Exam 2 Flashcards

Question

Depression: Treatment Types Medication

Answer 1

1. **SSRIs** → Selective Serotonin Reuptake Inhibitors 2. **SNRIs** → Serotonin and Norepinephrine Reuptake Inhibitors 3. **Electroconvulsive Therapy** (ECT) 4. **Transcranial-Magnetic Stimulation** (TMS) * Applies a magnetic pulse to brain * For treatment-resistant depression 5. **Ketamine** * Theory: Suppresses neurotransmitter activity & alters activation patterns & connectivity * Limited long-term research *(Be Cautious)* * Seems to require higher doses 6. **Exercise / Physical Activity**

Answer 2

**Therapy + Medication:** *Combining the _two is better_ than either alone by 10% – 20% * Medications quicker, therapy longer-lasting effects **Cognitive Behavioral Therapy (alone):** * As effective as medication for severe depression * CBT = more effective than medication at preventing relapse

Answer 3

**Two Types:** 1. Bipolar Disorder I. 2. Bipolar Disorder II. _Bipolar I. _→ at least one Manic Episode _Bipolar II._→ Includes hypomanic episodes – not full manic episodes

Answer 4

**Manic Episode:** Mania that... * 1+ weeks, Most of the day, Nearly every day **OR** requires hospitalization **Hypomanic Episode:** * 4+ days of clear changes in functioning/behavior **BUT** impairmentisn’t as significant

Answer 5

Must have: *both* 1. Distinctly elevated or irritable mood 2. Abnormally increased activity or energy Must have _3_ of the following: - Increased goal-directed activity - Talkative/ rapid speech - Racing thoughts - Decreased need for sleep - Increased self-esteem - Distractibility - Excessive risky behavior

Answer 6

**Prevalence:** * Bipolar I. → affects ~1% of population * Bipolar Types combined → ~ 4% **Average Onset Age:** Between 18 - 22 years old **Gender:** * Prevalence: No gender differences * Symptoms: Women report more depressive episodes

Answer 7

~ 15% of people with a diagnosis die by suicide 25% report suicide attempts >50% report suicidal ideation in the past 12 months

Answer 8

Heritability = high. * Ranges from 70-90% heritability Shares genetic risk factors with schizophrenia and MDD

Answer 9

**Heritability = high.** * Ranges from 70-90% heritability Genetics → Shares genetic risk factors with Schizophrenia and MDD **Brain:** * _Reduced Volume_: Prefrontal, & Limbic Structures * _Increased Activation_: emotion regions (amygdala + striatum) * increased response to high rewards * Mania → Hypersensitivity to dopamine receptors

Answer 10

Reward Sensitivity: **How motivated/excited a person is to obtain a reward** * increased response to reward cues * _Reward Sensitivity_: Predicts BP onset & severity of symptoms

Answer 11

Goal Striving: **Increased pursuit of extreme goals** * Ie: if you do this thing you will win a million dollars * Atypical Goal Striving → Predicts future Mania symptoms & onset of BD

Answer 12

1. **Medication:** 1st line of treatment 2. **Talk Therapy:** very useful when paired with medication

Answer 13

Medications: * Mood stabilizers * Anticonvulsants * Antipsychotics _Mood Stabilizer_: **Lithium** * Very effective _Mood Stabilizer_ * 1/3 of patients = dramatic improvement * 1/3 = some improvement * 1/3 = no improvement * *Protective Against Suicide* _Antidepressants = Risky Meds_: * Potential to trigger Mania * **BUT** _helpful_ when paired with _Mood Stabilizers_ to prevent triggering mania Risky Behaviors: Medication non-compliance is _high_ in BD

Answer 14

1. Psychoeducation & **Family-Focused Education** 2. **Social Rhythms Therapy** * Create _Routines + Life Charts_ to help regulate mood (ie: sleep) * _Life Carting_: Identifying personal patterns & triggers 3. **Goal Regulation** * Break down *large goals* into smaller steps (goal pacing) 4. **Behavioral Activation** * use it carefully *start small, build up*

Answer 15

Bipolar Disorder: x10 more prevalent in artists

Answer 16

**Experience that cuts across disorders** * ie: bipolar disorder, schizophrenia, depression, substance abuse, anorexia

Answer 17

**Suicide is the _11th leading cause of death_** * **2nd** leading cause in ages: _10 - 35 years old_

Answer 18

* Men ~4x to commit suicide * Women are more likely to *attempt* suicide * Highest death rates in _White Men_

Answer 19

Adolescents: * 24% of high school girls and 15% boys have serious suicidal thoughts * Most students that had suicidal thoughts did not act on them * **more common in people with depression**

Answer 20

Social Influences: * Economic recessions * Media reports of suicide * Social Isolation * Access to means Psychological Influences: * Difficulty with problem-solving * Hopelessness * Impulsivity

Answer 21

1. Safety Protocols **preventative** * Hospitalization * Means Restriction (decrease access to lethal things) 2: Evidence-Based Treatments * Dialectical Behavior Therapy (DBT) * Cognitive Therapy for Suicide Prevention (CT-SP)

Answer 22

1. Social / Environmental Prevention: * Healthcare access + Government programs 2. Reduce stigma of mental illness 3. Treat the associated mental health disorder

Answer 23

1. Specific Phobias 2. Social Anxiety Disorder (SAD) 3. Generalized Anxiety Disorder (GAD) 4. Panic Disorder 5. Agoraphobia

Answer 24

**Fear:** * Present focused: response to immediate danger/threat * Intensity builds quickly **Anxiety: ** * Future focused: anticipate and prepare * ongoing feeling/worry of anticipation * Example: Thinking about an upcoming project that’s due

Answer 25

There is an **optimal level of arousal** (stress) that **maximizes performance** * Low arousal = low performance * _Moderate arousal = Optimal Performance_ * High arousal = declining performance

Answer 26

Disordered when... 1. Symptoms are pervasive and persistent 2. It involves excessive avoidance 3. It causes significant distress and impairment

Answer 27

**Internal:** * >50% of ppl with one anxiety disorder meet criteria for another anxiety disorder **External:** * 75% meet criteria for another psychological disorder * 60% also have depression

Answer 28

Anxiety Disorders = one of the most common mental disorders **BUT** * only ~25% of people who qualify for diagnosis seek treatment (so estimates are likely off)

Answer 29

Textbook Definition: Persistent, irrational, narrowly defined fears that are associated with a specific object or situation. DSM-5 Definition: Intense, persistent fear of a specific object or situation that is excessive or unreasonable.

Answer 30

* Immediate fearful response to phobia exposure * Avoidance / Endured w intense Distress * Persistent fear, anxiety, & avoidance: _6+ months_ * Affects daily life

Answer 31

* ~12% of the general population (may be an underestimation) * 3x more common in women

Answer 32

* Chronic – phobias don't usually go away with treatment * Age of onset varies widely * Often comorbid with other specific phobias

Answer 33

**Evolutionary Adaptation** - being scared helped protect us from harm **Classical Conditioning** - When a stimulus is paired with something scary, we can become conditioned to fear the stimulus. * ie: Baby Albert wasn't scared of the Rat, *but* when it was paired with a load noise (feared stimulus) → the baby became conditioned to fear the Rat - phobia translated

Answer 34

Medications -- NOT recommended - _Meds = Short-Term Solution_ *(can become a "safety behavior")* - Benzodiazepines = *addictive* & short-term solution - Beta Blockers = not addictive, but are short-term solutions Cognitive Behavioral Therapy (CBT) –- **Highly Effective** and Quick! - Exposure therapy - In-vivo exposure (real life exposure) - Imaginal exposure Levels of exposure, slowly increase (ie: level 1 = room filled with dog toys, level 10 = petting a dog)

Answer 35

_DSM-5 Definition_: "Fear or anxiety specific to social settings, in which **the individual feels noticed, observed, or scrutinized."** * Social Anxiety Disorder = ALMOST identical to Specific Phobia definition in DSM-5

Answer 36

* Fear of social rejection (and that others will notice your anxiety) * Social interaction cause distress * Social interaction is avoided or endured with intense anxiety/distress * Fear and anxiety are disproportionate to the situation _KEY COMPONENT: **Fear of Evaluation_**

Answer 37

* ~12% of the general population * Slightly higher rates in women

Answer 38

* Chronic – doesn't usually go away with treatment * Onset age: Adolescents – Early Adulthood * High comorbidity with other anxiety disorders and depression * Impairment Ranges: moderate to severe

Answer 39

**Medication:** * SSRIs → Very effective * BUT _relapse_ rates = high when medication is stopped **Psychological Treatments:** * Cognitive Behavioral (Preferred method of treatment by **AMA**) * ie: exposure, rehearsal, role-play in group settings * Social Skills Training * ie: Extensive modeling of behaviors * Attention Bias Modification Training * A computer-based method that helps retreain people to focus on positive stimuli instead of negative stimuli. * seems to help reduce anxiety (more data needed to know how long affects last)

Answer 40

**Textbook Definition:** "Excessive and uncontrollable worry about a number of events or activities, and associated with symptoms of (physical) arousal."

Answer 41

* Excessive worry at least 50% * Trouble controlling these worries At least _3 of the following_: * Restlessness or feeling “keyed up” or on edge * Easily fatigued * Difficulty concentrating or mind going “blank” * Irritability * Muscle tension * Sleep disturbance (falling asleep, restless sleep)

Answer 42

* Lifetime prevalence ~ 6% * Gender: 2x more women than men (approximately 2:1 ratio)

Answer 43

* Often a chronic condition * Heritability ~33% * Comorbidity: High overlap with MDD

Answer 44

Cognitive Behavioral Therapy (CBD) * Identify, track, and challenge worries Mindfulness Based Cognitive Therapy * Focus on present moment * When mind wanders to ‘what ifs’, gently bring it back to present * Relaxation strategies * Identifying thoughts + emotions *remembering anxieties aren’t facts* * Self-compassion Medications * SSRIs * Benzos – **not** a good solution

Answer 45

Big Differences: * GAD = Big worries + Trouble controlling worries * MDD = Sad Mood + Anhedonia (difficulty experiencing pleasure)

Answer 46

**DSM-5 (in class) Definition:** "A sudden onset of intense apprehension, terror, and/or feelings of impending doom, peaks quickly (10 minutes)"

Answer 47

* Recurrent, unexpected panic attacks * Persistent worry about having another panic attack * or about the consequences of another attack (losing control, having heart attack, “going crazy,” etc.) * Significant change in behavior because of/related to attacks **(ie: avoidance)** * Can occur with or without Agoraphobia *(The Fear of being in a situation difficult to escape or receive help)*

Answer 48

Physical Symptoms: * shortness of breath, chills, chest pain, etc... **Psychological symptoms:** * Depersonalization—feel like outside body * Derealization—feel like world isn’t real * Fear of losing control/going “crazy” * Fear of dying

Answer 49

* ~3-4% of the population * 2x as prevalent in women * ~20% of college students have a panic attack *(most only have one)* * Intermittent Course - goes away, but comes back

Answer 50

* First attack usually experienced after high stress situation * The _**response**_ to panic attack _determines_ if one develops Panic _Disorder_ * Many adults who experience attack, never go on to develop Panic Disorder

Answer 51

**Medication:** * Benzodiazepines – **not** recommended, *relapse* frequent **Therapy:** * **Exposure** is key – and very effective! * Interoceptive Exposure: exposure to physical sensations associated w panic attack * _Goal_: watch anxiety go up, cope with it, learn that you will be okay

Answer 52

During a panic attack – **focus on present moment** * Focus on Breath * What can you see, hear, taste, smell to help bring you to present * wait for symptoms to lessen

Answer 53

**In Vivo Exposure:** Exposed to the fear in real life **Imaginal Exposure:** Imagining a fear vividly **Interoceptive Exposure** Triggering physical sensations to learn they are not harmful **Virtual Reality Exposure:** Being exposed to the fear via VR

Answer 54

**The fear or anxiety about being in situations difficult to escape or receive help**

Answer 55

Fear or anxiety about being in situations _difficult to escape or receive help_ * These situations are avoided or endured with intense fear/anxiety *Note: Often portrayed as being house bound, but it’s not necessarily the case*

Answer 56

* Anxiety = 30-60% heritable * Some genes may elevate risk for disorders * Genetic vulnerability for anxiety & depression may overlap

Answer 57

**Relevant Brain Regions:** * Limbic System is Key* * Heightened activity in the amygdala / insula * Diminished activity of the prefrontal cortex in response to threatening stimuli **Neurotransmitters:** * Serotonin and GABA are disrupted * Norepinephrine levels increases Sympathetic Nervous system involved: physical symptoms

Answer 58

**Positive Feedback Loop** When a person reacts anxiously to their physical symptoms this increases their anxiety.

Answer 59

**Exposure Therapy:** effective for 70–90% of clients who do it **Mindfulness/relaxation and acceptance:** A promising approach **Medications:** Effective, but _high relapse rates_ when medications are stopped *(SSRIs better long-term choice)* **_Psychological treatments_ are the _preferred_ method**

Answer 60

School prevention programs * may be helpful in reducing future anxiety symptoms / disorders BUT **evidence is mixed**

Answer 61

OCD = **The presence of unwanted intrusive thoughts and/or habitual behaviors**

Answer 62

**Obsessions:** * Recurrent, persistent and unwanted thoughts, impulses or images * thoughts are: Intrusive, inappropriate, irrelevant/irrational * Thoughts are **not** just excessive worries about real life problems * Attempt to suppress, ignore thoughts or try to neutralize with some other thought /action (i.e., compulsion) **Compulsions:** * Repetitive _behaviors_ or mental acts that person feels driven to _perform in response to an obsession_ or rule that must be followed *Acts are done to _reduce anxiety or distress_ or to prevent an obsessive thought * they are _excessive_ or aren’t realistically connected

Answer 63

**Prevalence:** only ~ 1-2% of the population **Gender:** _Equal_ effect * Men = childhood, earlier onset, *(possibly more chronic course)* **Onset Age** = 19.5 years * 25% of cases start by 14 years **Course:** Chronic Condition * can be extremely severe and debilitating

Answer 64

**Moderate genetic influences** * Twin consistency: MZ twins = 57%, DZ twins = 22% **Comorbidity:** Comorbid with mood and substance use disorders

Answer 65

**Medical Treatment:** * SSRIs * Benefit about 60% * Relapse is common when medication is stopped (*without* therapy) * Transcranial Magnetic Stimulation (TMS) **Cognitive-Behavioral Therapy:** * _Most effective treatment_ for OCD * **(ERP)** Exposure and Response Prevention: * **Very effective** * BUT... 1/3 unwilling to begin ERP (and 1/3 who start it, drop out) **Deep brain stimulation:** Only in extremely severe (treatment resistant) cases

Answer 66

Set up situations that will trigger compulsions **ERP Therapy + SSRIs = Best/Most effective treatment plan**

Answer 67

**Heritability:** range of 40% - 50% **Brain:** * _Frontal-Striatal Circuitry_: Over activity when shown stimuli that provoke obsessions * Successful treatment of OCD using ERP (exposure therapy) results in less overactivity in these brain regions reduces

Answer 68

**Cognitive Model:** _People with OCD try harder to suppress their obsessions than others._ * White Bear Experiment: *"Don't think about the bear!!"* → instruction actually makes you think about the bear WAY more. * **Theory:** Paradoxical Effect. *_Actively trying to suppress thoughts makes you think about them more_*

Answer 69

Obsessions/Compulsions come from unconscious conflict you are trying to suppress

Answer 70

1. Post-traumatic stress disorder (PTSD) 2. Acute stress syndrome

Answer 71

1. Dissociative Amnesia 2. Dissociative Fugue 3. Dissociative Identity Disorder (aka Multiple Personality Disorder)

Answer 72

**PTSD Definition:** _Recurring symptoms of numbing, re-experiencing, and hyperarousal following exposure to a traumatic stressor._ Cause = Exposure to trauma Symptom Domains: 1. Intrusive Memories 2. Avoidance 3. Negative changes in mood and thoughts 4. Changes in physical / emotional reactions

Answer 73

**DSM-5 Trauma Definition:** "Exposure to actual or threatened death, serious injury or sexual violence."

Answer 74

PTSD Symptom: Intrusive Memories **Unwanted memories of traumatic events, flashbacks or nightmares.** * memories that cause intense discomfort in response to reminders of trauma

Answer 75

PTSD Symptom: Avoidance **Avoiding reminders of the trauma:** * _Internal_ Avoidance: Memories, thoughts or feelings * _External_ Avoidance: People, places, activities

Answer 76

PTSD Symptom: Negative Changes in Mood & Thoughts * **Decreased Interest & Pleasure** * Negative thoughts about self & others * Trouble recalling aspects of the trauma

Answer 77

PTSD Symptom: Changes in Physical / Emotional Reactions * Irritable * Reckless or self-destructive behavior * Hyper vigilance * Exaggerated startle response * Trouble concentrating * Sleep disturbance

Answer 78

**Definition:** Just like PTSD, but symptoms only between 3 days -- 1 month **Issues w Diagnosis:** Are we pathologizing/stigmatizing a common, short-term response to serious trauma? Is this harmful?

Answer 79

Prevalence: ~7% * Women = 2x more likely as men to develop ptsd * *but* men are more likely to be exposed to trauma) Course: ~ 33% report symptoms 10 years later

Answer 80

Most common traumas: * Sexual assault * Accidents (man-made and natural) * Combat

Answer 81

Commonly Comorbid With: * other anxiety disorders * depression * substance abuse

Answer 82

* Self-blame * Conditioning / Learning: * flashbacks triggered by cues reminded of trauma *(result of _post-trauma_ Fear Conditioning)* * Avoidance / Operant conditioning * avoidance initially alleviates anxiety, but keeps it long term * The brief alleviation of anxiety makes us avoid more → Operant Conditioning (rewarded behavior)

Answer 83

Hippocampus: Smaller in size & less activity * Limbic system is also important Heritability: _No reliable data_ for who will develop PTSD after trauma

Answer 84

1. Cognitive abilities -- problem solving/ reasoning skills 2. Emotional Regulation Skills 3. Social connectedness 4. Active Coping

Answer 85

a. Medication b. Prolonged Exposure c. Cognitive Processing Therapy d. EMDR (Eye-movement desensitization and reprocessing)

Answer 86

Medications: * SSRIs * Benzodiazepines - often prescribed but **NOT** a good approach

Answer 87

Prolonged Exposure: * Building up resources - Relaxation Training * Imagery Rehearsal - _Describing Trauma_ in Detail * Exposure - Confront feared or avoided _triggers_

Answer 88

*more tolerable than ERP bc there is no exposure* 1. Identify Problematic Beliefs 2. Challenge them 3. Write about impact 4. Process Emotions

Answer 89

**Recalling trauma memory while focusing on specific eye movements.** * Helps the brain reprocess the memory in a way that reduces its emotional impact **not supported by evidence, but not harmful** *(if it makes you go to therapy, great!)*

Answer 90

**Dissociative Amnesia** – sudden gaps in memory **Dissociative Fugue** sudden extensive memory loss **Dissociative Identity Disorder** having multiple personalities

Answer 91

*used to be called: Multiple Personality Disorder* **Definition: "Disruptions of identity characterized by 2 or more distinct personality states (alters)"** **Disclaimer:** * Controversial * Research is limited * Info comes from select peopleD

Answer 92

1. Disruptions of identity characterized by _2 or more distinct personality_ states (alters): 2. _Gaps in memory_ of events or important personal information that is _beyond ordinary forgetting_

Answer 93

**Host** ⇒ the main person (the identity that keeps other identities together) **Alters** ⇒ the different Identities/ States **Switch** ⇒ the transition from one personality to the other **System** ⇒ collection of alters

Answer 94

DID Prevalence: **No good data** (we don’t know)

Answer 95

* Rarely diagnosed until adulthood * Most receive mental health treatment for ~7 years before diagnosis

Answer 96

* Most people have _initially 2-4 alters identified_ when diagnosed * Average number of identities after diagnosis is _~10-15 different Alters_

Answer 97

DID = **High Comorbidity Rates** Comorbid with: PTST, Depression, Substance Abuse Disorders

Answer 98

Cognitive Theories: (limited research) 1. **Trauma** - Experiencing severe _early childhood trauma _ 2. **Socio-cognitive Model** - DID is not naturally occurring but is _caused by suggestion, reinforcement in therapy or society_, and role-play. Neurobiological Causes: *super* limited research * Hippocampal + Amygdala volume differences * Brain activation patterns?

Answer 99

**Therapists Role in Development:** * DID could be caused or enhanced by post-trauma treatment. * Suggestive therapy techniques might promote symptoms in vulnerable people **Media:** * Pre Sybil = 79 DID cases → Post Sybil = thousands... * TikTok + YouTube → increased interest and diagnoses (self-diagnosis increase)

Answer 100

**Hippocampal + Amygdala volume differences** * PTSD has **very** similar Brain changes... * DID is **highly** comorbid with PTSD * (hard to know if DID is _just related to the PTSD_ ...?) * Brain activation patterns? * *super limited research* * most reliable info: Prefrontal Dysfunction

Answer 101

**Psychodynamic Approach:** * Believes DID comes from _trying to block traumatic events from consciousness_ (repress) * Treatment Goal: Overcome Repression _Phase approach_: 1. Stabilize / gain trust (could take years) 2. Confront and process traumatic memories and emotions 3. Manage daily living – less reliance on dissociation * **Hypnosis** = can _worsen_ symptoms* **Overall: No well-validated treatments available**

Exam 2 Flashcards

Chapter: 5, 6, 7 (125 cards)