the rest Flashcards
(92 cards)
1
Q
General description of AFRID?
A
- Avoiding/restricting food intake that leads to weight loss/nutritional deficiency/psychosocial impairment.
- Triggers include low appetite, sensory issues or fear after adverse eating experiences (e.g., chocking)
2
Q
General description of Pica?
A
Consumption of non-food items for at least a month (sensory, boredom, stress, are all triggers)
3
Q
General description of rumination disorder?
A
Regurgitation of food without nausea or disgust (so, without like their choice/effort)
4
Q
Comorbidity of EDs and other mental disorders % + common?
A
> 70% (mood, anxiety, substance, neurodevelopment and personality disorders)
5
Q
What do BED, AN and BN have in common?
A
Over-evaluation of weight and shape
6
Q
What is the most prevalent ED?
within the whole DSM chapter
A
- Specified: BED
- Eating disorder not otherwise specified (EDNOS) = most prevalent
7
Q
How many people of the general population have an ED?
A
75% (that feels weirdly high? I need to re-check this)
8
Q
How many patients in treatment for ED?
A
About 50%
9
Q
What does the incidence look like (1985-2019) in AN and BN?
A
- AN = stable
- BN = decrease
10
Q
What could be an explanation for BN’s decrease over the years?
A
- Obesity is more common (less need for compensatory behaviours)
11
Q
What is a pattern observed with the AN incidence over the years?
A
That more and more children (15-19) were diagnosed with AN (and EDs in general)
they’re detected more often: as the overall number is static
12
Q
What is seen as a main (cognitive) reason for EDs in general?
coping/reason
A
Control
13
Q
What is a comorbidity seen between EDs, but also OCD, BDD and autism?
thought-wise, related to reason for EDs
A
Recurrent, time-consuming and intrusive thoughts (that cause anxiety and distress)
- Obsessions quite similar
14
Q
What are three examples (cognitive impairments) of rigid thinking styles in EDs
A
- Deficits in mental flexibility
- Holding on to old habits
- Extreme focus on details/difficulties in seeing the whole picture (weak central coherence)
15
Q
What are three controlling behaviours in ED?
A
- body checking
- Counting (e.g., calories)
- Rituals and rules (e.g., arranging food a certain way on a plate)
16
Q
What does the “first stage” of EDs consist of (basically, the instigator/how it starts off)?
A
Positive consequences (reinforcement):
- Feeling of control
- Relieves anxiety (short-term)
- Things like increased self-esteem, escaping from negative emotions
17
Q
What does the “second stage” of EDs consist of (what happens after the first stage)?
A
Negative consequences:
- Psychological
- Social (isolation, conflicts, etc.)
- Physical
18
Q
What are some psych consequences of EDs? (6)
A
- Negative mood increases
- Stress
- Obsessive behaviours increase
- Problems with concentration
- Emotional numbness
- Body avoidance
19
Q
What are some physical consequences of EDs?
A
- Lanugo (hair that covers the body)
- Russell’s sign (on the fingers bc of self-induced vomiting)
- Teeth erosion
- Heart problems
- etc.
I got lazy
20
Q
Barriers to seeking help in EDs?
A
- Lack of knowledge (sufferers and professionals)
- Acknowledgement of ED (as it takes away coping)
- Shame, fear of stigma, problems with disclosure
- Lack of knowledge about treatment
21
Q
Specifiers of OCD?
A
Insight:
- Good/fair
- Poor
- Absent/delusional
Tic-related
- Current or past history of tic disorder
22
Q
What are the four dimensions of OCD described in the lecture?
basically types
A
- Contamination & cleaning
- Responsibility for causing or not preventing harm & checking/reassuring seeking
- Taboo thoughts about sexual activity, violence and plasphemy
- Need for order/symmetry or order/counting
23
Q
What makes OCD hard to diagnose?
A
It’s simalarity to many other disorders, meds and even medical conditions (dementia, GAD, other OC-related disorders, etc.)
24
Q
What four general disorder types share high comorbidity with OCD (which is the highest)?
A
- Substance use
- Impulse-control
- Mood
- Anxiety (highest)
act this is from highest to lowest (down-top)
25
How does OCD differ from OCPD? (4)
- OCD is about compulsions/obsessions, OCPD is about rigidity, need for control and perfectionism
- OCD is associated with feelings of anxiety, whereas OCPD is associated with feelings of tension
- OCPD's patterns show in multiple domains, OCD is more specified to one or few domains
- OCD is egodystonic (conflicts with own perception/values), OCPD is egosyntonic (doesn't conflict)
26
Epidemiology of OCD?
| 12 month
1.2%
27
Age of onset OCD?
Childhood/early adulthood
28
How many people with OCD receive the right treatment?
| idk what they mean with right tbh
30%
29
Circuit involved with OCD?
cortico-striatal-thalamo-cortical (CSTC) circuit (involved with movement selection/initiation, reinforcement and rewards)
30
What four main types of interventions are there for OCD?
- CBT (cognitive & exposure and response prevention)
- Inference based approach (IBA)
- Medication
- Neuromodulation (rTMS, DBS)
31
What are the main goals of cognitive therapy in OCD?
| (2)
- Normalizing intrusive thoughts (as they see these as more important/dangerous than they are)
- Focus on repairing cognitive dysfunctions/biases
32
Two main parts of exposure and response prevention (ERP) for OCD?
- Exposure (no shit) = overcoming avoidance
- Response prevention = reducing compulsions
33
What is the cognitive technique "estimation of catastrophe" for OCD?
Breaking down the obsession/catastrophe to calculate the actual chance of said catastrophe happening (especially, the cumulative chance of the full event happening)
34
What is the cognitive technique "pie technique" for OCD?
Focuses on the estimation of the responsibility (i.e., factors that contribute and make a pie chart of said factors)
35
What is flooding in OCD?
Exposure to a very frightful thing (e.g., touching inside of the toilet for contemanation fear)
36
How does the exposure work in ERP (that is to say, what technique/order is used for the exposure)
A fear hierarchy (small to biggest)
37
What can be a very important part of exposure for the patient?
| it makes them feel more safe
Supported exposure (healthcare prof is there with them)
38
Efficacy of CBT for OCD?
- 70% responsive
- 35% decrease on Y-BOCS
- Average symptom decrease of 60-80%
39
Why are SSRI's commonly used in OCD?
- Because it generally seems to help the effectiveness of CBT
- Because it can help with relapse (which is not uncommon)- if meds are taken lifelong (on a lower dosis)
40
When people with OCD are not responsive to CBT and medication, what is the next option? (therapy-resistant)
Neuromodulation
41
Within the CSTC circuit, what pathway shows hyperactivity in OCD?
The direct pathway from the cortex > striatum > thalamus
42
What does rMTS focus on (brain region wise) in OCD?
- Dorsolateral prefrontal cortex
- Superior motor area
43
What does rTMS do?
Non-invasively stimulates a certain brain area by inducing an electrical current within it
44
Efficacy of rTMS?
- More effective than placebo (sham rTMS)
- Improves depression as well
45
What is DBS?
Invasive, put an electrode in a certain part of the brain (which can then stimulate a part)
46
What is a plus for DBS (as opposed to rTMS)?
That the stimulation can be given fulltime
47
What are the main targets of DBS in OCD?
- Ventral capsule/ventral striatum
- Nucleus accumbens
- ALIC/BNST/STN (anterior limb blabla- idk if u need to actually know that)
48
DBS is generally used to target specific brain structures, or brain circuits- what is a new discovery that betters treatment (i.e., what do you actually need to target)?
Patient-centred stimulation (so seeing what brain circuits/areas are needed to target on a patient by patient basis)
49
Besides the stimulation, what is it that DBS actually does?
Normalizes the fronto-striatal hyperconnectivity
50
Downside of DBS?
Requires a lot of optimization (it can take up a year to work for a patient- people need specific frequency's etc.)
51
Symptom improvement in DBS? (timewise)
Affective symptoms around minutes-hours, obsessions in days and compulsions within weeks
| mostly remember the order
52
How much did Y-BOCS (worldwide studies) decrease with DBS?
47% (as opposed to the 35% of normal treatment)
53
What cognitive bias improves with DBS?
cognitive flexibility
54
Patient experience with DBS?
| (2)
- Improvement of mood
- Increase of self-confidence, spontaneous actions, etc.
55
What is a common symptom seen in body dysmorphic disorder (BDD), not part of the DSM criteria?
| Hint: dangerous
Suicidal ideation and attempts
56
Prevalence of suicidal ideation and attempts (%) in BDD?
80 and 24-28%, respectively
| 44% attempts in adolescents
57
cognitive thoughts/feelings associated with BDD?
Shame and self-disgust
58
What two specifiers are there for BDD?
- Insight (like OCD)
- Muscle dysmorphia
59
How many people (%) in BDD qualify as having poor (or worse) insight (specifier)?
at least (?) 80%
| idk she also said up to
60
Why is muscle dysphoria specifically a sub-type in BDD?
| it's because of prevalent problems in this sub-type (2)
Misuse of anabolic steriods & similarities with eating disorders
| overuse
61
When was BDD first diagnoses?
In 1891- thus, it has been around a long time
62
Comorbidity of BDD with other mental disorders?
| (6)
- Mood disorders (71-80%)
- Personality disorders (57%)
- Substance (30-50%)
- SAD (31-37%)
- OCD (17%)
- EDs (3-9%, AN specifically)
| im not expecting you to know the percentages
63
What are 5 common features between OCD and BDD?
- Genetic overlap (especially in OCD with symmetry)
- Physical past traumatic event (especially sexual abuse)
- Sex ratio (equal gender ratios)
- Perfectionism
- Attentional biases
| body image disturbances also, but lecturer doesnt agree
64
What are main differences between OCD and BDD? (3)
| besides the symptoms themselves lol
- OCD, on average, has a better level of insight *(32-38% absent/delusional insight in BDD compared to 2-4% in OCD)*
- BDD shows higher comorbidity with SUD, suicidality and worsening symptoms
- BDD have higher rates of past emotional and sexual abuse
65
Similarities AN and BDD? (4)
- Body image disturbances
- Perfectionism
- Higher intensity of negative emotions, worry as coping
- Abnormalities visuospatial processing and reward processing
66
Differences AN and BDD? (4)
- BDD can be concerned with the entire body (not just weight/shape)
- More hopelessness, psychosocial impairment and family burden in BDD
- Higher delusionality, poorer QoL in BDD
- Lower self-esteem and increased levels of MDD in AN
67
AN and BDD both show increased connectivity in (different) brain areas, which are these?
- AN = insula-orbitofrontal cortex
- BDD = occipital cortex
| note occipital <> perception biases in BDD
68
BDD prevalence general population?
| NL
1-2%
69
In what type of setting (e.g., student) is BDD most prevalent?
Cosmetic/dermatology settings
| thus pooled prevalence is must higher
70
What is a main problem with/for BDD in mental health settings?
It is rarely recognized and it takes a long time to get a diagnosis
71
In what other specific populations are higher rates of BDD reported?
| (4)
- Mental health settings
- Student/ballet dancers
- Maxillofacial surgery
- Plastic surgery (least prevalent in this row)
| note these come from different studies, one old
72
Prevalence of BDD in adolescents?
12%
| this was in an acne clinic
73
What type of cognitive process is impacted in BDD?
Visual information processing
74
How is visual information processing impacted in BDD?
Bias towards details (enhanced detail processing)
75
What brain region (or hyperactivity in it) is associated with the enhanced detail processing in BDD?
The ventral visual stream (which is associated with this detail processing)
76
What system is involved in BDD that can also be seen in OCD (and other disorders in this course)?
The dopamine system- wooooo
| also serotonin
77
What type of attentional biases (3) are seen in BDD (also seen in OCD)
- **Selective attention**: focus on disorder-relevant stimuli (and self-referent and easthetic details in BDD)
- **Distorted cognition**: perfectionist thinking and maladaptive beliefs- misinterpretation of ambiguous social scenarious
- **Memory deficits**: inaccurate coding and recall of face/body stimuli
| Latter is specifically in BDD
78
Five personality factors in BDD?
- Perfectionism
- Neurotocism
- Behavioural/social inhibition
- Unassertiveness
- Rejection sensitivity
79
What is a cultural factor that affects BDD?
Exposure to unrealistic beauty standards
80
Two family factors affecting BDD?
- Family dysfunction/overprotection (especially when OC-related disorders are present within the fam)
- Family accommodation (like in OCD)
81
Identity factors in BDD?
| (2)
- Gender affects it (women focus more on areas of the body, earlier age of onset, etc. and men have overall worse functioning)
- Greater rates in queer individuals and racial/ethnic minorities
82
BDD & social media?
- BDD symptoms increase when focused on social media (and vice versa)
- And more opportunity for "upward comparison"
| limited research tho
83
Four main treatment options for BDD?
- Cosmetic treatment (most common)
- Medication
- CBT
- Neurmodulation
84
Cosmetic "treatment" results BDD?
| (3)
- short term satisfaction, longterm no
- More procedures = worse prognosis
- Although more recent research shows that there is improvement
| Note for the last point that with long follow up, worse improvement
85
Medication in BDD?
- SSRI (50-60% response)
- Clomipramine/Desipramine (clom. better response)
- Antipsychotic (no response, only one, small study)
- Psilocybine (very small study, 58% response)
86
In what six ways does CBT treat BDD? what symptom/factor do these target?
| excludes EMDR/ImRs for trauma
- Changing norms/dealing with failure (Genetics/personality/psych)
- Thought exposure (negative thoughts and beliefs)
- Attentional training/mirroring (selective attentional bias)
- Response prevention (BDD rituals)
- Learning to tolerate tension (Anxiety/depression/shame)
- Exposure (avoidance)
| this is important!
87
What is an important factor to increase when wanting to treat BDD with CBT?
Motivation; they need to be convinced this will work
88
Main targets of cognitive therapy (not CBT) in BDD?
- BDD-thoughts (reasoning processes) and restructuring them into helping thoughts
- Value attached to appearance
89
What cognitive distortions are especially prevalent in BDD?
| (3)
- Mind reading (negative interpretation of behaviour/feeling of others)
- All-or-Nothing thinking
- Jumping to conclusions
90
Four types of dysfunctional assumptions (thoughts)?
| BDD
- Automatic
- Basal assumptions/core cognitions
- Conditional assumptions (if this, then that)
- Instrumental assumtpions (have to (not) do this, because of that)
91
What is mirror retraining in BDD?
- minimizing mirrors/at least distance away from it
- positive associations/describing or neutral/objective describing
- start with a body part that isn't BDD focus
| pictures/movies can be used
92
How is neuromodulation looking for BDD?
Promising, but limited research as of yet
