulnerability described as an excessive neurobiological response to stressful life events * Genetic pattern involved in this vulnerability  serotonin transporter gene-linked polymorphic region of the brain (general tendency to develop depression/anxiety, not specific) * Psychological vulnerabilities  feelings of inadequacy and sense of uncontrollability for coping with difficulties in life events as well as depressive cognitive styles, triggering of these = pessimistic response leading to depression * These interact with genetic vulnerabilities to form neuroticism and negative affect * Strong correlation between  genetic and generalised psychological vulnerabilities * Stressful life events trigger onset of depression in genetically vulnerable individuals * Process: Stressful life events  activate hormones  affect neurotransmitter systems * Interplay between cognitive style and neurochemical state ^^ * Interpersonal relationships and cognitive styles protect individuals from effects of stress and development of mood disorders and rate and success of recovery * BD and mania have a different genetic basis and response to social support * These individuals are highly sensitive to life events and experiences of these as well as the striving of goals possibly because of the behavioural approach system (BAS) in the brain * Negative stressful events = depressive episode * Positive stressful events = manic episode * Also highly sensitive to disruptions in circadian rhythm * Posses neural networks that predispose them to mood BD

Question 433

Describe the integrative model of mood disorders (Ch 7)

Answer 433

Integrative Model of Mood Disorders Biological Vulnerability  Psychological Vulnerability  Stressful Life Events (Depression [personal loss, social rejection, humiliation] & Mania [achievements, new opportunities, perfectionistic striving])  Activation of stress hormones with wide-ranging effects on neurotransmitter  Mood Disorder Biological Vulnerability  Psychological Vulnerability  Stressful Life Events (Depression [personal loss, social rejection, humiliation] & Mania [achievements, new opportunities, perfectionistic striving])  Depression (negative attributions, sense of hopelessness, dysfunctional attitudes, negative schema) and Mania [positive attributions, sense of power, dysfunctional attitudes, grandiose and impulsive schema])  Mood Disorder Biological Vulnerability  Psychological Vulnerability  Stressful Life Events (Depression [personal loss, social rejection, humiliation] & Mania [achievements, new opportunities, perfectionistic striving])  Problems in interpersonal relationships and lack of social support  Mood Disorder

Question 434

What are the most effective treatments for managing mood disorders? (Ch 7)

Answer 434

Most effective treatments:  Biological treatments affecting monoamine neurotransmission – relieve symptoms and preventing relapse  ECT – alter neurotransmission  Transcranial magnetic stimulation – alter neurotransmission  Psychological treatments – alter neural function and chemical transmission Large increase in treatment over last 2 decades, especially treatment with antidepressant agents (75% patients treated while those using psychotherapy decreased) Most patients are left untreated as  there is a failure to recognise, identify and diagnose mood disorders and a lack of awareness of effective treatments

Question 435

What are the 2 major approaches to the psychological treatment of depression? (Ch 7)

Answer 435

1. Cognitive-Behavioural Therapy (CBT) – Beck 2. Interpersonal Psychotherapy – Weissman and Klerman

Question 436

Describe cognitive-behavioural therapy (Ch 7)

Answer 436

1. Cognitive-Behavioural Therapy * Cognitive therapy: Treatment approach that involves identifying and altering negative thinking styles related to psychologically disorders such as depression and anxiety and replacing them with more positive beliefs and attitudes, and ultimately more adaptive behaviour and coping styles * Grew out of observation of deep-seated negative thinking in generating depression * Patients are taught:  To examine their thought processes while depressed to recognise depressive errors in thinking  That errors in thinking can directly cause depression * Thoughts are often automatic and unconscious making this more difficult * Process of treating:  Enquire about automatic thoughts and introduce idea of looking at one’s own thoughts  Recognising and identifying cognitive errors and negative schemas  Correcting cognitive errors and replacing them with less depressing and more realistic/positive thoughts  Targeting negative schemas by taking a Socratic approach (teaching by asking questions) to uncover faulty thinking patterns and underlying schemas  Carry out therapy in the clinic and at home alone (daily life)  Therapists must be highly skilful and trained

Question 437

Define cognitive behavioural therapy (Ch 7)

Answer 437

Treatment approach that involves identifying and altering negative thinking styles related to psychologically disorders such as depression and anxiety and replacing them with more positive beliefs and attitudes, and ultimately more adaptive behaviour and coping styles

Question 438

What are 4 cognitive-behavioural approaches similar to CBT? Describe them (Ch 7)

Answer 438

* Related cognitive-behavioural approaches:  Cognitive-Behavioural Analysis System of Psychotherapy (CBASP) – integrates cognitive, behavioural and interpersonal strategies and focuses on problem-solving skills, especially regarding relationships; designed for individuals with chronic depression and tested in trial  Mindfulness-based therapy – effective in treating depression and preventing future relapse and recurrence  Mindfulness-Based Cognitive Therapy (MBCT) – combination of mindfulness-based therapy techniques and CBT; effective in the context of preventing relapse/recurrence in patients who are in remission for a depressive episode; especially effective for those with more severe disorders  Behavioural treatment – increased activities can improve self-concept and reduce depression; as effective and sometimes more effective than cognitive approaches; focuses on preventing avoidance of social and environmental cues that produce negative affect/depression (that lead to avoidance/inactivity); focus on facing these cues/triggers and develop coping skills; exercise over weeks/months is also very effective (better at preventing relapse compared to medication); exercise increases neurogenesis (generating of neurons which leads to resilience to depression)

Question 439

Describe interpersonal psychotherapy (IPT) (Ch 7)

Answer 439

2. Interpersonal Psychotherapy (IPT) * Interpersonal Psychotherapy: brief treatment approach that emphasises resolution of interpersonal problems and stressors, such as role disputes, in marital conflict or forming relationships in marriage/new job which has demonstrated effectiveness for treating problems such as depression * Relationship problems  stressors  cause mood disorders * Having too little social support/relationships  risk for developing mood disorders * Process of IPT:  Structured (15-20 sessions, 1 per week)  Focuses on the 4 interpersonal concerns  Recognising and identifying life and relationship stressors/triggers/disputes  Focus on disputes that are associated with onset of depressive symptoms and continuous ones without resolution  After identifying, resolutions are aimed at by determining what stage of interpersonal dispute the couple are at  Once identified, therapist clearly defines the dispute and develops strategies for resolving it for both parties * Marital therapy is applicable to older, depressed women who are typically affected by dysfunctional marriages * Main 4 interpersonal concerns: (1) Dealing with interpersonal role disputes (e.g. marital conflict) (2) Adjusting to the loss of a relationship (e.g. grief over death of a loved one) (3) Acquiring new relationships (e.g. getting married/work relationships) (4) Identifying and correcting deficits in social skills (that prevent initiating & maintaining relationships) * Three stages of interpersonal dispute: (1) Negotiation stage  both partners are aware that it is a dispute and are trying to renegotiate it (2) Impasse stage  dispute slowly worsens beneath the surface and results in low-level resentment yet no attempts are made to resolve it (3) Resolution stage  partners are taking some action such as divorce, separation or recommitting

Question 440

Define Interpersonal Psychotherapy (Ch 7)

Answer 440

brief treatment approach that emphasises resolution of interpersonal problems and stressors, such as role disputes, in marital conflict or forming relationships in marriage/new job which has demonstrated effectiveness for treating problems such as depression

Question 441

What are the 4 main interpersonal concerns regarding interpersonal psychotherapy? (Ch 7)

Answer 441

* Main 4 interpersonal concerns: (1) Dealing with interpersonal role disputes (e.g. marital conflict) (2) Adjusting to the loss of a relationship (e.g. grief over death of a loved one) (3) Acquiring new relationships (e.g. getting married/work relationships) (4) Identifying and correcting deficits in social skills (that prevent initiating & maintaining relationships)

Question 442

What are the three stages of interpersonal dispute regarding interpersonal psychotherapy? (Ch 7)

Answer 442

* Three stages of interpersonal dispute: (1) Negotiation stage  both partners are aware that it is a dispute and are trying to renegotiate it (2) Impasse stage  dispute slowly worsens beneath the surface and results in low-level resentment yet no attempts are made to resolve it (3) Resolution stage  partners are taking some action such as divorce, separation or recommitting

Question 443

What are the effects of therapy for depression? (Ch 7)

Answer 443

Effects of therapy  psychological approaches and medication are equally effective immediately following treatment (all more effective than placebo conditions or psychodynamic treatments) for MDD and PDD (around 50% benefit from treatment) Similar results are reported in children and adolescents (CBT is very effective when medications do not work) Studies have not found a difference in treatment effectiveness based on severity of depression (baselines depression severity does not predict the efficacy of CBT and antidepressant medications – adding CBT enhances treatment) IPT can be effective in treating women with post-partum depression (especially if they cannot go on medication after birth); studies show that IPT should be the first choice of therapy for these women thought CBT seems to have the same effectiveness; also effective in school settings for children

Question 444

Describe the prevention of depression (Ch 7)

Answer 444

PREVENTION Institute of Medicine (IOM) – introduced 3 types of prevention programmes for mood disorders Three types of prevention programmes: (1) Universal programmes – applies to everyone (2) Selected interventions – target individuals at risk of depression due to many factors (3) Indicated interventions – individual is already showing mild symptoms of depression May be possible to ‘psychologically immunise’ at risk children and adolescents against depression by teaching appropriate cognitive and social skills (selected interventions) CBT is somewhat to significantly more effective than usual care in preventing future episodes of depression depending on if child’s parents are experiencing depressive episodes themselves (indicated interventions) Results show  interventions are particularly powerful yet less so when family members are experiencing depressive symptoms too (this, depression should be treated in the whole family to be fully effective) Therapy delivered during the acute phase (showing depressive symptoms but not depression disorder yet) has a long-lasting and successful effect that protects patients from relapse/recurrence Continuation CBT – reduces risk for relapse Maintenance CBT – reduces risk for recurrence

Question 445

What does IOM stand for and what did it introduce? (Ch 7)

Answer 445

Institute of Medicine (IOM) – introduced 3 types of prevention programmes for mood disorders

Question 446

What are the three types of prevention programmes the IOM introduced? (Ch 7)

Answer 446

Three types of prevention programmes: (1) Universal programmes – applies to everyone (2) Selected interventions – target individuals at risk of depression due to many factors (3) Indicated interventions – individual is already showing mild symptoms of depression

Question 447

Describe the psychological treatments for bipolar disorders (Ch 7)

Answer 447

Medication (lithium) and psychological treatments that manage interpersonal/practical problems These also increase compliance with medication regimens which lead to better treatment outcomes – make patients more cooperative and consistent in taking medication which is difficult when mania occurs or when patients desire ‘pleasures’ of mania to escape depressive episodes Interpersonal and social rhythm therapy (IPSRT) – treatment approach that regulates circadian rhythm (eating and sleeping cycles) and other daily activities and helps cope more effectively with stressful life events, especially interpersonal conflict Results of IPSRT  longer intervals without manic/depressive episodes compared to standard treatment, found that family tension is associated with relapse in BD thus treatments aimed at helping families understand symptoms and develop coping skills and communication styles can help prevent relapse (this with medication is most effective in preventing relapse) CBT  effective for patients with the rapid-cycling specifier (antidepressant medication for depressive episodes is largely ineffective) Family-focused therapy  more rapid recovery and more often in remission

Question 448

Describe suicide (Ch 7)

Answer 448

Suicide – any death resulting from injury, or another act, that is self-inflicted with the intention to die DSM-5-TR  provides free-standing symptom codes for suicidal ideation and behaviour as well as a history of suicidality to draw attention to this psychopathology (even without other diagnoses) RISK FACTORS Four risk factors for suicide  family history, neurobiology, psychological disorders and stressful life events Studies on risk factors behind suicide – developed by Schneidman Method used to study these conditions that make one vulnerable – Psychological autopsy Psychological autopsy: Postmortem psychological profile of a suicide victim constructed from interviews with people who knew the person before death

Question 449

What are the 4 risk factors of suicide? (Ch 7)

Answer 449

family history, neurobiology, psychological disorders and stressful life events

Question 450

Define psychological autopsy (Ch 7)

Answer 450

Postmortem psychological profile of a suicide victim constructed from interviews with people who knew the person before death

Question 451

Describe how family history is a risk factor for suicide (Ch 7)

Answer 451

* Higher risk of someone committing suicide if someone in their family already did * Strongest predictor of suicidal behaviour - family history of suicide (6x the risk especially if it was a sibling) * Often due to disorders running in families * Is this due to a strategy they are familiar with or is there an inherited trait that leads to suicidal ideation? * Both factors seem to contribute (aggressive/impulsive traits = greater risk) * Seems to be a biological basis

Question 452

Describe how neurobiology is a risk factor for suicide (Ch 7)

Answer 452

* Low CNS serotonin activity, HPA & cortisol social-stress response may be associated with suicide and attempts * Decreased serotonin --> impulsivity, mood instability and tendency to overreact * Due to transmission of biological vulnerabilities and traits (impulsivity) may mediate family transmission * Certain chronic medical conditions also have high risk - epilepsy, Huntington's disease, cancer, etc * Main factors at play --> specific gene variants, functional polymorphism regulating monoaminergic affecting regulation

Question 453

Describe how psychological disorders are a risk factor for suicide (Ch 7)

Answer 453

* 80%+ who take their lives have an existing psychological disorder (mood, substance abuse and impulse control disorders * Mood disorders --> largest group (60% of suicides) however many who have it do not take their lives and vice versa * Strong predictor of suicide --> hopelessness (component of depression [and other disorders]) * Interpersonal theory of suicide --> negative cognitive styles such as perception of ourselves as a burden on others and a diminished sense of belonging (powerful predictors of hopelessness and thus suicide) * Alcohol use --> 25%-50% of suicides (especially in college students and adolescents) * Around 1/3 of adolescents who take their lives are intoxicated during the act * Combination of disorders with substance/alcohol abuse and control/impulse problems = strongest vulnerability to suicide * Trait called sensation-seeking and past suicide attempts --> strongly predicts suicide * Disorder characterised by impulsivity - borderline personality disorder (make manipulative and impulsive suicidal gestures without necessarily wanting to kill themselves and then sometimes accidentally do * Depression and borderline personality disorder - especially deadly

Question 454

Describe how stressful life events are a risk factor for suicide (Ch 7)

Answer 454

* Severe/stressful events that leads to shame/humiliation, physical/sexual abuse, disruption of natural disasters * Preexisting vulnerabilities - psychological disorders, impulsivity traits and lack of social support = higher chance of suicide

Question 455

(Ch 7)

Question 456

(Ch 7)