Final Exam Flashcards
(88 cards)
1
Q
50% of mood disorders are comorbid with…
A
anxiety
2
Q
Most vulnerable pop to mood disorders
A
Indigenous (4x general)
3
Q
Gender difference of major depressive episodes
A
female 2x as likely but gap decreases with age
4
Q
Most common mood disorder in children
A
Dysthymia - as early as 3 months old
5
Q
MDD in elderly
prevalence, comorbidity, difficulty, gender
A
Liiiitle lower prevalence of MDD
1/3 comorbid with anxiety
Illness and dementia make diagnosis difficult
Gender difference reduces
6
Q
Reccurent MDD
A
Episodes sperated by at least 2 months, during which, not depressed
7
Q
Dysthemia (persistant depression)
A
Compared to MDD, dysthemia is more severe in duration, # of symptoms, response to treatment, and comorbidity
8
Q
Dysthemia vs MDD duration for diagnosis
A
Dysthemia: at least 2 years
MDD: at least 2 weeks
9
Q
Pure dysthemic syndrome
A
Full criteria of major depressive episdoe not met
High relapse rate
10
Q
Double depression
A
Intermittent major depressive episodes with pure dysthymic syndrome
11
Q
Most important distinciton when diagnosing and why
A
Duration (chronicity)
Determines course, family history, and cog. style
12
Q
Mean age of onset for MDD
A
29 if in treatment
25 if not in treatment
Increasing prevalence in adolescence tho
13
Q
Prediction of MDD relapse
A
duration of episode
14
Q
Integrated grief
A
adjustment to loss (after acute grief) in normal way
15
Q
Complicated grief syndrome
A
Grief beyond 6-12 months
normal –> disorder
Suicidal ideations
Rigid/fixed thots
16
Q
Pathological grief reaction
A
Predicted by dependency on loved one
Intrusive mems, distressing yearning, avoidance of reminders
17
Q
Premenstrual dysphoric disorder (PMDD)
A
Experienced by ~2-5% during premenstrual cycle
Physical symptoms, severe mood swings, anxiety
18
Q
Disruptive Mood Dysregulation Disorder
A
6-18yrs old
Chronic and severe irritability and difficulty regulating emotions
19
Q
Mania durations
A
Mania - 1+ week
Hypomania - 4 days
Seperate manic episodes must have symptom free period of 2+ months
20
Q
Bipolar I vs Bipolar II
symptoms and onset
A
Bipolar I: major depressive episode alternate with full manic episodes; onset 18
Bipolar II: major depressive episode alternate with hypomanic episodes (better functioning); onset 22
21
Q
Cyclothymic disorder
symptoms and onset
A
Milder but more chronic version of BPD
Mood elevation instead of mania
Depression instead of major depression
Onset: 12-14
1/3-1/2 devlop into full BPD
22
Q
Cycling: rapid, ultra, ultra-ultra
A
Rapid-cycling: 4+ episodes within a year
Ultra Rapid-cycling: every 4 days
Ultra-ultra Rapid-cycling: within 24hrs (circadian)
More episodes = more severe, lower response to treatment
23
Q
BPAD
Rapid switching
A
no break between mania and depression
24
Q
MDD heritability
A
36%
25
BPAD heritability
75%
26
Neurotransmitter and Mood disorders
Balance (e.g. low serotonin) and subtypes of NTs more important than specific levels
↑ activation of HPA axis ∴ ↑ cortisol
27
Sleep vs mood disorders
↑ REM ∴ ↓ slow wave
Interupted sleep/insomnia (MDD)
Hypersomnia (BPAD)
Bidirectional
28
2 cognitive theories of depression
Beck: cog. distortions of triad/self-schema
Learned hopelessness: pessimistic explanatory style
29
# depression
Stress generation hypothesis
inc probability of stressful events for individuals with depression
30
Pharmaceutical treatments of depression
Tricyclic antidepressants: block reuptake of NTs in synapse
MAO inhibitors: block removal of NTs
! SSRIs: block presynaptic serotonin reuptake !
SSNRIs:more stimulant effects than SSRIs
31
ECT for depression treatment
∆ brain fxn and structure
↑ serotonin, ↓ cortisol
Promote neurogenesis in hippocampus
High relapse rate but acute relief in 50-60%
ECT > TMS for psychotic depression
32
# depression
Transcranial magnetic stimulation
Magnetic field alters elec activity
More localized ∴ ↓ side effects than ECT
33
Pharmaceutical treatments for BPAD
Mood stabilizers (lithium): prevent and treat manic episodes but severe side effects
Antidepressants
Anticonvulsants
Atypical antipsychotics
34
Method to build structure and routine for day-to-day in BPAD
Social Rhythm therapy
35
Preventing Mood disorder relapse
Maintenance treatment
CBT and SSRIs equally good
Family-focused treatment
36
Suicide prevalence
| Canada, gender, age
CAN: 9th leading cause of death (2nd in adolescents)
♂ > ♀ :
* ↑ difference in high-income countries
* choose more violent ways ∴ ↑ success
Age:
* highest in 70+
* Lowest in 15u
37
Risk factors of suicide
Family history
Impulsivity (↓ serotonin)
Comorbidity with psych disorder (60% mood)
38
Interpersonal theory of suicide
1. Thwarted belongingness + perceived burdensomeness
2. Desire
3. Capability to engage (↓ fear, ↑ pain tolerance)
4. Suicide attempt
39
Undetermined suicide-related bhvr I vs II
I: no injury
II: non-fatal injury
40
Suicide treatments
CB: dialectal bhvrl therapy: problem solving
Crisis intervention: hosptial, hotline, meds
Psychosocial: Finding purpose/community/involvement
41
Schizophrenia criteria
Need 2:
* Delusions (+ve)
* Hallucinations (+ve)
* Disorganized speech or bhvr (+ve)
* -ve Symptoms
Context: not specific to situation, cultural relativity
42
# Schizophrenia
Positive symptoms
Distorted reality
Delusions: irrational ideas that are believed to be true (denial of internal change?)
- grandeur
- persecution
- cotard's syndrome (∆ body part)
- capgras syndrome (s/o replaced with imposter)
Hallucinations: sensory without input
- auditory (most common)
- auditory verbal
Disorganized thot/speech
Disorganized/catatonic bhvr
43
# schizophrenia
Negative symptoms
Losses or deficits in certain domains
Usually more severe and harder to treat than positive
Affective flattening (expression, not feeling)
Alogia (speech)
Avolition (BAS)
Anhedonia (pleasure)
Asociality
43
# schizophrenia
Negative symptoms
Losses or deficits in certain domains
Usually more severe and harder to treat than positive
Affective flattening (expression, not feeling)
Alogia (speech)
Avolition (BAS)
Anhedonia (interest/pleasure)
Asociality
44
Associated features of schizophrenia
Cognitive deficits (memory, cog., attention) ∴ ↓ inhibition, info filtering, communication, coping
Inappropriate affect
Anhedonia (↓ interest/pleasure)
↓Social skills
45
Phases of schizophrenia
Prodromal: symptoms before meeting full criteria
Acute: active psychosis (mainly +ve)
Residual: ↓ +ve, remain/↑ -ve
46
Schizophreniform Disorder
↓ duration (months)
↑ response to treatment
better premorbid fxn
no flat affect
47
schizoaffective disorder
schizophrenia + mood disorder
↑ duration
psychosis without mood disorder for 2+ weeks
48
Delusional disorder
1 persistant delusion
Subtypes (more realistic than schizophrenia):
* erotomanic: belief that someone is in love with them
* somatic: feels afflicted with physical defect/med condition
* jealous
* grandiose
* persecutory
* shared psychotic disorder: develop as result of delusional s/o
49
Brief psychotic disorder
presence of 1+ positve symptom
≤1 month, then return to normal
cause: high stress situation
50
Attenuated psychosis syndrome
some symptoms but aware of troubling/bizarre nature
51
schizotypal personality disorder
like schizophrenia but less severe
52
Prevalence of schizophrenia
♂ = ♀
↑ age = ↓ likelihood of ♂ onset ∴ inc gap
↑ diagnosis in minority groups
Universal, but outcomes better in low income countries!
53
Genetic causes of psychotic disorders
Mult. gene variances combine
↑ severity and # of relatives = ↑ risk (quantitative trait loci)
Recessive gene
54
Neurotransmission influences in psychotic disorders
↑ stimulation of striatal D2 receptors (movement)
↓ stimulation of prefrontal D1 receptors (-ve symptoms)
55
Brain structure influence on psychotic disorders
Enlarged ventricles = ↓ development of adjacent structures
Hypofrontality: ↓ frontal lobe activation (-ve)
↓ gray matter on temp. and frontal. lobes
Dysfxnl PFC, limbic (amyg), hippocampus
56
Psychosocial factors of psychotic disorders
Stress
High expressed emotion (family)
↓ SES (sociogenic, social drift)
57
Neuroleptic treatment of psychotic disorders
Dopamine antagonist
↓ +ve symptoms
e.g. thorazine, haldol, navene
Issues: 25% unresponsive, high relapse
Side effects: typical depr symptoms, akinesia, parkinsons, tardive dyskinesia
58
Atypical antipsychotics for psychotic disorder
↑ efficacy, ↓ side-effects
Bind to dopamine recpetors (and others)
E.g. clozapine, olanzapine, risperidone
59
Psychosocial treatments for psychotic disorders
Family therapy (↑ support, ↓ relapse)
Social skills training (↑ practical life skills)
CBT
Stress Management training
60
Anorexia consequences
Starvation => lanugo, constipation, cold intolerance
CV complications
Kidney and liver damage
Osteoporosis => bone fractures
↓ immune fxn
Purging => electrolyte imbalance
20% mortality
50x suicide risk
Comorbidity: depression, anx, OCD, substance abuse
61
Prevalence/course of eating disorders
lifetime: BED > BN > AN
gender gap: AN + BN > BED
onset: AN < BN < BED
62
Bulimia Consequences
Electrolyte imbalance => cardiac arrhythmia, kidney failure
Erosion of dental enamel
Enlarged salivary gland
Ruptured esophagus and stomach
Intestinal problems from laxatives
Comorbidity: mood disorders, anxiety, BPD, self-harm, substance abuse, impulsivity
63
Affect and emotion regulation in BN
1. pressure to be thin and internalized thin-ideal
2. body dissatisfaction
3. dieting and -ve affect
4. bulimic symptoms
64
Sociocultural risk factors of EDs
↓ self-esteem
↑ SES
Western culture
Media
Modeling
Attempted dieting (withdrawal stress)
Gay men
Female athletes
Family norms
Cultural fasting
65
Biological risks of EDs
Heredity - neuroticism, disibhibition, malad. coping (highest for AN)
Hypothalamus dysfunction
Low serotonergic activity (impulsive)
↑ ovarian hormones (BE highest postovulation)
Weight suppression (highest past weight - current weight)
Heightened awareness of gut sensations
66
Weight suppression and BED maintenance
1. ↑ WS
2. ↓ leptin
3. ↑ reward sensitivity and ↓ reward satiation
4. ↑ food enjoyment & ↑ time till full
5. ↑ binge eating
67
ED treatments
| meds and psycho
SSRIs for BN and BDE
CBT: different for each ED
Family therapy (esp for adolescent AN)
Interpersonal therapy
68
Comorbidity b/w substance use and other disorders
50% of people with alcohol disorder have additional psychiatric or gambling disorder
69
Depressant effect (CNS and tolerance)
↓ CNS activity => ↓ arousal => relaxation
Most likely to produce tolerance and withdrawal
70
Alcohol effects (short and long term)
Short-term:
↑ GABA system: ↓ anx
↑ Chloride = ↓ neurocommunication
↑ Serotonin = ↑ cravings
↑ dopamine (indirectly) = ↑ pleasure
↑ endogenous opioids = ↓ pain
↓ glutamate = ↓ memory
Long-term:
Disease of liver, stomach, pancreas, intestines
Coronary artery disease
Brain damage (dementia, WK)
FAS
71
Alcohol withdrawal
Tremors
Nausea
Anxiety
Agitation
Insomnia
Delirium
72
Pharmacological treatments of alcohol disorder
Benzodiazepines: ↓ withdrawal
Naltrexone: ↓ endogenous effects
Antabuse: aversion
73
Component treatment for alcohol disorder
1. conditioning
2. covert sensitization
3. contingency management
4. community reinforcement
74
Amphetamine effects
| main and low dose
↑ release and ↓ reuptake of NE and dopamine
↑ transmission between CNS + PNS ∴ ↑ NRG
Low dose:
↑ elation + vigour
↓ fatigue + appetitie
75
Amphetamine effects
| high dose/intoxication and OD
High dose:
euphoria or affect blunting
↑ sensitivity, irritability
↓ judgement and fxn
↑ anxiety and tension
↑ HR + BP => chest pain
Perspiration or chills
Nausea
↓ weight + strength
seizures/coma
respiratory depression
Severe/OD:
hallucinations
paranoid delusions
agitation
insomnia
76
Addiction and withdrawal of amphetamines
Addiction:
↓ inhibition
sleep disruption
social isolation
Withdrawal:
apathy/boredom
fatigue -> prolonged sleep
irritability
depression
77
Amphetamine consequences
MDMA/ecstacy: long-term memory problems
cocaine fetal exposure ⇒ ↓ auditory processing and language
78
High dose and withdrawal of tobacco
High dose:
blurred vision
confusion
convulsions
death
Withdrawal:
-ve affect
insomnia
irritability
restless
↑ appetite ∴ ↑ weight
↓ concentration
79
Pharmaceutical tobacco treatment
Wellbutrin: antidepressant, ↓ cravings
Agonist substitution: nictine replacement
Aversion therapy: silver nitrate, conditioning
80
Opioid potency
opium < morphine < heroin < fentanyl
81
Opioid effect (initial, side, withdrawal)
Analgesic
Euphoria + dulled senses
Drowsiness/relaxation
Slowed breathing
Side effects:
itchiness
imparied resp.
nausea
vomiting
Withdrawal: worst flu symptoms
82
Opioid risks
Highly addictive
liver failure (from ↓ resp and CV)
blood-borne illness
depr., anx., etc
83
Opioid treatments
Receptor antagonist: naloxone
Agonist sub (harm reduction): methadone, buprenorphine
84
Hallucinogen effects
∆ perception
↑ SNS (f-or-f rxn)
blurred vision
↑ epi and NE
bind to serotonin and acetylcholine receptors
Tolerance builds fast but toli break brings back down quick
85
Biological causes of substance disorders
Genetic: mainly affects experience/response
Neurobiology:
* reward centre: dopamine (directly in amph.) and MOP-r
* - sensitization: ↑ exposure = ↑ dopamine release
* anxiolytic effect
86
Opponent-process theory of substance disorders
↑ sensitization with use ∴ ↑ dose => cycle
87
cognitive factors of substance disorders
expectancy effect
conditioning
alcohol myopia
