PSY311 Midterm 2

Question 1

What is anxiety?

Answer 1

“Anxiety is a negative mood (1) state characterized by bodily symptoms of physical tension (2) and apprehension about the future” (3).

'’perceived threat’’

Question 2

describe the graph about anxiety, arousal and weakstrong and low/high arousal

Answer 2

optimal arousal and optimal performance = middle arousal. Moderate arousal for strong performance because some anxiety is good! = optimal
little or too high arousal does not work

Question 3

Anxiety disorder all combined.

What is aoo?

Answer 3

Childhood and adulthood (like GAD)

Question 4

Anxiety disorder, what is the biological contributions?

Answer 4

Inherit a tendency (anxious, tends…etc.)

Anxiety is associated with (dys)regulation of various hormones, neurotransmitters and circuits

Question 5

What is the HPA axis?

hypothalamus, anterior pituitary

Answer 5

(very close to hypothalamus) and adrenal cortex → it is our primary response to stress. ACTH travels all the way to the adrenal gland(also called adrenal cortex) that are located above the kidneys and they secrete various thing like adrenaline and cortisol). the negative feedback loop is very important because it kinda ask: did you deal with the stressor or not? Ideally, you are not suppose to be always in the alarm state. once you deal with the stressor you are supposed to calm down. that’s why the negative feedback is important.

Question 6

Is there a specific NT related to anxiety?

Answer 6

No! serotonin, gaba, norepinephrine and others

gaba levels is known to decrease serotonin level, increase norepinephrine level. there is a lot!

Question 7

What is Gray’s motivation theory?

BAS/BIS/FFF

Answer 7

BAS: behavrioral activation system. it is saying something like, we are sensitive to reward (could be praise, validation, money etc.). = work more, try new things. more novelty seeking , extraverty. the NT Dopamine is very important+

BIS: behavioral inhibition system –> highly overactive. In case of anxiety, it works too much. high neuroticism, anxiety, high apprehension
Sensitive to punishment, to threat
Avoidance behavior: anxiety, tendency to apprehensively
evaluate the situation (potential threats)
Bidirectional activation: PFC (prefrontal cortex) ↔ limbic system

FFF: fight/flight/freeze

all related to the sympathetic nervous sustem: stress response: burns energy

Question 8

What are some psychological contributions to anxiety disorders? + what are some important cues?

Answer 8

Classical conditioning (e.g. Little Albert) (ex. just seeing a dog…)

Sense of control: is develop quite early with parental aptitude, early-life foster a sense of foster (can either see a safe or uncontrollability work)

Anxiety sensitivity: can be predisposed, might also be fearful to anxiety symptoms. ‘’like being anxious to be anxious’’ ‘’fear to be overwhelmed with anxiety’’ (it is something that feeds the panic cycle in panic disorder - ex. you won’t need to see the dog, just thinking about it will trigger you, remembering how it felt).

Important cues

External cues: environment similar to where initial panic attack occurred

Internal cues: inner cognitive and physiological processes
associated with initial panic attack

Question 9

What are some social contributions to anxiety disorders?

Answer 9

Exposure to stressful life events (e.g. death of a loved one, divorce, growing up in low socioeconomic environment, violence)
Lack of social support (it plays a lot, it worsen a lot the others one)- having a good social support can protect the person to develop mental disorder
Societal factors (e.g. media, societal values)

Question 10

What is the anxiety disorders: biopsychological model

Answer 10

psychological (faulty cognition + maladaptive learning) + biological (evolutionary predispositions +geneticpredispositions + biochemical disturbances) + sociocultural (cultural pressures)

Question 11

From Barlow, 2000. describe the anxiety disorders: triple vulnerability model

Answer 11

Generalized biological vulnerability: genetic, heritable, uptight, personality traits (neuroticism, stress response)
Generalized psychological vulnerability: across all anxiety symptoms
Specific psychological vulnerability: what might other think? creates apprehension. Ex. developing an apprehension of dog because you’re parents are scare of them, life experience too
–> it comes together, at least two, to develop an anxiety disorder

Question 12

what is comorbidity in terms of anxiety disorder?

Answer 12

High comorbiidtybetween anxiety disorders and suicidal ideation & attempts
- common with anxiety and depression

Comorbidity between anxiety-related disorders

Anxiety disorder often occurs first (before physical disorders)

Question 13

GAB: diagnostic criteria

Answer 13

Excessive anxiety and worry, occurring more days than not for at least 6 months

Finds it difficult to control the worry
Anxiety or worry is associated with ≥3 of the following six  symptoms:
1 Restlessness or “on edge”
2.Being easily fatigued
3.Difficulty concentrating (or “mind going blank”), scared of the future 
4.Irritability
5.Muscle tension
6.Sleep disturbance

Symptoms cause clinically significant distress or impairment in social, occupational, or other areas of functioning

Disturbance is not due to substance abuse or medical condition
Disturbance is not better explained by another mental
disorder

Question 14

GAB: statistics
What is the course? What is the age of onset? What is the sex ratio? What is the comorbidity? What about the elderly? and side effect of tranquilizer?

Answer 14

Course: Chronic
In individuals who face(d) stressful life event(s)

Onset ≈age 30 years

More insidious (gradual) development relative to other anxiety disorders, gradually getting more intense

Sex ratio: ≈2:1 in women (on the exam) twice then men
Comorbidity:
Women: greater comorbidity with mood and other anxiety disorders
Men: greater comorbidity with substance abuse
More prevalent in the elderly
More in age 45+ years (vs. young adults)
≤10% Often prescribed minor tranquilizers (valium, zanac), but side effects (small motor impairment- like muscle jammer, decrease of motor coordination-, memory impairment- important cuz there is a link with getting older and that (similar to amnesia but not that intense, irritable, sleep disturbance)
minotorize it

Question 15

GAB: etiology

Answer 15

• genetic component
• Distinct cognitive characteristics (Dugas, Ladouceur et al., 1998)
• intolerance of uncertainty: worry about not being in control
• positive beliefs about worry: hold stronger that belief that worry is effective
• poor problem orientation: won’t face it ex. a friend of a friend told me that dogs bite, then I’ll avoid them altogether. Avoiding activities, people, places, addiction
• cognitive avoidance: trying to distract themselves in hopes to not think about what is stressing them

Question 16

Borlow image on GAD

Answer 16

Generalized psycho + biological vulnerabiity – stress – anxious apprehension –> worry process (a loop of intense cognitive processinfm inadequate, avoidance of imagery, restricted autonomic response) = GAD

Question 17

What are the treatment for GAD?

Answer 17

Pharmacological:
**Benzodiazepines (short-term) -tranquilizer. modest term effect.
** Antidepressants (SSRI= selective serotonin reuptake inhibitors- most common antidepressants) inhibit reuptake. can release a part of the anxiety system and will help reduce depression symptoms. It is often taken for a longer time than benzodiazepines would. side effect: sleep disturbances, nausea, sexual dysfunction
today we won’t rely only on drugs

Psychosocial:
Cognitive-behavioral therapy
Mindfulness meditation : increasing in popularity. detach observation, breathing, yoga, mindful eating, be in the present.no fixation on emotion

Question 18

What is a panic disorder?

Answer 18

Panic attacks are periodic, short bouts of panic that occur suddenly, reach a peak, and pass
Those who suffer often fear they will die, go crazy, or lose control
Panic attacks typically happen in the absence of a real threat
it is difficult to pinpoint how many panic attack implies a panic disorder and are often accompanied with agoraphobia within the first year (they feel unsafe, unable to escape)

Question 19

Name the panic disorder: diagnostic criteria

Answer 19

A. Recurrent unexpected panic attacks

B. At least one of the attacks has been followed by ≥1 month of one or both of the following:
I. Persistent concern or worry about additional panic attacks or their consequences
II. A significant maladaptive change in behavior related to the
attacks

C. Disturbance is not attributable to the physiological effects of a substance or another medical condition

D. Disturbance is not better explained by another mental disorder

Question 20

Name some symptoms of Panic disorder including the main 4

Answer 20

AT LEAST 4 of them
Need at least 4 of them (often the first 4)
1. Palpitations, pounding heart or accelerated heart rate
2. Sweating
3. Trembling or shaking
4. Sensations of shortness of breath or smothering

5. Feelings of choking
6. Chest pain or discomfort
7. Nausea or abdominal distress
8. Feeling dizzy, unsteady, light-headed, or faint
9. Chills or heat sensations
10. Numbness or tingling sensation (i.e. Paresthesia)
11. Derealization or depersonalization: detach from reality, dissociation
12. Fear of losing control or “going crazy”
13. Fear of dying
14. Other symptoms (e.g., neck soreness, headache, uncontrollable screaming or crying) may be seen. Such symptoms should not count as one of the four required symptoms.

Question 21

Panic disorder and agoraphobia (explain it)

Answer 21

Agoraphobia: marked fear or anxiety about two or more of the following five situations:
Using public transport
Being in open spaces
Being in enclosed places
Standing in line or being in a crowd.
Being outside of the home alone

Question 22

Explain the maladaptive side effect to the panic disorder

Answer 22

Agoraphobic avoidance: look at the escape place, avoided place where they don’t feel safe. it is difficult, if you’re a student and scare of places… you need to endure anxiety and keep going.

Enduring anxiety: need to travel for job but they are scared.

Interoceptive avoidance: avoidance of internal physical sensation. Ex. also doing exercise = heart rate increase =remind you of the feeling of getting a panic attack.

Substance (ab)use;

Question 23

Panic disorder: statistic, sex ratio, onset, cultural differences

Answer 23

Sex ratio
More common in women 3-4 women
Agoraphobia (and avoidance) and women
Alcohol and men
AOO: ≈25-29 years
Most 1st unexpected panic attacks occur at/post- puberty

Cultural differences
Susto in Latin America: sweating, heart rate, insomnia less worrying
Ataques de nérvios in Caribbean: bursting into tears
Kayak-angst in Inuit: intense fear of drowning and disorientation (fisher at sea)

Question 24

Panic disorder: etiology

Answer 24

Inherited tendency to be overly reactive to daily stressful events
Misattribution of bodily responses as being catastrophic: ex being short of breath and automatically attributed that to a panic attack and they are aware of that so they trigger it.

Association between situation(s) and biological response are quick to form. where and what happens is associated very quickly. Ex: i should not be in this place, because thinking about it, triggers an alarm right away

Question 25

Panic disorder: treatment

Answer 25

Pharmacological: Selective Serotonin Reuptake Inhibitors (SSRIs) Benzodiazepines Psychosocial: * **Cognitive restructuring: element of cognitive therapy. it is about challenging these maladaptive thoughts. * *relation techniques: deep breath * *interoceptive exposure: counteract the exposure. it is at first in a supervised environment. Trying to get a headache to trigger you, spinning on a chair. the point is to face those feeling and sensation and to see that there are not related to a panic attack The three above are panic control treatment (PCT) → works best on the long run

Question 26

Explain what it takes to have a specific phobia

Answer 26

A. Marked fear or anxiety about a specific object or situation B.The phobic object or situation almost always provokes immediate fear or anxiety C.The phobic object or situation is actively avoided or endured with intense fear or anxiety D.The fear or anxiety is out of proportion to the actual danger posed by the specific object or situation and to the sociocultural context E.The fear, anxiety, or avoidance is persistent, typically lasting for 6 months or more F.The fear, anxiety, or avoidance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning G.The disturbance is not better explained by the symptoms of another mental disorder

Question 27

Explain different types of a specific phobia

Answer 27

Animals: around 7 years. Fears of spiders, snakes, dogs... Natural environment: water, storm, height (tend to lcuster) 7 years old. Blood-injection-injury: **Physiological reactions: Strong vasovagal response **Phobia develops over fear of fainting **Autonomic system system is activated reacardio (causing the heart to drop, its an expression) **it affects the nerve, the blood vessel (widen), legs arm (extremities) = blood pressure drop and it goes to your ed more and more = brian is very deprive with oxygen until fainting occurs **fear of fainting - the panic cycle. very specific to a situation AOO: ≈9 years Situational: ex. dentist (agoraphobia) and closephoria E.g. Fear of public transportation, fear of small spaces, fear of flying, going to the doctor, work, etc. AOO: ≈20-25 years

Question 28

Specific phobia: statistics

Answer 28

``` Lifetime prevalence - not at the exam Women: 9.8% Men: 4.9% AOO average of all of them: ≈8 years Course: chronic People often don't seek treatment: prefer to adapt their lifestyle ``` Developmental awareness: need to consider what is appropriate for the age bracket (monster under the bed is not a phobia…!) it tends to develop as an anxiety disorder if it continues

Question 29

Specific phobia: etiology

Answer 29

Biological vulnerability – Heritable tendencies - Preparedness (evolutionary perspective of our fear and anxiety): - Low threshold for defensive reactivity: would faint easier, like it takes much less then somebody else to react Life circumstances as ways to develop a specific phobia: spook by something, certains phobia starts young - direct experience and conditioning - Indirect vicarious experience - Informational transmission: rare. mostly for PTSD. you did not see it, you heard about it through a newspaper, someone,

Question 30

Specific phobia: treatment

Answer 30

Consistent exposure-based exercises Systematic desensitization (Joseph Wolpe) Building the fear hierarchy Gradually moving up and exposing individual to feared (can have loved one in the session with you) think of spider

Question 31

what is separation anxiety, diagnostic criteria and what are the treatment?

Answer 31

Originally viewed as “childhood anxiety” → can persist into adulthood (“adult disorder” as well) Prevalence: 4.1% in youth(what is the age exactly? it is criticize); 6.6% in adults → you don’t start as an adult, it goes from youth to adult) As adults they might stay close to their caregivers, stay at their house/family house, or buy one close to theirs even how inconvenient it can be //not part of DSM5 Persistent and unrealistic worry that something will happen to the parents during one’s absence Separation anxiety: diagnostic criteria Etiology Genetic component Stressful life event Parenting: let the child explore while being there

Question 32

Social anxiety disorder (SAD) what is it?

Answer 32

A. Marked fear or anxiety about one or more social situations in which the individual is exposed to possible scrutiny by others. B. The individual fears that he or she will act in a way or show anxiety symptoms that will be negatively evaluated C. The social situations almost always provoke fear or anxiety D. The social situations are avoided or endured with intense fear or anxiety E. The fear or anxiety is out of proportion to the actual threat posed by the social situation and to the sociocultural context F. The fear, anxiety, or avoidance is persistent, typically lasting for 6 months or more G. The fear, anxiety, or avoidance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning H. The fear, anxiety, or avoidance is not attributable to the physiological effects of a substance (e.g., a drug of abuse, a medication) or another medical condition I. The fear, anxiety, or avoidance is not better explained by the symptoms of another mental disorder, such as panic disorder, body dysmorphic disorder, or autism spectrum disorder J. If another medical condition is present, the fear, anxiety, or avoidance is clearly unrelated or is excessive

Question 33

Social anxiety disorder (SAD)stats?

Answer 33

Lifetime prevalence: 3.3% Sex ratio: Only slightly more common in women (barely a difference) Onset: Adolescence, peaking at age 15 years ( is there an influence of self-esteem? overweight is - judgment from others, make a conscious choice of clothing…) Affected by cultural norms: more common in certain cultures

Question 34

ocial anxiety disorder (SAD) etiology?

Answer 34

``` Biological Some people born with trait of inhibition: no symptom alone is sufficient for the SAd, they need to be together) Detect and react to angry faces quicker limbic system is activated not the prefrontal ↑ amygdala activation ↓ cortical activation ``` Environmental factors Learnt from parents (or culture) to be concerned with opinion of others Social evaluation is dangerous!

Question 35

SAD and interpersonal cycle + treatment

Answer 35

people have biased social perceptions/expectations --> leads them to behave in maladaptive ways in social situations --> resulting social behavior elicits negative reaction treatment : individual + group CT (group works best because of role-playing - creating desensitization, 40% work on the long run).

Question 36

SAD no alarm, false alarm etc

Answer 36

no alarm: thinking about you having not so good speaking skill does not help. Low self esteem- emotion dysregulation, self-confiance . direct experience: you did speak in front of people. you are the center of attention (always your perception of negative feedback). At the end it becomes a false alarm. false alarm: you don’t need to be the center of attention, just the idea of it triggers you - negative evaluation is anchor in your head) anxious apprehension specific psychological vulnerability: cultural context is important too. you need ot be careful of what you say because certain people are there (a bit like my family) - today is it a anxiety disorder

Question 37

PTSD: Criteiron

Answer 37

Exposure to actual or threatened death, serious injury, or sexual violence in ≥1of the following four ways: (directly, witnessing, learning and experiencing epeated or extreme exposure to aversive details of the traumatic event(s) -very specific to ptsd. Think about the first responder, they see the aftermath of the scene, the after scene). Presence of ≥1 of the following intrusion symptoms (thoughts/memories, dissociative reactions, intense or prolonged psychological distress), reactions to inter and external cues that resemble an aspect of the traumatic events) c. Persistent avoidance of stimuli associated with the traumatic event(s) d. Negative alterations in mood and cognition associated with the traumatic event(s), beginning or worsening after the traumatic event(s) occurred, as evidenced by ≥2 of the following seven: (page 21) e.Marked alterations in arousal and reactivity associated with the traumatic event(s), beginning or worsening after the traumatic event(s) occurred, as evidenced by ≥2 of the following

Question 38

PTSD: Etiology

Answer 38

Social Cultural influences: | strong support group: if you don’t have one, the idea of not being able to rely and to trust someone increases.

Question 39

PTSD: Key terms

Answer 39

Cognitive re-experiencing: Intrusive thoughts, nightmares, flashbacks Avoidance: Of trauma-related stimuli; inability to recall trauma Emotional numbing: Loss of interest, detachment, restricted affect, foreshortened future Somatic hyperarousal: Sleep disturbance, irritability, difficulty concentrating, startled, hypervigilance

Question 40

PTSD: Statistics

Answer 40

Lifetime prevalence: 8% Higher rates among women than men Higher rates among certain trauma victims Combat veterans Childhood trauma Rape victims Intensity/severity of trauma: very subjective Family history Little or no social support system Hippocampal damage: stress and memory trouble there is a true alarm

Question 41

PTSD: treatment

Answer 41

SSRIs Quick relief of anxiety and panic attacks High risk of relapse Beta blockers (blocking effects of adrenaline) Effects on heart rate and blood pressure Relieves negative reactivity related to traumatic event MDMA (hallucinogenic and stimulant properties) Pilot studies on efficacy and safety: wasn’t a large scale. The patient presents with MDMA- 3 doses- (low dose or full dose). Improvement in all the symptoms, the effectiveness was shown,the safety was shown and maintained up to a year in combination with psychotherapy. it has chemical affinity with serotonin

Question 42

How do sufferers shoukd face their trauma? | type of therapy: pet and CBT, EMDR

Answer 42

Prolonged exposure therapy (derived from CBT- which was developed for mood disorder) → it is about arranging the reexposure to the dramatic event but so it could be therapeutic rather than traumatic again. Unlike phobia, you cannot exactly recreate the same environment. With PET, the therapist relies on the imaginal exposure. you help the victim to develop a narrative (known as constructionist narrative) → rebuilding the global picture of what happens that day and every session you add some details very gradually (again, similar to desentization) until it seems complete. The client can think and talk about the event without having the emotional distress/danger with it, used in potential ptsd within clients. As a prevention.Dolson college shooting, a hospital develops a preventive approach to PTSD. Cognitive therapy to correct negative assumptions (e.g. self-blaming and guilt). Essentially it is CBT but we focus on the cognitive part. Can prevent PTSD if done early focus on negative stigma to diagnose a PTSD with all the symptoms, roughly three month after the event and sometimes years and years before enough symptoms appear and fulfill the criteria to be diagnosed. Eye-movement desensitization and reprocessing (EMDR) - role is to reduce vividness and emotionality - it is controversial, both cognitive and eye movement have been found effective. Although, EMDR was found more effective in treating anxiety symptoms while cognitive therapy is found more effective for depressive symptoms.

Question 43

what is acute stress disorder?

Answer 43

Experiencing, witnessing a traumatic event Develops within 1 month following a traumatic event very important Persists up to 1 month Symptoms similar to PTSD → can turn into PTSD if not treated

Question 44

what is adjustment Disorder (Stress Response Syndrome in DSM-5)?

Answer 44

* *short term condition: develop within 3 months following life stressor and persists up to 6 months * *difficulting coping with a stressor * *reason: anything. painful breakout, changing job (even for the better, upcoming marriage * *Anxious or depressive reactions to life stress (develop symptoms of clinical depression but does not involve the physical symptom - change in appetite, weight ,etc.) * *You can use ptsd treatment, beta blockers, antidepressant, cognitive therapy to alleviate symptoms and reduce the duration

Question 45

what is attachment Disorder?

Answer 45

Disturbed and developmentally inappropriate behavior in children Emerging before age 5 years Unable to form normal attachment relationships **Type 1: Reactive Attachment Disorder: disturb inappropriate way to relate socially→ failed to initiate social interaction or someone initiates it and you are paralyze from it and remove yourself. inhibition * *Type 2: Disinhibited Social Engagement Disorder: inappropriate too. overly interesting, sitting on the lap of a stranger, doing anything to develop a relationship to be initiated. cause: neglect, abuse etc. but it is quite rare.

Question 46

what is OCD?

Answer 46

1. Presence of obsessions, compulsions, or both. --> obsession: Recurrent and persistent thoughts, urges, or images that are experienced. The individual attempts to ignore or suppress such thoughts, urges, or images, or to neutralize them with some other thought or action --> compulsion: Repetitive behaviors or mental acts that the individual feels driven to perform in response to an obsession or according to rules that must be applied rigidly The behaviors or mental acts are aimed at preventing or reducing anxiety or distress, or preventing some dreaded event or situation; however, these behaviors or mental acts are not connected in a realistic way with what they are designed to neutralize or prevent, or are clearly excessive

Question 47

OCD: criteria

Answer 47

b. The obsessions or compulsions are time-consuming or cause clinically significant distress or impairment in social, occupational, or other important areas of functioning C. The obsessive-compulsive symptoms are not attributable to the physiological effects of a substance or another medical condition D. The disturbance is not better explained by the symptoms of another mental disorder

Question 48

OCD: examples of obsession and compulsion

Answer 48

obession: symmetry, cleaning/contamination, forbidden thoughts Compulsions: ordering/arranging, repetitive washing, checking avoiding it is not clear why it is one form or the other, it is unclear obsessions vs compulsions a– b b→a with DSM-5 the individual does not have to have both obsession and compulsions. they can have either or or. obsession without the compulsion and vs. BUT VERY RARE. usually the two are combined

Question 49

OCD key terms + adulthood aoo? course? substance use?

Answer 49

Obsessions OR Compulsions (trying to press your thoughts away = not always physical or observable) Insight: recognizing obsessions (not clear; either early or not in life)/compulsions as excessive or unreasonable Distress/impairment: time-consuming or cause marked distress or significant impairment: checking the lock over and over again Obsession: not throw anything away because you were once living in poverty. That would be an example without having the compulsion as well.. ocd is more an adult conditioning Sex ratio: equal AOO: mid-20s Course: chronic substance use, eating disorder

Question 50

OCD: Etiology what is generalized Biological Vulnerability? what is generalized Psychological Vulnerability? what is Specific Psychological Vulnerability?

Answer 50

Generalized Biological Vulnerability **Genetic influence: what is the family history? any anxiety related disorder? **Dysfunctional orbitofrontal-caudate-thalamic pathway (prefrontal cortex, thalamic) → it all works together. various rejoins working together. impaired decision making, impair impulse control, emotion dysregulation,= use compulsion to alleviate stressing thoughts and increasing the risk display obsession and compulsion. not clear what is going on. dysregulation in serotonin transport = a possibility but we don’t rely on this assumptions very much 40-60% treated sir SSRI do not show improvement. you can rely only on that. Generalized Psychological Vulnerability * *Sensitivity to anxiety: persistent thought * *Things in life are uncontrollable Specific Psychological Vulnerability **Thought-action fusion: think that thinking about certain thoughts will increase the chance of it happening. Ex: thinking about cheating and now you think it is as bad as actually cheating- I’’should not think about it’’--> increase the stress even further.

Question 51

OCD: treatment

Answer 51

Medication **SSRIs: Beneficial, but slow effect and relapse Psychological treatments ** CBT Exposure and Response Prevention (ERP)--> not the most popular **Expose to whatever upsets them and, then, not allow to perform their compulsion. block them from performing their ritual (ex. dust on a furniture, not let them clean). Show them that thinking something ≠ it will happen. not popular, not everyone wants to put themselves in that position and it can bring discomfort, very unpleasant **Combo not more effective than therapy alone

Question 52

what is compulsive? (think of the photo)

Answer 52

behavioral pattern, inability to disregard large quantities of objects.thy are aware but there is emotional attachement.

Question 53

what is body dysmorphic disorder?

Answer 53

obsessive of some aspect of your body is severely flawed and it would take some exceptional measure to hide it/fix it. mostly imagined. if real it is exaggerated (ex. acne) 7 hours of the day and more. starts at adolescence. you create a routine to avoid certain aspects of it.

Question 54

Body-Focused Repetitive Behaviors (BFRB) | BFRBs part of the obsessive-compulsive spectrum

Answer 54

chronic start at adolescence all high in anxiety cognitive therapy and it is suggested that the clients keep a journal: what are your thoughts, feelings, etc.? body focused repetitive behavior. maladaptive coping mechanism you need to unlearn that habit or replace it with a healthy pattern

Question 55

what are the 4 types of behavior include in the body-focused repetitive behviors (BFRB)

Answer 55

Chronic skin picking: Excoriation disorder, ” Chronic hair-pulling: Trichotillomania Chronic nail biting: Onychophagia. very common. Chronic cheek-biting: bite the imperfect area

Question 56

what does mood spectrum include?

Answer 56

Depression and mania contribute independently Mood disorders: characterized by severity and duration Unipolar: major depresison and dysthymia Bipolar disorder: Bipolar I & II, cyclothymia

Question 57

Major depressive disorder (MDD) | what is it? what are the symptoms?

Answer 57

≥5 of the following symptoms have been present during the same 2-week period, most of the day and nearly every day, and represent a change from previous functioning; at least one of the symptoms is either (1) depressed mood or (2) anhedonia 1. Depressed mood most of the day, as indicated by either subjective report or observation made by others 2. Markedly diminished interest or pleasure in all, or almost all, activities (anhedonia) * *The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning * *The episode is not attributable to the physiological effects of a substance or to another medical condition * *The occurrence of the major depressive episode is not better explained by other mental disorder * *There has never been a manic episode or a hypomanic episode

Question 58

MDD statistics

Answer 58

``` Lifetime prevalence : 16% Sex ratio: 2:1 AOO: ≈25 years Adolescent onset also observed Greater chronicity Poor response to treatment Increased family inheritance Mean duration: 2-9 months Course: chronic ```

Question 59

MDD statistics cntd.

Answer 59

**Specifier for depression Recurrent: if two episodes occur at least two months apart Chronic: if two episodes occur less than two months apart **85% of individuals experience a second episode Chronic because of the high risk of relapse

Question 60

Persistent depressive disorder (Dysthymia) PDD

Answer 60

PDD vs MDD Statistics Lifetime prevalence: ≈1.5% PDD = MDD: Both show greater chronicity if adolescent onset PDD vs. MDD: Fewer symptoms More constant chronic course Less responsive to treatment- cause it is more persistent

Question 61

PDD: Diagnostic criteria

Answer 61

A. Depressed mood for most of the day, for more days than not, as indicated by either subjective account or observation by others, for at least 2 years B. Presence, while depressed, of ≥2 of the following: 1. Poor appetite or overeating 2. Insomnia or hypersomnia 3. Fatigue 4. Low self-esteem 5. Poor concentration or difficulty making decisions 6. Feelings of hopelessness C. During the 2-year period of the disturbance, the individual has never been without the symptoms for more than 2 months at a time D. Criteria for an MDD may be continuously present for 2 years E. There has never been a manic episode or a hypomanic episode, and criteria have never been met for cyclothymic disorder F. The disturbance is not better explained by a another mental disorder G. The symptoms are not attributable to the physiological effects of a substance or another medical condition H. The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning unipolar depressive disorder there is not hypomanic episode

Question 62

Premenstrual dysphoric disorder (PMDD)

Answer 62

``` Lifetime prevalence: ~2-5% of women Incapacitating emotional reactions during premenstrual period Controversial at first still a bit Includes: Physical symptoms Anxiety Severe mood swings as it goes, it takes over their life to (a week before and last a few days after the period) ```

Question 63

Disruptive mood dysregulation disorder (DMDD)

Answer 63

**quite new **Thought to account for youth with severe irritability, Bipolar I Not Otherwise Specified **Childhood depressive disorder - there is a debate whether it would be bipolar type 1 for kids AOO: 10 years **Features for 3 times/day nearly every day for ≥12 months: *Extreme irritability, anger *Recurrent temper (verbal or physical) outbursts NOS: not always specified. patient have symptoms but don’t fit in a bracket (like bipolar 1 or 2)- the psychiatrist might not know where to put up. SO now we need to reduce this category so DMDD was created. What's the treatment? therapy, stress management, anger management, group therapy (child, caregiver,family members etc)

Question 64

Mixed episode | Meets criteria for major depressive episode and mania for ≥1 week nearly every day

Answer 64

Dysphoric mania: display all diagnose with manic episode and display some symptoms of dysphoria. don’t need to be diagnoses Agitated depression Frustrating, confusing and debilitating- interfere with there lives… so you can give mood stabilizer

Question 65

Psychological dimension: depressive disorders

Answer 65

Seligman’s learned helplessness People become depressed or anxious when they make an attribution that they have no control over the life stress it is the repeated exposure to uncontrollable aversive environmental stimulate would lead gradually believe that harm is inescapable it is suggested that Seligmen's original theory had it almost backwards: brain default state is to assume no control is present. The presence of hopefulness is what is exactly learnt. and it is learned quite early with responsibilities as a child with parental attitude. it is limited but relevant still. ``` Depressive cognitive triad Negative cognitive belief system Self-blame schema These errors and schemas are automatic Supported by research ```

Question 66

Psychological dimension: depressive disorders | What is beck interpretation?

Answer 66

Beck’s negative cognitive style Depression may result from interpreting everyday life (self, world, future) negatively Cognitive errors Beck became “father of cognitive therapy” you ask the client to keep a journal, how did you feel about it and once in therapy you go and look at it in cognitive therapy. Being mindful of the event and how you react to it.

Question 67

Psychological dimension: depressive disorders | What is Abramson's concept of hopelesness?

Answer 67

Negative inferences or attributional styles Internal: any harm done, failure ‘’it is my fault’’ Stable: my problems are always there Global: it follows my in all the area of my life Hopelessness (more related to anxiety overtime then depression)

Question 68

Depressive disorders: medication

Answer 68

* * Promising: ketamine: higher rate of clinical remission of depression * * glutamate is a NT, an excitatory. You can take that once a week. Don’t need this as much (very important) * * Common: antidepressants * * Tricyclic antidepressants (TCAs-SNRIs) * * Monoamine oxidase inhibitors (MAOIs): last resort. effective in atypical depression. * * Selective Serotonin Reuptake inhibitors (SSRIs): very common * Increase amount of serotonin in the synaptic gap

Question 69

Depressive disorders: medication (the common one = antidepressant) pros and cons

Answer 69

Pros: Better than placebo Possibly better for severe episodes highly effective with psychological treatment ``` Cons: Usually not an immediate benefit Physiological side effects → high dropouts possibly due to the side effects Sexual dysfunction is a big one ‘’won’t work anyway’’ kinda mentality SSRIs MAOIs side effect are now less major then before Not everyone responds to medication High relapse rate ```

Question 70

Depressive disorders: ECT and TMS again combined with psychological treatment

Answer 70

Treatment-resistant and/or severe conditions Electroconvulsive therapy Electric shock administered to the brain for >1 sec Side effects (e.g. confusion, trouble concentrating); follow-up needed Transcranial magnetic stimulation Magnetic fields stimulating the brain for ≈30 min Effective yet temporary measure Predominant: CBT Cognitive component: Identification (monitoring) and re-evaluation (restructuring) of faulty thinking patterns (cognitive errors) Behavioral component: Behavioral tasks: keeping a journal, hypothesis-testing, role-playing, taking a walk Predominant: Interpersonal therapy Involves resolving issues in existing relationships Goals: Deal life event with interpersonal conflict or adjust to loss of relationship Acquire new relationships Identify and correct social skills deficits Helps with mood CBT and this therapy are recommended ``` Also promising: Animal-assisted therapy Art therapy Music therapy (self-awareness, sublimation, not having to express yourself) ```

Question 71

what about relapse with treatment for depressive disorders

Answer 71

lower rate for the combination of treatment