Diagnosis & Psychopathology 3 Flashcards
Priority 1 (49 cards)
0
Q
What are some risk and course factors associated with Major Depressive Disorder?
A
- 50%-60% of those who have one major depressive episode will have more
- ~15% of individuals with MDD die by suicide
- relapse is predicted by
- absence of social support
- family hostility, criticism, and overinvolvement
1
Q
What is the suicide rate associated with Bipolar I Disorder?
A
10-15%
2
Q
List some gender differences in prevalence and risk of Major Depressive Disorder.
A
- MDD about twice as common in adolescents and women than men by age group
- MDD may be underdiagnosed in men
- women may express well-being more extremely (in both directions)
- risk factors in women include passivity, dependency, poverty, having young children
- having multiple roles is a protective factor for women
- marriage is a protective factor, but more for men than women
3
Q
What are prevalence rates and other factors associated with post-partum depressive symptoms?
A
- 50%-80% of women experience tearfulness and mood swings in the first few days after giving birth
- within four weeks of giving birth, 10%-20% of women experience Sx meeting criteria for a mood disorder
- Sx typically last 2-8 weeks, can persist for one year
4
Q
What is “double depression?”
A
- Dx of both Major Depressive Disorder and Dysthymic Disorder
- associated with lower recovery rates and higher relapse rates than episodic Major Depressive Disoder, greater psychological disturbance, and increased suicide attempts
5
Q
What is the etiology of Seasonal Affective Disorder?
A
- believed to be abnormal regulation of pineal melatonin secretion
- can be responsive to light therapy
- phenotype with hypersomnia and carbohydrate craving more responsive
- phenotypes with insomnia and weight loss, chronic depression, incomplete summer remission less responsive but may benefit
6
Q
What is the role of genetics in the etiology of mood disorders?
A
- 60%-65% of individuals with a bipolar disorder have a relative with bipolar or unipolar depression
- having either parent with depression increases risk of having depression
7
Q
What is the role of stress in the etiology of mood disorders?
A
- appears to be more impactful on early course of uni- and bipolar depression, e.g., critical to first or second episode
- depressed people report 3x as many stressful life events as non-depressed
- day-to-day stressors are also associated with depression, esp. mild forms
8
Q
What is the catecholamine hypothesis of mood disorders?
A
- imbalance of catecholamines (incl. e.g., norepinephrine) affect mood
- depletion produces depression
- excess produces mania
- supported by fact that tricyclics and MAOIs increase availability of norepinephrine and lithium decreases norepinephrine and dopamine
9
Q
What is the permissive theory of mood disorders?
A
- low serotonin produces mood disorder, then norepinephrine levels determine type:
- depression is due to low norepinephrine and low serotonin
- mania due to high norepinephrine and low serotonin
- supported by SSRI action
10
Q
What are some sleep cycle irregularities associated with depression?
A
- unusually rapid REM onset
- reduced slow-wave sleep
- early morning wakening
11
Q
Name a behavioral intervention for sleep cycle disturbances associated with depression.
A
Sx can sometimes be reduced with partial sleep deprivation or going to sleep 5-6 hours early
12
Q
What factors in attributional style are associated with the learned helplessness approach to understanding depression?
A
- attributing negative events as
- global (vs specific)
- stable (vs transient)
- internal (vs external)
- emphasis on hopelessness
13
Q
What is the self-control model of depression?
A
- selective attention focusing on
- negative events
- immediate outcomes
- stringent self-evaluation standards
- dysfunctional attributions
- positive outcomes external
- negative outcome internal
- dysfunctional self-conditioning
- insufficient self-reinforcement
- excessive self-punishment
Rehm’s Self-Control Therapy is based on these findings.
14
Q
Describe general indications for prescribing tricyclic and SSRI antidepressants.
A
typically used to treat classic depression Sx
15
Q
Describe indications for prescribing MAOIs.
A
usually used for treating atypical depression, e.g., that with anxiety, hypochondria, and obsessive-compulsive Sx
16
Q
Discuss efficacy and other relevant factors in pharmacological treatment of mood disorders.
A
- 60% of depressed patients improve (40% do not)
- almost half treated relapse within a year of Rx termination
- up to 50% of patients unilaterally reduce or discontinue medication, in part due to side effects
17
Q
What two therapies are mentioned as being effective for depression?
A
- CBT
- IPT (interpersonal therapy)
18
Q
Describe the three stages of Beck’s CBT for depression.
A
- ID automatic thoughts producing depression
- understand how thoughts distort reality
- come to see how thoughts are unfounded
19
Q
Describe Wolpe’s behavioral model of “neurotic depression.”
A
- similar to learned helplessness: prolonged exposure to inescapable aversive stimuli leads to increased emotional arousal and eventually depressed mood
- i.e., depressed mood due to low rate of response contingent reinforcement
20
Q
Describe behavioral approaches to depression treatment.
A
- increasing pleasurable activities
- improving social skills (not clearly related to depression relief)
- best when combined with cognitive therapies
21
Q
Describe etiology and treatment of depression according to Interpersonal Therapy.
A
- depression arises from interpersonal difficulties arising early in life, esp. attachment
- considers depression to be an illness
- Tx focuses on
- interpersonal deficits and conflicts
- difficult role changes
- prolonged grief reactions
22
Q
Discuss effectiveness of CBT vs medication in treatment of depression.
A
- both about equally effective overall
- CBT more effective for milder depression
- meds more effective for moderate to severe
23
Q
What are the indications for Electroconvulsive Therapy?
A
- severe endogenous depression w/delusions and suicidal ideation
- depression has not improved w/meds
24
What are some of the side effects of Electroconvulsive Therapy?
- nonverbal (nonsense syllables, geometric figures) memory and learning impaired
- verbal memory and learning impaired
* bilateral ECT only; if ECT is right hemisphere-unilateral, impairment appears not to occur or be undetectable within 6 months
25
How does combining psychotherapy and medication affect relapse of depression?
- no consistent additive superiority of therapy plus med maintenance
- relapse rates lower with psychotherapy alone vs meds alone
26
What risk factors are associated with depression relapse?
- persisting residual symptoms
- increased expressed emotion in family
NOTE: Think expressed emotion = criticism
27
Discuss prevalence rates and other relevant factors in anxiety disorders.
- anxiety disorders are the most common psychiatric disorder among older adults
- GAD is most prevalent among anxiety disorders
- depression commonly comorbid with anxiety among adults, esp. older adults
- anxiety in older adults may be underdiagnosed and is probably undertreated
* may be more likely to attribute Sx to physical health issues and so seek medical rather than psychological help
28
Describe three types of panic attack.
- unexpected/uncued (out of the blue)
- situationally bound/cued (almost invariable w/cue)
- situationally predisposed (more likely, but not invariable w/cue)
29
Discuss prevalence rates for Panic Disorder.
- overall prevalence of 1%-2% (w/ or w/o Agoraphobia)
- very rare in children
* argued that children not capable of linking panic Sx to catastrophizing about death
30
Discuss prevalence and comorbidities of Panic Disorder with Agoraphobia
- 1/3 to 1/2 of people with PD have Agoraphobia (community samples)
- comorbidities:
* GAD highest
* Social Phobia, Specific Phobia fairly high
* PTSD lowest
31
Discuss the etiology of Panic Disorder.
- evidence of high sodium lactate levels
- evidence of genetic predisposition
* more prevalent among first degree relatives
32
List three CBT approaches for Tx of Panic Disorder.
- exposure to internal cues associated with attacks
- exposure to somatic Sx through controlled inducement
- alterations of distorted interpretations of somatic sensations
Note: CBT generally considered to be most effective
33
Discuss prevalence and other factors associated with Social Phobia.
- prevalence 5%
- third most common adult mental disorder worldwide
- some studies show equal gender occurrence; others 3:2 women:men
- onset typically during adolescence, but can occur after a significant life event
- typical course is chronic and lifelong
34
Name two types of pharmacological interventions for Social Phobia.
- anti-depressants
| - beta-blockers
35
Discuss prevalence, onset, and course of Specific Phobia.
- onset usually early childhood
* may be younger in women than men
- vasovagal response/fainting common (75%) in Blood/Injection/Injury subtype (short increase in bp/heart rate followed by drop)
- other subtypes show increase in blood pressure
36
Discuss etiology of phobias according to different theories.
- psychoanalysis: paralyzing conflict due to unacceptable impulses toward person/object
- behaviorism: classically conditioned response
- biology: some stimuli are biologically prepared, e.g., those that pose or have posed a threat to survival
37
Discuss treatment approaches for Specific Phobia.
- imaginal exposure
- in-vivo exposure
- hypnosis (to induce relaxation, gain access to relevant memories; SP patients tend to be highly hypnotizable)
- tricyclics (imipramine) and SSRIs
- for Blood/Injection/Injury: applied tension with exposure
38
Discuss treatment approaches for Agoraphobia without Panic.
- in-vivo exposure with response prevention
* best when combined with medication
- group therapy with significant others present
39
Discuss demographic factors, comorbidity, and differences in onset associated with Obsessive-Compulsive Disorder.
- OCD sufferers have a disproportionately large fraction of high SES and high IQ individuals
- typical comorbidity with Major Depressive Disorder
- in late onset (adolescence or later), obsessions and compulsions begin at about the same time
- in early childhood onset (pre-adolescence), compulsions tend to start 1-2 years earlier than obsessions
- early onset is associated with:
* male gender
* tic disorders
* familial loading for OCD
* higher frequencies of repeating compulsions and of hoarding obsessions and compulsions
40
Discuss theories of etiology of Obsessive-Compulsive Disorder according to different theories.
- psychodynamic: overdevelopment of ego and superego, over-reliance on reaction formation and displacement
- behavioral: initial anxiety response to previously neutral stimulus (classical conditioning), followed by compulsive rituals to avoid stimulus (negative reinforcement)
- biopsychology: OCD associated with basal ganglia & frontal lobe abnormalities.
41
Discuss treatment approaches to Obsessive-Compulsive Disorder.
- exposure with response prevention, with a preference for in-vivo over imaginal exposure
- habituation with thought stopping for obsessions
- supportive therapy for concomitant depressed mood, sexual dysfunction, and family relationship issues
- SSRIs, but Sx tend to reappear after discontinuation if pharmacotherapy alone
42
Discuss treatments for Posttraumatic Stress Disorder other than EMDR.
- CBT emphasizes prolonged exposure and stress inoculation, as well as coping skills
- pharmacotherapy can reduce depression, panic, and psychotic Sx when they are too intense but is not a cure in itself
- brief psychodynamic psychotherapy works to integrate experience of trauma
- hypnosis and relaxation training can decrease motor tension and autonomic arousal
- crisis intervention can help prevent development of delayed or chronic Sx and reduce distress
43
Discuss Eye Movement Desensitization and Reprocessing therapy for Posttraumatic Stress Disorder.
- patients select an anxiogenic memory
- patients then follows a cue with their eyes (lateral movement of therapist's finger, a light, etc.)
- patient responds to Q: "What comes up?"
- process repeats until memory no longer anxiogenic
- EMDR as effective as other exposure-based Tx
- lateral eye movement as such may not be necessary
44
Discuss disorders that are commonly comorbid with Generalized Anxiety Disorder.
- substance-related disorders
- mood disorders
- other anxiety disorders, esp.:
* Social Phobia
* Specific Phobia
* Separation Anxiety Disorder
* OCD
* PTSD
45
Name two factors moderating CBT for Generalized Anxiety Disorder.
* client's expectations of improvement
| * client's tendency to interpret ambiguous stimuli as threatening
46
Name two treatments for Generalized Anxiety Disorder.
- progressive muscle relaxation
| - cognitive restructuring (decatastrophizing)
47
List some psychopharmacological treatments for anxiety disorders.
- antidepressants (based on physiological similarity between panic and depression)
* tricyclics (imipramine)
* MAOIs
* benzodiazepines (alprazolan)
NOT EFFECTIVE: beta-blockers
48
Discuss primary and secondary gains in the context of Conversion Disorder.
- primary gain: symptom reduces anxiety and keeps internal conflict out of conscious awareness
- secondary gain: symptom helps individual avoid aversive activity or obtain support
