exam 2 Flashcards
1
Q
Prevalence MDD in US according to lecture
A
- 16.2%, 2x as common in women, 3x as common in poverty
2
Q
What to rule out when assessing depression - as discussed in the lecture-
A
Physical conditions (thyroid), Bipolar, substance induced mood disorder, biological components
3
Q
Structured Interview and Self-Report Questionnaire for Depression
A
- mentioned in lecture- used to assess symptoms: Structured=Hamilton Rating Scale for Depression, therapeutic session, verbal communication, can be ambiguous, self report questionnaire= Beck’s Depression Inventory II- standardized, shows deviation from norm- how do we know people are telling the truth- difficult to study because of accuracy issues
4
Q
Major Depressive Disorder (MDD)
A
- including symptoms of a major depressive episode- at least 1 Major depressive Episode, has experienced normal mood, can have anxiety but not hypomanic, significant distress/impairment, no other cause (medical, psychotic, substance). MDE symptoms: must have 5 for 2 weeks with depressed mood or loss of interest
1. Depressed Mood
2. Loss of Interest/pleasure
3. Appetite/Weight change
4. Sleep change
5. Psychomostor agitation/retardation
6. Fatigue/loss of energy
7. Worthlessness/guilt
8. Difficulty concentrating/indecisiveness
9. Thoughts of Death/Suicide
5
Q
Persistent Depressive Disorder
A
- aka chronic depression, dysthymia, depressed mood most of the day, most days, 2 years, must have two or more of following symptoms, never without for more than 2 mos
- poor appetite/overeating
- insomnia/hypersomnia
- low energy/fatigue
- low self-esteem
- poor concentration/difficulty making decisions
- feelings of helplessness
6
Q
Disruptive Mood Dysregulation Disorder
A
- severe, recurrent, tantrums- 3per week, negative mood most of day, most days, present in two settings for at least 12 months, dx between 6-18, symptoms present before age 10
7
Q
Premenstrual Dysphoric Disorder
A
- in most menstrual cycles during past year, 5 symptoms were present in final week before menses and improved within a few days of onset. Cause significant distress or interference in functioning
- Mood Swings
- Irritability, anger, conflicts
- Depressed Mood/Helplessness
- Anxiety/on-edge
- Decreased Interest
- Difficulty Concentrating
- Lack of energy
- Changes in appetite
- Sleeping too much or too Little
- Subjective sense of overwhelmed/out of control
- Physical symptoms/bloating
8
Q
Postpartum Depression
A
- know what this is as described by the text.- 13% of women, caused by hormonal imbalance/social isolation, stress peripartum, depression/anxiety peripartum,history of depression
9
Q
Understand CBT for depression
A
(Cognitive Therapy and Behavioral Activation Therapy). Note that these therapies have demonstrated the most empirical effectiveness in treating depression. BAT- increases activity in lateral frontal dorsal area- do fun stuff every day with a coach- Levinson, 70’s
10
Q
Main biological treatments for depression outside of medication?
A
- Electroconvulsive therapy, transcranial magnetic stimulation (less troublesome, but less effective), liglight therapy (seasonal- resets circadian rhythms, increased photon absorbtion, production of melatonin)
11
Q
Classes of depression medications? Which came first? Which is most commonly used today?
A
MAOI’s- 1957, diet restrictions, now last resort. Work by breaking down norep, serotonin, tyramine, can spike BP. Tricyclics- also in 50’s, too many side effects, still used if SSRI’s don’t work. Blocks Ach, inc Norep, serotonin. SSRI’s- 1980’s, block reabsorption of Seratonin Novel Antidepressants (Wellbutrin)- work on dopamine & norep, may increase anxiety (stimulating)
12
Q
Understand relationship between psychotropic medications, BDNF and neuroplasticity.
A
- BDNF Protein- support growth of new neurons in the brain, depression is correlated with a decrease in the production of BDNF, antidepressants and exercise increase BDNF . Anti-depressants combined with BAT & CBT can support growth in brain areas that support happiness & motivation
13
Q
Know the neurotransmitters implicated in depression.
A
- deficiency of serotonin, norep
14
Q
Define treatment resistant depression
A
- two trials of meds don’t work. 30-60% first trial doesn’t work, 15-33% multiple interventions don’t work, 20-50% of patients are nonadherent- ECT, TMS, light tx, sleep tx, limit blue light, sleep in cool environment
15
Q
Define Circadian Rhythm and know methods for balancing it
A
- daily rhythm, sleep clock, can cause sleep disturbances, trigger manic episodes, tx= light box, melatonin 3 hrs before sleep- establish night ritual
16
Q
Understand reasons behind mindfulness meditation for depression
A
- decreases anxiety, decreases rumination about past, leads to increase in activity in left frontal lobe (related to happiness)
17
Q
Understand Seasonal Depression and light therapy treatment
A
- 1 ½-2 hrs daily, inc serotonin levels, increased photon absorbtion, balancing of circadian rhythm and melatonin levels
18
Q
Know endogenous and exogenous depression as defined in the text.
A
- exogenous (reactive) depression from reacting poorly to environmental stressors. Endogenous depression is genetically/biologically oriented- little link to environmental causes
19
Q
Bipolar I
A
- at least 1 manic episode (plus more is okay), rule out other disorder, may be rapid cycling or have psychotic features. Usually 3 episodes/year (more is rapid cycling), ultracycling can happen in same day, delusions/hallucinations=psych features. Symptoms: abnormally inflated/irritable mood and increased activity not caused by a substance + 3 (+4 if mood is irritable)
1. grandiosity
2. decreased need for sleep
3. very talkabive/pressured speech
4. flight of ideas
5. distractability
6. Increased goal-directed activity
7. Excessive involvement in pleasurable activities that have high potential for negative consequences
20
Q
Bipolar II
A
- 1 hypomanic episode, 1 major depressive episode, not another disorder
21
Q
Cyclothymia
A
- hypomanic/depressive symptoms, no major episodes, 2 years, (1 yr in kids), significant distress/impairment, not due to other disorder
22
Q
Know the definition of Euphoria as defined by the text.
A
- short term intense happiness, when lingers leads to grandiosity/mania (far end of happiness/euphoria continuum)
23
Q
Understand and be able to distinguish between manic and hypomanic episodes-
A
Manic 1 week, has distress/impairment in functioning/psychotic features
Hypomanic- 4 days, less severe, no impairment, no hospitalization, no psych features, but is a change in functioning noticeable to others
24
Q
Understand Rapid Cycling specifier of bipolar (how many cycles/ yr compared to typical bipolar?)
A
- typical is 3 episodes/year, more is rapid cycling, or even ultracycling
25
Neurotransmitters related to Bipolar
- low serotonin & high norepinephrin
26
Bipolar medications are called?
- Mood stabilizers, lithium, may be combined with anticonvulsants, antipsychotics or even antidepressants (careful not to trigger manic episode)
27
Connection between substance use and suicide?
- 30% of suicides are under influence at TOD
28
What are the 3 parts involved with a professional assessment of suicide risk?
- suicidal ideation (thoughts), means, intention- probably have told someone
29
What is the professional response if a person is assessed to be at risk of suicide?
Contract, stay in communication, put a hold on plan until x, may need to intiate 5150 process
30
According to the lecture, what do most people want who attempt suicide? (it is something other than wanting to die)
– A way to escape from current situation (cognitive distortion)
31
What is considered a "cry for help" in suicide prevention? What is this an invitation to do?
Talking about wanting to die, feeling hopeless, trapped, a burden, worthless/lonely. Saying fatalistic things- all end soon, can’t take it anymore, etc. We should listen, address suicide openly, reduce access to means, develop safety plan, help access resources
32
Know the following verbal warning signs of suicide:
Talking about wanting to die
Talking about feeling hopeless
Talking about feeling trapped in unbearable pain
Talking about being a burden to others
33
Know the following behavioral warning signs of suicide:
Impulsive/ reckless behavior
Withdrawing or feeling isolated
Lack of interest in appearance and hygiene
Displaying extreme emotional/behavior changes (either suddenly much better or much worse)
34
Know the 4 "tips" for suicide prevention
1. Listen
2. Ask Directly
3. Listen for reasons for living
4. Help the person be safe for now
35
Understand developing a safety plan
- accessing resources, stay in contact, get rid of means
36
Define psychosis
- severe impairments in perception, cognition, emotions, manifests in behavioral phenomena (delusions, hallucinations, disorganized speech)
37
Schizophrenia
- 2 or more for 1 month +1, 2 or 3, sx for at least 6 mos, sig decline in functioning/self care, not due to other disorders
1. Delusions
2. Hallucinations
3. Disorganized Speech
4. disorganized/catatonic behavior
5. Negative symptoms
38
Brief psychotic disorder
- same sx as schiz, 1 or more sx for 1 day-1mo
39
Schizophreniform
– 2 or more sx, 1 mo-6 mo
40
Schizoaffective disorder
- schizophrenia+mood episode (dep or manic), has delusions or hallucinations for more than 2 weeks in the absence of a major mood episode at some point, should have sx a majority of the time
41
Delusional disorder
- does not meet criteria for schiz, but has delusion(s) for more than 1 month. Other than delusion, functioning largely normal, if manic/dep episodes occur, they are brief
42
Understand the three major clusters of symptoms and differences between them.
Positive- Delusions, hallucinations
Negative- Absence- flat affect, apathy, withdrawl, lack of pleasure
Disorganized- inappropriate reactions- disorganized speech, behavior, catatonic behavior
43
Understand the difference between schizoaffective disorder and mood disorders.
- psychotic episodes occur when not having a mood episode
44
Generally understand the Phases of Schizophrenia. You do not need to know time periods and duration but just the general order and what happens.
Prodromal Phase – Days to Years
Peculiar behaviors, negative symptoms
```
Active Phase
Psychotic Prephase – < 2 months
First positive symptom
Full-Blown Schizophrenia > 6 months
Full-blown schizophrenia, many positive and negative symptoms
```
Residual Phase – Ongoing
After treatment. Resembles prodromal phase
45
Neurotransmitters involved with schizophrenia are?
High Dopamine, low serotonin, GABA, glutamate
46
Know the brain structures related to schizophrenia
dysfunction in prefrontal cortex, enlarged ventricles (loss of brain cells), esp in temporal lobe (auditory hallucinations)
47
Know the following about Schizophrenia medications:
* Typical - also called First Generation Antipsychotics - Intolerable side effects and only affect positive symptoms. Reduce violent behavior, block dopamine receptors
* Atypical - also called Second Generation Antipsychotics - Less side effects. Affect positive, negative and disorganized symptoms, less relapse
48
Know environmental risk factors for schizophrenia
- prenatal complications- low blood flow, O2 to brain, infections. Trauma, stressful life events. Large amt of expressed emotion in family, Marijuana
49
Know Milieu Therapy and Token Economy for treating psychotic disorders as described in the text.
Praise inpatient psychotics for self-care/positive behaviors. Token- reward these behaviors with points that can buy desired privileges
50
Understand the different types of delusions
- persecutory, referential- things have special meaning for me, grandiose, erotomanic, nihilistic
51
Understand Substance/medication induced psychotic disorder
- delusions/hallucinations, occur due to substance, cause distress/impairment, different than intoxication/withdrawal
52
Generalized Anxiety Disorder
– most of the time, for 6+ mos, 3+ sx (1 in kids), causes impairments
1. Restlessness, easily startles
2. Easily Fatigued
3. Difficulty concentrate/mind goes blank
4. Irritability
5. Muscle tension, twitches, headaches
6. Sleep disturbances
7. Digestion issues, nausea, lightheaded, trouble breathing
53
Specific Phobia Disorder
- immediate fear about specific thing/situation, avoided, persistent (+6mos), caused by classical cx, observational learning, verbal instruction, genetic predisposition (resistant to extinction). Maintained through avoidance, stimulus generalization (elevators- tunnels- enclosed spaces) Treat with exposure modeling, systematic desensitization, flooding
54
Social Anxiety Disorder
- Anxiety about evaluation, persistent, avoids, out of proportion, 33% also dx with avoidant personality disorder
55
Agoraphobia- Know the situations that bring about fear or anxiety in Agoraphobia and why they are avoided.
- 2 or more of following, fear of being embarrassed/incapacitated, fear peer rejection- need companion to help them just in case, +6mos
1. Using public transportation
2. being in open spaces
3. being in enclosed spaces
4. standing in line/being in a crowd
5. being out of the house alone
56
Understand Panic Attacks
| *What happens and how long they typically last.
-abrupt surge of intense fear, usually 4-10min- a symptom not a disorder
57
Know the symptoms of a panic attack
- 4 or more- increased heart rate, sweating, shaking, shortness of breath, feelings of choking, chest pain, nausea, dizzy, chills, numbness, derealization, depersonalization, fear of losing control/going crazy, fear of dying- usually happens to people who are especially physiologically aware- 1 symptom can set off attack
58
Know the 2 types of panic attacks
- expected and unexpected - which is required for diagnosis of panic disorder? Why?- unexpected required for dx, leads to fear of attacks, maladaptive behavior (agoraphobia), otherwise attributable to phobia disorder
59
Neurotransmitters correlated with anxiety disorders.
- poor fx of serotonin/GABA, extra norep
60
Understand the Personality Risk Factors of anxiety disorders
- behavioral inhibition (4 mos), high neuroticism, react with negative affect, type A personality types
61
Know the Cognitive Risk Factors of anxiety disorders
- Sustained neg beliefs about future, belief in lack of control over environment (childhood trauma/punitive), attention to threat, negative self-eval (social anx disorder), Borkovec’s cognitive model- worry reinforced b/c distracts from negative emotions
62
Understand how classical conditioning and observational learning are causes of phobias
.- rumination, lack of control, reward/punishment- generalization, etc.
63
Understand the connection between panic disorders and the Anxiety Sensitivity Index.
– some people misinterpret normal anxiety symptoms as a sign that something is very wrong- ie “unusual body sensations scare me” “I must be having a heart attack”- cognitive factors- high score predicts panic disorder
64
Know psychological treatments of anxiety
- Relaxation training, CBT- challenge & modify negative thoughts, increase ability to tolerate uncertainty, worry only during scheduled times, focus on present moment (mindfulness), phobias are maintained due to avoidance, stimulus generalization, panic control therapy- somatic symptoms in safe environment- learn to cope
65
Understand Systematic desensitization and flooding for treating phobias
- works through hierarchy in imagination while maintaining relaxation, then confronts real stimulus- anxiety & relaxation are incompatible. Flooding just face it and eventually anxiety recedes
66
Understand Panic Control Therapy
- exposure to somatic symptoms in safe environment, use of coping strategies to control sx (ie deep breathing, relaxation)
67
What is Selective Mutism (to be covered on 3/23 - see PowerPoint)
- consistent failure to speak in social situations in which there is an expectation, children,
68
What is Separation anxiety disorder as described by the text.
- children, last at least 4 wks, fear of separation from PCG, impacts normal functioning, must be developmentally inappropriate, fear of sleeping alone, nightmares about separation, may display tantrums or physical symptoms (stomachache)
