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Flashcards in Unit 2 Deck (91):
1

anxiety

emotional/ cognitive symptoms (worry, dread) and physical symptoms ( arousal and tension)

2

anxiety disorder

most common mental disorder
-1/3 develop at some point
- only 1/5 seek treatment
-women are 2x as likely as men

3

anx disorder comorbidities

tend to be high with other disorders- depression, asthma, chronic pain, hypertension, IBS

4

ADs are distinguished by

1) type of objects that are feared
2) content of associated thoughts and beliefs

5

panic attack

particular type of fear response and common symptom in many anx disorders

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unexpected panic attack

no evident trigger- evident of panic disorder

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expected panic attack

known trigger= situationally bound and predisposed

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phobia

more intense persistent fear (distress) and a greater desire to avoid the feared object or situation
-associated dysfunction
-specific item of fear

9

phobia diagnostic criteria

1) fear of situation or object
2)immediate anxiety response
3)go to extremes to avoid the situation
4)fear is disproportionate to accompanying danger
5)may have panic attacks associated with phobia
6)must cause clinically significant distress/ social impairment (dysfunction)
7)persistent fear- symptoms must be present for at least 6 months

10

phobias stats

9% of US have symptoms
many suffer from more than one
women 2x men
vast majority don't seek treatment

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general subtypes

1)animals
2)natural environment
3)situations
4)medical

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treatment (phobia)

-exposure therapy
-systematic desensitization (in vivo= place in the feared environment; covert= imagined)
-best= actual contact with feared object

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social anxiety disorder

anxiety about being watched by others and fear of being embarrassed or judged negatively
-signif distress or impairment and avoidance

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subtypes of SAD

performance- may be narrowly affected by oral presentation, etc
general subtype- broadly affected by social
-in both, people rate themselves as doing more poorly than they are

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SAD stats

12% lifetime prevalence
onset= teen years- may follow humiliation
duration is usually life long, but may decrease in adulthood
-comorbidity and self medicating are common

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SAD treatment

behavior and cognitive techniques
-group therapy can be helpful
-antidepressants, beta blockers, benzos

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antidepressants (SSRIs)

most often prescribed
-prozac, celexa, lexapro, Zoloft
-taken daily for long term use
not addictive
appropriate for regular feelings of anxiety

18

Beta blockers

can help with physical symptoms of social anx
-safe for most patients, few side effects, not habit forming
-propranolol (infernal)-can lower BP

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benzodiazepines

found to be effective (1950s) in decreasing anx
-valium, Xanax, Ativan, klonopin
-agonist for GABA
-negative= tolerance builds up and drowsiness (should be tapered off to stop)

20

panic disorder diagnostic criteria

1)person experiences recurrent panic attacks
AND 2) person is apprehensive about having it for at least one month
OR 3)person develops behaviors designated to avoid PAs
-high comorbidity rate (83% have 1+)
-3-4% of pop (1/4 pop has panic ATTACK at some point)

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bio perspective-panic disorder

1) genetic
2)increased amygdala activity (heightened startle reactions and abnormally sensitive neural networks)
3)biochem abnormalities

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SSRI

can decrease PAs (1960)
increase serotonin and decrease norepinephrine activity
-bring improvement to at lead 80% of panic disorder patients

23

agoraphobia

fear of being in public places/ situations where escape may be difficult should they panic or be incapacitated
-typically develops in 20s and 30s
-go to great lengths for avoidance
-must have symptoms for at least 6 months
-create "safe zones" which they do not leave

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agoraphobia treatment

-skype/ home therapy (difficult)
-variety of exposure therapy
-support group
-home based self help
-medications to decrease anxiety (+psychotherapy)

25

generalized anxiety disorder (GAD)

1)excessive/ unreasonable anxiety and worry under most circumstances- free floating anxiety
2)person finds it hard to control the anxiety-"anxious apprehension"= hallmark- frequently checking and diff with decisions
3)physical symptoms (restlessness, fatigue, muscle tension, sleep probs)
4) distress or dysfunction
5)not due to meds or stimulants
6)symptoms must last at least 6 months

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GAD stats

6% prevalence in US
appears in adolescence
more common in women (2:1)
shows up in care settings for physical symptoms
disorder worsens during stressful periods

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GAD therapies

1) changing maladaptive assumptions (rational emotive therapy)
2)breakdown the worrying (increase self awareness)
3)barbiturates (50s)- addictive and dangerous
-benzodiazepines (60s)- work quickly and addictive
-antidepressants (SSRIS take 2 weeks to work) and azapirones work on serotonin

28

OCD

recurrent obsessions and or recurrent compulsions (only need one to be diagnosed)
diagnosis:
1)causes great distress or
2)takes up time (>1hr/day)
OR 3) interferes with daily function
-can be paired with trichotillmania, body dimorphic disorder, hoarding, and excoriation

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OCD stats

1-2% US in given year (3% prev. over lifetime)
equally common between sexes
40% seek treatment

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common obsessions

-contamination
-doubts
-need for order/ symmetry
-aggressive/ horrific impulses
-unpleasant/ unwanted sexual imagery

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common compulsions

-cleaning/ washing
-checking
-demanding assurances
-organizing
-counting**
-repeated touching

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OCD therapy

-psychoeducation
-SSRIs(prozac)

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stress disorder

exposure to traumatic event/ stressor is explicitly listed as diagnostic criterion
symptoms= anxiety, depression (comorbid), dissociation, anhedonia, aggression

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stress response

influenced by how we see the event and how we judge our capacity to react to the event effectively

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sympathetic NS

hypothalamus excited SNS which stimulates key organs

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hypothalamic pituitary adrenal (HPA) axis

hypothalamus signals the pituitary gland which stimulates the adrenal cortex to release corticosteroids into the bloodstream

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adjustment disorder

psych response within 3 months of exposure to common identifiable stressor- resulting in emotional/ behavioral symptoms
-stressors may be single or repeated exposures
-distress and dysfunction
-very common- therapy aiming at increasing coping ability

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acute stress disorder

symptoms (same as PTSD) begin within 4 weeks of trauma and last 3-30 days

39

PTSD

symptoms may begin shortly or after period of time from trauma and last over 1month**
symptoms= exposure to trauma, intrusive/ reliving trauma (nightmares/ flashbacks), avoidance of trauma linked stimuli, changes in cognition or mood, changes in reactivity (hyperarousal)

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PTSD triggers

-disasters= 10x more common than combat- natural or accidental- 1st responders are more likely than civilian
-combat= increased deployment leads to increased risk
-victimization/ abuse= 1/3 victims of physical or sexual abuse develop due to human caused trauma nature (destroys societal/ human trust)
-terrorist/ torture

41

PTSD risks

1) pre existing factors (attitudes, hormones, prior trauma)
2) nature of trauma
3) support after trauma (or lack thereof)

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uncovering

reliving trauma in safe environment; such as prolonged exposure (high dropout rate)

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covering

supportive therapy and stress management to seal over pain
-CBT= most effective for PTSD

44

dissociation

affects memory, personal identity, and consciousness of time and environment
-can be defense against trauma; may become pattern if trauma is repeated= disorder

45

dissociative identity disorder

person must have 2+ distinct identity or personality states, which may alternate within the individual's conscious awareness

46

DID diagnostic criteria

1- disruption of identity with 2+ distinct personalities
2-memory gaps in events
3- not due to substance abuse

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host personality

primary- usually takes birth name, appears most often, tends to be passive and dependent

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alters

each with unique set of memories, behaviors, thoughts and emotions; may have different abilities

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mutually amnesic

relationships in which sub personalities have no awareness of one another

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mutually congnizant

patterns in which each sub personality is aware of the others

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one-way amnesic

most common relationship/ pattern- some personalities are aware of the others, but each pattern isn't mutual

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reintegration

of various sub personalities into host is the goal goal of therapy

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depersonalization/ derealization disorder

characterized by persistent/ recurrent experiences of depersonalization OR derealization OR both

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depersonalization

experiences of unreality, detachment, or being an outside observer with respect to oneself

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derealization

experiences of unreality/ detachment with respect to one's surroundings

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psychogenic amnesia

amnesia with a psychological cause- affects episodic memory
1- cannot recall autobiographical info (usually trauma)
2- distress/ dysfunction
3- not due to substance abuse or neuro condition

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dissociative amnesia diagnostic criteria

1- cannot recall autobiographical info
2- distress/ dysnfunction
3- not due to substance abuse or a neuro/ medical

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localized amnesia`

most common. amnesia of memories during period of stress/ trauma- clear cut time period

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selective amnesia

loss of some memories during a period of time, but not all memories

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generalized amnesia

begins with a particular event and extends back in time - tends to have sudden onset and wandering

61

dissociative fugue

subtype of dissociative amnesia= extensive loss of episodic memory and unexpected travel from home region

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major depressive episode

5 different types of symptoms:
-emotional
-physical
-cognitive
-motivational
-behavioral

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major depressive disorder

experienced major depressive episode and never had manic or hyperactive episode

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monoamine hypothesis

depression is caused by depletion in the levels of NTs (serotonin, NE, DA)... clear problems with this hypothesis developed in the 1980s= clinical effects take time to be visible and only a minority of patients have low 5HT levels

65

reactive (exogenous) depression

follows clear-cut stressors/ events

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endogenous depression

caused by internal/ bio factors

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Beck- cognitive theory on depression

4 interrelated components:
-maladaptive attitudes= develop in childhood
-cognitive triad= negative views of oneself, future, and world
-errors in thinking= 1-arbitrary interferences (logic errors), 2-minimization (of accomplishments), 3-magnification (of problems)
-automatic thoughts= steady stream of negative repetitive thoughts

68

persistent depressive disorder (formerly, Dysthymia)

generally milder than MDD, fewer and shorter symptomatic periods
-intermittent normal moods
-1/10 develop MDD
-early onset= higher likelihood of comorbid substance abuse

69

premenstrual dysphoric disorder

new to DSM-V: mood symptoms develop in women 7-10 days before period and start to improve days after period
treatments= SSRIs, birth control, exercise, sleep...

70

manic episode

requires symptoms A and B
A= -abnormally and persistently elevated or irritable mood
-AND persistently increased activity or energy level
-lasting at least one week OR requiring hospitalization
B= 3 or more: -grandiose/ increased self esteem
-decreased sleep
-flight of thoughts
-talkative/ distracted
-risky behavior

71

hypomanic episode

low level mania
1) symptoms at least 4 consecutive days
2) same symptoms as manic, but not as severe
3)change in functioning
4)change in mood
5)not due to drug/ stimulant

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rapid cycling

people that experience 4+ mood episodes within one year

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BP I

diagnostic criteria: 1- at least one manic episode at some point (hospital or one week long)
2- episode may be followed by depressive episode, but not needed for diagnosis
3-distress/ dysfunction
4-not due to med/ drug

74

BP II

1- must have had 1+ major depressive episode
2-must have had at least 1 hypomanic ep
3- never have had manic episode

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cyclothymic disorder

person experiences at least 2 years of numerous periods of symptoms of both hypomania and mild depression (NOT episodes... symptoms)
-chronic fluctuating mood- not symptom free for over two months

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permissive theory

low serotonin may open the door for mood disorder, NE level determines the type
-low 5HT, high NE= mania
-low 5HT, low NE= depression

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DA with BP

increased dopamine activity can also lead to mania
-lithium decreases DA activity and can calm mania

78

depression- behavioral treatment: Lewisohn

1-reintroduce person to pleasurable activities and schedule
2- reward non-depressive behaviors
3- help improve social skills

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depression- cognitive treatment: Beck

1- increasing activities
2-challenging client's negative thinking
3-identifiy illogical thinking
4- change primary maladaptive attitudes

80

depression-bio treatment

1- antidepressants
2-ECT
3-brain stimulation treatments
*combo of meds and psychotherapy= best

81

MAO inhibitors

slow body's production of monoamine oxidase and stop break down of NE (MAO breaks down NE)
-helpful in 1/2 patients
-can take up to 3 weeks to work
-dangerous increase in blood pressure = diet restrictions

82

tricyclics

-similar to SSRI mode of action
-60% effective
-take for 10+ days for effects
-side effect= dry mouth and constipation

83

SSRIs and SNRI (and NRIs)

increase 5HT activity- take 2 to 6 weeks to work and urged to stay on for at least 6 months
-in 25%, cease to work within a few years= switch med

84

SSRI discontinuation syndrome

when stopped, SSRIs may lead to symptoms of nausea, dizziness, neurological probs in 20% of people who stop abruptly

85

TMS

creates pulsating magnetic fields to stimulate brain surface
-non invasive and few side effects- comparative effectiveness to antidepressants and ECT

86

DBS

invasive surgery- rare- deeply implanted electrodes stimulate area 25 in deep brain circuit

87

VNS

surgical implantation (chest/ neck) to stimulate the vagus nerve

88

light therapy

primarily for seasonal depression- natural light minus UV, 30 min to 2 hrs/ day
-can improve symptoms in a few days of treatment

89

therapeutic lifestyle change (TLC)

integrative approach for mild/ mod depression= new lifestyle changes
-6 major changes (exercise, social, omega 3, light, sleep...)

90

mood stabilizers

lithium was first used in 1949- approved in 1970 by FDA
-very effective for BP; best with mania, but helps depressive episodes too
-people have been overprescribed in past (side Es)

91

anticonvulsant medications (lamictal)

work by calming hyperactivity in brain- prescribed for rapid cycling
-mood stabilizers have 60% improvement with manic patients and decrease in new mood episodes (preventative)
-Lamictal= effective for depressive episodes
-antidepressants can trigger manic episodes (leading to BP)
-antipsychs for BP with hallucinations/ delusions (short term and may be in combo with other med)