Exam III Flashcards
(148 cards)
1
Q
What is anxiety?
A
Complex pattern of 4 types of RXNs to a perceived threat
2
Q
4 types of anxiety RXNs
A
- Somatic
- Cognitive
- Emotional
- Behavior
3
Q
Somatic anxiety RXN
A
- Increase in heart rate & respiration
- Muscle tension
- Shaking
- Dry mouth
4
Q
Cognitive anxiety RXN
A
- Anticipation of harm
- Rumination
- Sense of unreality
- Problems concentrating
5
Q
Emotional anxiety RXN
A
- Fear
- Terror
- Irritability
- Restlessness
- Dread
6
Q
Behavior anxiety RXN
A
- Escape avoidance
- Hyper vigilance
- Agression
- Freezing (not seen often)
7
Q
Specific phobia
A
Marked & persistent fear of an object or situation
8
Q
Specific phobia results in what type of response
A
Immediate anxiety response
-Will completely avoid or endure with intense distress
9
Q
Do those w/ specific phobias know that it is excessive or unreasonable?
A
Yes (not kids tho)
10
Q
How do specific phobias affect one’s life?
A
Produces marked distress or interferes w/ normal functioning
11
Q
Most common specific phobias
A
- Animals
- Natural environment
- Situations
- Blood injections
- Injuries
12
Q
Lifetime prevalence of specific phobia
A
13%
13
Q
Course of specific phobia
A
- Begins during childhood
- Stable & persistent
14
Q
Comorbidity of specific phobia
A
- Other anxiety disorders
- Major depression
- Oppositional defiant disorder
*More likely than any other anxiety disorder to be circumscribed
15
Q
Percentage of people w/ specific phobia who NEVER seek treatment
A
90%
16
Q
Social phobia
A
Marked & persistent fear of a social situation
17
Q
Most typical social phobias
A
- Public speaking
- Talking w/ others
- Using public toilets
- Eating/drinking around others
- Writing while someone watches
18
Q
Lifetime prevalence of social phobias
A
12% in US
3% internationally
19
Q
Course of social phobias
A
- Onset usually in adolescence or early preschool
- Associated w/ humiliation
- Prevalence ^ w/ age
- Relatively stable
20
Q
Comorbidity of social phobias
A
- Another anxiety disorder
- Depression
- Avoidant PD
- Drug/alcohol abuse
21
Q
Generalized Anxiety Disorder (GAD)
A
- Excessive worry & anxiety, occurring most days for at least 6 mo.
- Unable to control worry
- Anxiety/worry is free floating
- Causes clinically significant distress or impairment in functioning
22
Q
GAD: anxiety/worry associated w/ >= 1+ of the following
A
- Restlessness
- Easily fatigued
- Difficulty concentrating
- Irritability
- Muscle tension
- Sleep disturbance
23
Q
Lifetime Prevalence of GAD
A
M = 3% W = 5%
24
Q
Course of GAD
A
- Onset in childhood/adolescence
- Chronic
25
Comorbidity of GAD
- Another anxiety disorder (50%)
- Mood disorder (70%)
- Substance abuse disorder (33%)
26
Obsessive Compulsive Disorder (OCD)
Characterized by either obsessions or compulsions
27
Obsession
Recurrent & persistent thoughts, impulses, or images that are intrusive, inappropriate & cause marked anxiety or distress
28
Most common obsessions
- Germs/contamination
- Fear of harm to self or others
- Concerns w/ symmetry, excessive moralization or religiosity
29
Compulsion
Repetitive behaviors or mental acts perfomed in a rigid, ritualistic manner in order to reduce distress or prevent an imagined dreaded event from occurring
30
Most common compulsions
- Washing
- Counting
- Repeating words silently
- Checking
- Touching
- Arranging
31
What are 4 questions that are asked to determine where along the continuum (from normal to abnormal) anxiety symptoms fall?
1. How realistic is it?
2. How severe is it?
3. How persistent is it?
4. How problematic or impairing is it?
32
Which anxiety disorder is most likely to not comorbid with another disorder?
Specific phobia
33
Lifetime prevalence of OCD
1-3%
34
Course of OCD
Age of onset:
M = 6-15 yrs
W = 20-29 yrs
- Chronic if untreated
- Highly debilitating
35
Comorbidity of OCD
60-80% cases co-occur w/ at least one other disorder
50% w/ multiple
Most common: Depression (66%), GAD, phobias, panic attacks, substance abuse
36
Symptoms of a panic attack
- Heart palpitations
- Shortness of breath
- Derealization
- Fear of dying
- Sweating
- Shaking
- Paresthesia
- Nausea
- Dizziness
- Chills&hot flashes
- Feeling of choking
- Fear of losing control
37
Panic attack
- Recurrent
- Unexpected
- Persitent concern or worry about panic attacks
- Significant change in behavior as a result
38
Agoraphobia
- Being is situations where escape would be difficult or unable to get help if they became anxious
- Such situations are avoided, endured w/ distress or require presence of a loved one
39
Lifetime prevalence of Panic Disorder & Agoraphobia
3-5%
1/3 - 1/2 of those w/ panic disorder develop agoraphobia
-Panic disorder more common in women
40
Percentage of adults that have occasional panic attacks
28%
41
Course of Panic Disorder & Agoraphobia
- Onset in late adolescence/early adulthood
| - Chronic
42
Comorbidity of Panic Disorder & Agoraphobia
- GAD
- Depression
- Alcohol abuse
- ^ Risk for suicide attempts
43
Post Traumatic Stress Disorder (PTSD)
- Exposure to traumatic event
- Re-experiencing of traumatic event
- Persistent avoidance & numbing
- Persistently increased arousal
- Causes significant impairment in functioning
44
Biological theories for cause of anxiety disorders
- Genetics
- Neurotransmitters
- Brain circuits
- HPA axis
45
Genetics: Biological theory for cause of anxiety disorders
Higher concordance rate in monozygotic twins vs. dizygotic twins
Current thinking: emotional/behavioral reactivity to stimuli is inherited rather than specific anxiety disorder
46
Neurotransmitters: Biological theory for cause of anxiety disorders
Disregulation of GABA, norepinephrine, serotonin, & CCK implicated in different anxiety disorders
47
Brain circuits: Biological theory for cause of anxiety disorders
Dysregulated (e.g. OCD, panic disorder, PTSD)
48
HPA axis: Biological theory for cause of anxiety disorders
Fight or flight response
System gets disregulated so hypthalamus does not stop secreting CRH
49
Behavioral factors for anxiety disorders
- Classical conditioning
- Operant conditioning
- Observational learning
50
Classical conditioning
Does the name Pavlov ring a bell?
51
Operant conditioning
It's all about (-) reinforcement, baby
- Escape conditioning
- Avoidance conditioning
52
Observational learning
Watch those models
53
Cognitive factors for anxiety disorders
- Interoceptive awareness
- Anxiety sensitivity
- Tendency towards cognitive distortions
- Tendency towards maladaptive assumptions, w/o constructive problem solving
- Difficulties turning off upsetting thoughts
54
Interoceptive awareness
Increased attn to bodily sensations
55
Anxiety sensitivity
Belief that body symptoms have harmful consequences
56
Examples of cognitive distortions in those with anxiety disorders
- Catastrophizing
- Polarizing
- Shoulds
- Control fallacies
57
Maladaptive assumptions
e. g., "It's always better to expect the worst"
| - w/o constructive problem solving
58
Treating anxiety disorders
Focus on 4 primary problems
1. Excessive escape & avoidance behaviors
2. Emergency physiological RXNs to perceived threats
3. Sense of lack of control
4. Distorted information processing (hypervigilance for threat, cognitive avoidance)
- Behavioral & Cognitive Behavioral approaches
- Medication
59
Behavioral treatment for anxiety disorders
- Systematic desensitization
- Modeling
- Exposure response prevention (ERP)
- Flooding
- Imagery/role playing/ in Vivo (most effective)
60
Exposure response prevention (ERP)
Gradual exposure to feared situation while preventing engagement in avoidance or compulsive behaviors
-Teach alternate coping strategies
61
Flooding
Remain in anxiety-provoking situation until anxiety decreases
62
Diagnostic criteria for Anorexia nervosa
A. Refusal to maintain body weight @ or above a minimally normal weight for age & height (e.g. < 85% of that expected)
B. Intense fear of gaining weight/becoming fat
C. Body image disturbance, undue influence of body shape on self evaluation, or denial of the seriousness of low weight
D. In postmenarchial females, amenorrhea (absence of at least 3 consecutive menstrual cycles)
63
Amenorrhea
Absence of at least 3 consecutive menstrual cycles
64
Postmenarchial
Has had period
65
Subtypes of Anorexia nervosa
1. Retricting
| 2. Binge - eating/purging
66
Lifetime prevalence of Anorexia nervosa
1-2%
90-95% women
67
Course of Anorexia nervosa
Variable
68
Comorbidity of Anorexia nervosa
>70%
- Anxiety
- Depression
- OCD
- PTSD
- Borderline PD
69
Complications associated with Anorexia nervosa
- Lanugo
- Gastritis
- Hair loss
- Bradycardia (slowed heart rate)
- Arrhythmia (abnormal heart rate)
- Hypothermia
- Osteopenia
- Kidney problems
- Fertility problems
70
Lanugo
- Body grows fur (also seen in babies)
| - Complication associated w/ Anorexia nervosa
71
Mortality rate due to Anorexia nervosa
5-8%; some estimates are higher
72
Eating disorders
1. Anorexia nervosa
2. Bulimia nervosa
3. Not otherwise specified (NOS)
73
Diagnostic criteria for Bulimia nervosa
Must meet all 4 criteria
A. Recurrent episodes of binge eating, which is characterized by both:
1. Eating in a discrete period of time (e.g. w/i any 2hr period) a larger amount than most would eat
2. Perceived lack of control over eating during the episode
B. Recurrent inappropriate compensatory behavior in order to prevent weight gain
C. Binge eating & compensatory behaviors occur >= twice/wk for 3 months
D. Self-evaluation is unduely influenced by body shape & weight
74
Subtypes for Bulimia nervosa
1. Purging
| 2. Non-purging
75
Purging
- Vomitting
- Laxatives
- Enemas
- Diuretics
76
Non-purging
- Fasting
- Compulsive exercise
- Diet pills
77
Lifetime prevalence of Bulimia nervosa
3-5%
| W>M
78
Course of Bulimia nervosa
Variable
79
Comorbidity with Bulimia nervosa
- Mood disorder
- Anxiety disorder
- Substance abuse
- Borderline PD
80
Complications associated with Bulimia nervosa
- Tooth decay
- Electrolyte imbalance
- Intestinal dysfunction
- Dehydration
- Fatigue
- Swollen glands
- Kidney problems
- Fertility problems
81
Treatment outcomes for Anorexia & Bulimia 10 yrs after treatment
~40% recover fully
~35% functioning better
~25% chronically ill (individuals w/ anorexia &/or Borderline PD over-represented in this group)
82
Ego dystonic
At odds w/ person's self image
Are more amenable to change
83
Ego syntonic
In line w/ person's self image
Are less amenable to change
84
Symptoms of Bulimia vs. Anorexia wrt ego syn/dystonic
Bulimia > Dystonic
| Anorexia > Syntonic
85
What is on Axis II?
Personality disorders
86
Definition of personality
Complex pattern of behaviors, thoughts & feelings; stable across time & across many situations
87
Definition of personality disorder
- Individual's personality traits are maladaptive
- Behaviors, thoughts & feelings interfere w/ daily life, particularly relationships
- Traits persist from adolescence or early adulthood, onward
88
3 Personality clusters
A: Odd & eccentric (3)
B: Dramatic & erratic (4)
C: Anxious & fearful (3)
89
Cluster A PDs
Odd & eccentric (3)
1. Paranoid PD
2. Schizoid PD
3. Schizotypal PD
90
Paranoid PD
Chronic, pervasive mistrust & suspicion of fother people that is unwarrented & maladaptive
91
Schizoid PD
Interest in & avoidance of interpersonal relationships; emotional coldness toward others
92
Schizotypal PD
- Chronic pattern of inhibited or inappropriate emotion & social behavior
- Aberrant cognitions
- Disorganized speech
93
Cluster B PDs
Dramatic & erratic (4)
1. Antisocial PD
2. Borderline PD
3. Narcissistic PD
4. Histrionic PD
94
Antisocial PD
- Pervasive pattern of criminal, impulsive, callous, or ruthless behavior
- Disregard for rights of others
- No respect for social norms
95
Borderline PD
- Rapidly shifting & unstable mood, self concept & interpersonal relationships
- Impulsive
- Cutting
- Terrified of being abandoned
96
Narcissistic PD
- Grandiose thoughts & feelings of one's own worth
| - Obliviousness to others' needs
97
Histrionic PD
- Rapidly shifting moods
- Unstable relationships
- Intense need for attention & approval
- Dramatic/seductive behavior
98
Cluster C PDs
Anxious & Fearful (3)
99
Avoidant PD
- Pervasive anxiety
- Sense of inadequacy
- Fear of being criticized, which leads to the avoidance of social interactions & nervousness
100
Dependent PD
- Pervasive selflessness
- Need to be cared for
- Fear of rejection, leading total dependence on & submission to others
101
Obsessive Compulsive PD
Pervasive rigidity in one's activites & interpersonal relationships, including emotional construction, extreme perfectionism & anxiety about even minor disruptions in one's routine
102
Theories of Antisocial PD
Adrenaline junkies
- Genetic predisposition
- Deficits in brain structure & functioning
- Low levels of arousability
- Testosterone levels are ^
- Harsh & inconsistent parenting
- Physical abuse
- FUMES (tempermental characteristics)
103
FUMES
Theory of Antisocial PD
Tempermental Characteristics
- Fearless
- Unresponsive to pain
- Muscular/mesomorphic
- Empathy deficient
- Stimulation seeking
104
Theories of Borderline PD
- Fundamental deficit: emotional dysregulation
- Physical, sexual abuse
- Reliance on others for coping; poor self-confidence decreases ability to ask for help
- Unable to integrate +/-, vacillate between extremes
105
Fundamental deficit: emotional dysregulation
Theory of Borderline PD
- Temperment
- Childhood environment: instability, abuse, neglect & parental psychopathology
106
Treatments for Antisocial PD
- Very few seek treatment & are not good candidates for psychotherapy
- Lithium & atypical antipsychotics help w/ imulsivity & aggression
- SSRIs: ?efficacy?
107
Treatments for Borderline PD
- Dialectical Behavioral therapy (Type of CBT)
| - Drug treatments for reducing symptoms of anxiety, depression & impulsivity (SSRIs, atypical antipsychotics)
108
Dialectical Behavioral Therapy (DBT)
- Mindfullness (noticing)
- Distress tolerance (Mona Lisa smile)
- Emotion regulation
- Interpersonal effectiveness
109
5 dimensions of the Five Factor Model of Personality
"The Big 5"
1. Openness
2. Conscienciousness
3. Extraversion
4. Agreeableness
5. Neuroticism
110
Symptoms of Dementia
- Memory impairment
- Aphasia
- Apraxia
- Agnosia
- Disturbance of executive functioning
- Changes in emotion & personality functioning
111
Aphasia
Language disturbance
112
Broca's aphasia
Expressive aphasia (can't get the words out)
113
Wernicke's aphasia
Receptive aphasia (Tono man)
114
Apraxia
Inability to carry out motor activities despite intact motor functions (forgetting how to use toothbrush)
115
Agnosia
Failure to recognize or identify objects despite intact sensory functioning (the man who mistook his wife for a hat)
116
Types of Dementia
- Alzeimer's disease
- Vascular disease (blockage of blood to the brain)
- Head injury (TBI)
- Progressive diseases (e.g. Parkinson's, Huntington's & HIV)
- Chronic drug & alcohol abuse
117
Dementia of the Alzeimer's type
- Usually begins after age 65, but early onset is possible
- Typically begins w/ mild memory loss
- About 2/3 show psychiatric symptoms (e.g. agitation, irritability, apathy & dysphoria)
- Progressive & fatal disease
118
Progression of dementia of the Alzeimer's type
- Memory loss & disorientation become profound
- Increased risk of violence, hallucinations & delusions
- Fatal disease (~8-10 yrs)
119
Prevention of dementia
- Aerobic exercise & mental activity may have (+) value
- Reduce the risk factors for stroke (e.g. avoiding smoking, obesity & hypertension may lower risk for vascular dementa)
- Intellectual activity (Nun study)
- Helmets
120
Nun study
Demonstrated a link between intellectual activity beginning early in life & reduced risk of Alzeimer's disease
121
Delirium
- Disturbance of consciousness w/ reduced ability to focus, sustain or shift attention
- Change in cognition or development of perceptual disturbance
122
Amnesia
Unlike Dementia & Delerium, only MEMORY is affected
123
Sundowning
Worsening of delerium @ night
124
Etiological theories of Alzeimer's
- Genetic factors
| - Deficits in acetylcholine, norepinephrine, serotonin, somatostatin & peptide Y.
125
Anterograde amnesia
Impaired ability to learn new info
126
Retrograde amnesia
Impaired ability to recall previously learned info
127
Implosion therapy
Imagninal exposure
128
Flooding therapy
In vivo exposure
129
What makes bulimia hard to treat
B/c of it's secretive nature, the disorder is usually well entrenched.
Therefore, high drop-out rate
130
2 Main factors of psychopathy
1. Affective-cognitive instability
| 2. Behavioral-social deviance
131
Snowden's recommendations for postponing the onset of Alzeimer's
1. Keep mentally stimulated
2. Avoid head trauma
3. keep blood folate levels high by taking folic acid supplementation, Vits C&E
4. Stay emotionally postitive & physically active
132
Most common psychological disorders among older adults
1. Anxiety disorders
2. Depression
3. Substance use disorders
133
Some reasons why it is difficult to asses & diagnose psychological disorders among older adults
- Can be the result of medical problems
- Side effect of medications
- Elderly tend to report physical issues rather than emotional
134
What makes medication management of anxiety disorderss in older adults more challanging than younger adults?
Those who seek help tend to go to their family physicians rather than mental health professionals
135
How common is depression in older adults?
```
1-5% = major depression
12-20% = acute or chronic care setting
```
Symptoms not quite meeting criteria for major depression:
~15% - community dwelling elderly
~30% - institutionalized elderly
136
Depletion syndrome
- loss of interest
- loss of energy
- hopelessness
- helplessness
- psychomotor retardation
137
Complicated grief
Eventually diagnosed as major depression
- profound guilt
- thoughts that one would be better off dead
- profound inactivity
- persistent impairment in functioning
- hallucinations that go beyond the common experience of hearing or seeing a dead loved one
138
Dementia
Loss of the ability to remember the most fundamental facts of life, express himself through language, and carry out basic everyday tasks
139
What substance abuse orders do older adults tend to develop?
- Alcohol
| - Medication
140
Korsakoff's syndrome
-Alcohol-induced persisting amnesic disorder = permanent cognitive disorder caused by damage to the CNS
**Memory loss for recent events & difficulty recalling distant ones
141
Echolalia
Repetitious - repeating what they hear
142
Palilalia
Repeating sounds or words over & over
143
Earliest symptoms of delirium
Early phase: mild symptoms such as fatigue, decreased concentration, irritability, restlessness, or depression
-Mild cognititve impairments, perceptual disturbances, or even visual hallucinations
144
Symptoms of delirium as disease worsens
- Disrupted orientation
- Mistaken location
- Distorted personal orientation
- Recent memory loss (memories occurring in the past 10 min)
145
Partial-syndrome eating disorder
Doesn't meet the full criteria for an eating disorder, but displays some symptoms
146
Which sports tend to have a higher prevalence of eating disorders?
- Gymnastics
- Ice skating
- Dancing
- Horse racing
- Wrestling
- Bodybuilding
147
What factors increase a person's vulnerability to PTSD?
Abuse
- Physical (domestic violence)
- Sexual (rape & incest)
* 95% of rape survivors qualify w/i 1st 2 wks
- 50% after 3 months
- 25% after 4-5 yrs
148
Prepared classical conditioning
Theory that anxiety is left over evolutionary tool for survival to bear offspring - natural selection for rapid conditioning of fear
