Week 19 + 20 Readings Flashcards
1
Q
Has the evolution of mental illness been linear, cyclical or progressive?
A
cyclical
2
Q
What is a cultural relativist view of abnormal behavior?
What alternative perspective is used to define abnormal behavior outside of cultural relativism?
A
A cultural relativist view considers mental illness within the context of cultural and temporal norms, rather than applying a fixed definition across societies.
A less cultural relativist view defines abnormal behavior based on whether it poses a threat to oneself or others or causes significant distress that interferes with work or relationships.
3
Q
How has the classification of mental illness been used as a form of social control?
A
In the past, behaviors that deviated from sociocultural norms were sometimes labeled as mental illness to silence or control certain individuals or groups.
4
Q
What is etiology?
A
The causal description of all of the factors that contribute to the development of a disorder or illness.
5
Q
What is trephination and what was its believed purpose in ancient treatments?
A
Trephination involved drilling holes in the skull, believed to release evil spirits or treat head injuries and conditions like epilepsy, dating back to as early as 6500 BC.
6
Q
How did ancient Chinese medicine explain mental and physical illness?
A
Ancient Chinese medicine attributed illness to an imbalance of “yin and yang,” with mental illness arising from this imbalance, and emphasized the need for harmony and proper flow of vital air for health.
7
Q
What is the “wandering uterus” theory, and how did it relate to mental illness in ancient Mesopotamia and Egypt?
How did the Egyptians and Greeks treat mental illness caused by the wandering uterus?
A
The “wandering uterus” theory, described in Mesopotamian and Egyptian papyri from 1900 BC, suggested that a dislodged uterus could cause mental illness by attaching to other body parts, leading to dysfunction and painful symptoms.
The Egyptians and Greeks used a somatogenic treatment involving strong-smelling substances, where pleasant odors were used to lure the uterus back into place and unpleasant ones to dispel it.
8
Q
How was mental illness understood and treated in classical antiquity?
A
Mental illness was often attributed to supernatural causes like demonic possession or godly displeasure, with treatments including religious healing ceremonies. The Hebrews saw madness as punishment from God, and treatment involved confession and repentance.
9
Q
What was Hippocrates’ approach to mental illness?
A
Hippocrates rejected supernatural explanations and proposed that mental illness resulted from imbalances in the body’s four humors (blood, yellow bile, black bile, and phlegm), with treatments like bloodletting for specific imbalances. He classified mental illnesses into epilepsy, mania, melancholia, and brain fever.
10
Q
How did Hippocrates and Greek physicians view mentally ill individuals?
A
Hippocrates and Greek physicians believed mental illness was not shameful and that mentally ill individuals should not be held accountable for their behavior, with care being provided primarily by family members.
11
Q
How did Galen’s views on mental illness differ from earlier beliefs?
A
Galen rejected the idea of a uterus having an animistic soul but agreed that an imbalance of the four bodily fluids could cause mental illness. He also introduced the idea that psychological stress could contribute to mental illness, paving the way for psychogenic explanations.
12
Q
How were Galen’s psychogenic theories received by later physicians?
A
Galen’s psychogenic theories were largely ignored for centuries, as most physicians continued to attribute mental illness to physical causes throughout the following millennium.
13
Q
What is the concept of an animistic soul, and how was it linked to mental illness?
A
The animistic soul is the belief that every person and thing has a “soul,” and mental illness was often attributed to animistic causes, such as evil spirits controlling an individual’s behavior.
14
Q
How did supernatural theories of mental illness resurface during the late Middle Ages, and how were the mentally ill treated?
A
Supernatural theories, fueled by natural disasters and political turmoil, dominated Europe between the 11th and 15th centuries. Mentally ill individuals, especially women, were often persecuted as witches, accused of demonic possession, and subjected to treatments like prayer, confessions, and relic touching.
15
Q
What was the role of the Church in the witch hunts, and how did some challenge the link between mental illness and demonic possession?
A
The Church’s Inquisition fueled witch hunts, peaking between the 15th and 17th centuries, with the publication of Malleus Maleficarum guiding the persecution. Johann Weyer and Reginald Scot argued that accused witches were mentally ill, not possessed, but their writings were banned by the Church.
16
Q
How were mental illness and its treatment addressed with the establishment of hospitals and asylums starting in the 16th century?
A
Beginning in the 16th century, hospitals and asylums, such as St. Mary of Bethlehem (Bedlam) and the Hôpital Général of Paris, housed the mentally ill, the poor, and the criminal, often in poor conditions. These institutions focused on confinement and public protection, with inmates living in filth, chained to walls, and exhibited for a fee.
Mental illness was treated somatogenically, with methods like purges, bleedings, and emetics.
17
Q
How were the mentally ill viewed in the 16th and 17th centuries, and how did this influence treatment?
A
The mentally ill were seen as akin to animals (animalism), lacking reason, control, and sensitivity to pain or temperature, and capable of violence without provocation. This view led to treatments aimed at instilling fear, believed to restore reason to the disordered mind.
18
Q
How did the treatment of the mentally ill change in the 18th and 19th centuries?
A
In the 18th century, protests against inhumane conditions led to a more humanitarian approach. Physicians like Vincenzo Chiarughi removed chains and encouraged hygiene, recreation, and occupational training. Philippe Pinel and Jean-Baptiste Pussin introduced “traitement moral” at La Bicêtre and Salpêtrière, which involved unshackling patients, providing better living conditions, and promoting purposeful activity and freedom.
19
Q
What is a traitement moral?
A
A therapeutic regimen of improved nutrition, living conditions, and rewards for productive behavior that has been attributed to Philippe Pinel during the French Revolution, when he released mentally ill patients from their restraints and treated them with compassion and dignity rather than with contempt and denigration.
20
Q
How did William Tuke and Dorothea Dix contribute to humanitarian reforms for the mentally ill?
A
William Tuke, driven by religious concerns, established the York Retreat in 1796, where patients were treated with dignity and courtesy. Dorothea Dix worked to change negative perceptions of mental illness in America and helped create institutions focused on compassionate care.
21
Q
How did the treatment of mentally ill individuals change in the United States compared to earlier practices?
A
Early American asylums, like Pennsylvania Hospital, followed somatogenic theories with treatments like blood-letting and tranquilizer chairs.
However, inspired by Tuke’s York Retreat, new private asylums like the Friends Asylum and Bloomingdale Asylum adopted psychogenic treatments, emphasizing compassionate care and physical labor.
22
Q
Why did moral treatment for the mentally ill decline in the late 19th century, and what did Dorothea Dix do in response?
A
Moral treatment declined due to overcrowding in asylums, which became more custodial and unable to provide adequate care. Dorothea Dix advocated for state hospitals, helping establish over 30 institutions in the U.S. and Canada between 1840 and 1880.
23
Q
How did the mental hygiene movement replace moral treatment in the late 19th century?
A
The mental hygiene movement, influenced by advancements in germ theory and medical treatments like vaccines, shifted focus back to somatogenic theories of mental illness. The movement was founded by Clifford Beers, following the publication of his memoir A Mind That Found Itself in 1908.
24
Q
What was the debate over the causes of hysteria in 18th and 19th century European psychiatry, and who were the key figures involved?
A
European psychiatry struggled between somatogenic (physical) and psychogenic (psychological) explanations for hysteria, which caused symptoms like blindness or paralysis without physiological causes. Key figures included Franz Anton Mesmer, who linked hysteria to imbalances in a magnetic fluid, and James Braid, who shifted to a belief in hypnosis. Charcot, Liébault, and Bernheim debated whether hysteria’s suggestibility was neurological or a general trait.
25
How did Josef Breuer and Sigmund Freud contribute to resolving the hysteria debate?
Breuer and Freud supported a psychogenic explanation for hysteria, treating it with hypnosis, which led to the development of the cathartic method, a precursor to psychoanalysis in the early 20th century.
26
What is the cathartic method?
A therapeutic procedure introduced by Breuer and developed further by Freud in the late 19th century whereby a patient gains insight and emotional relief from recalling and reliving traumatic events.
27
How did psychoanalysis influence the development of psychotherapy in the 20th century?
What factors contribute to the efficacy of psychotherapy, regardless of the specific approach used?
Psychoanalysis, the dominant psychogenic treatment in the first half of the 20th century, served as the foundation for over 400 different schools of psychotherapy, including behavioral, cognitive, psychodynamic, and client-centered approaches.
The efficacy of psychotherapy is primarily due to factors shared across all approaches: the therapist-patient alliance, the therapist’s commitment to the therapy, therapist competence, and placebo effects.
28
How did somatogenic treatments for mental illness evolve in the mid-20th century?
In the mid-20th century, psychotropic medications became the leading somatogenic treatment for mental illness, replacing earlier practices like restraints, electro-convulsive therapy, and lobotomies, which continued in American state institutions until the 1970s. The pharmaceutical industry began viewing and treating mental illness as a chemical imbalance in the brain.
29
What is the biopsychosocial model of human behavior, and how do genetic, psychological, and sociocultural factors contribute to mental illness?
How does the biopsychosocial model reflect historical thinking on mental illness?
The biopsychosocial model explains that mental illness can result from a combination of genetic predisposition, psychological stressors, and sociocultural factors like political unrest, poor living conditions, or problematic relationships. It acknowledges that both somatogenic (biological) and psychogenic (psychological) factors play a role.
Despite modern advancements, the biopsychosocial model continues to reflect the same somatogenic and psychogenic theories of mental illness that have been present throughout history.
30
How did the diagnosis of mental illness evolve, and who contributed to the development of standardized classification systems?
Why is a standardized diagnostic system important for the treatment and research of mental illness?
The recognition of mental illness diagnoses dates back to the Greeks, but it was not until 1883 that German psychiatrist Emil Kräpelin published a comprehensive system based on patterns of symptoms suggesting physiological causes. This paved the way for the American Psychiatric Association’s 1952 publication of the first Diagnostic and Statistical Manual (DSM).
A standardized diagnostic system creates a shared language among mental health providers, improving communication and clinical research by offering agreed-upon definitions of psychological disorders.
31
How did the DSM evolve, and what changes were introduced in the 1980 DSM-III?
What changes were made in the DSM-5, and why were these revisions important?
The DSM has undergone several revisions (1968, 1980, 1987, 1994, 2000, 2013), with the 1980 DSM-III introducing a multiaxial classification system that considered the whole individual rather than just the specific problem behavior. It included five axes: clinical diagnoses (Axes I & II), relevant medical conditions (Axis III), psychosocial/environmental stressors (Axis IV), and a global assessment of functioning (Axis V).
The DSM-5 combined the first three axes and removed the last two to streamline diagnosis and improve compatibility with other diagnostic systems, such as the World Health Organization's health diagnosis standards.
32
What are some criticisms of the DSM as a diagnostic tool?
The DSM has been criticized for being based on Western cultural norms, particularly those of the United States.
It uses a medicalized, categorical classification system, which assumes mental disorders are distinct types rather than existing on a continuum.
Additionally, the increasing number of diagnosable disorders (tripling since its 1952 publication) raises concerns about overdiagnosis, labeling, and stigmatizing individuals.
These concerns remain relevant even with the DSM-5 (2013).
33
How does the DSM-5 differ from the ICD-11 in diagnosing mental illness?
The DSM-5 is widely used in North America and reflects American psychiatric perspectives, while the ICD-11 is used globally and includes a broader range of health conditions. A key difference is that in the DSM-5, Gender Dysphoria is considered a mental disorder, whereas the ICD-11 classifies Gender Incongruence as a condition related to sexual health, not a mental disorder.
34
What is the name of the ancient Greco-Roman belief that mental illness was caused by an imbalance in the four bodily fluids?
humorism
35
The Greek physician Galen was one of the first people to believe that mental illness could have a ______ cause such as stress, in addition to other bodily causes.
social.
epidemiological.
supernatural.
psychogenic.
somatogenic
psychogenic
36
What book allows psychiatrists and psychologists to standardize their diagnoses of mental illness?
Psychogenic Causes of Mental Illness, vol. 3.
Diagnostic and Statistical Manual of Mental Disorders.
Malleus Maleficarum.
The Mind’s Yin and Yang.
Mental Illness A-Z
Diagnostic and Statistical Manual of Mental Disorders.
37
The idea that the cultural norms and values of a society can only be understood in their own context is known as what?
cultural relativism
38
Mesmerism
Derived from Franz Anton Mesmer in the late 18th century, an early version of hypnotism in which Mesmer claimed that hysterical symptoms could be treated through animal magnetism emanating from Mesmer’s body and permeating the universe (and later through magnets); later explained in terms of high suggestibility in individuals.
39
Why is perinatal depression often misunderstood and stigmatized?
Perinatal depression, previously called postpartum depression, contradicts the expectation that motherhood should be joyful. This stigma can cause shame and prevent mothers from seeking help.
40
How does stigma affect mood disorders like perinatal depression, MDD, and BD?
Stigma can lead to shame, reluctance to seek help, and lack of treatment, worsening conditions like perinatal depression, major depressive disorder (MDD), and bipolar disorder (BD).
41
Why are MDD and BD significant global health concerns?
The World Health Organization ranks MDD and BD among the top 10 causes of disability worldwide. BD also carries a high suicide risk, with 25%–50% attempting suicide.
42
What defines a major depressive episode (MDE)?
An MDE is a period of at least two weeks with significant distress or impairment, including depressed mood or anhedonia, plus at least five of nine DSM-5 symptoms.
43
What are the nine symptoms of an MDE according to the DSM-5?
1. Depressed mood
2. Anhedonia (loss of interest or pleasure)
3. Significant weight/appetite changes
4. Insomnia or hypersomnia
5. Psychomotor agitation or retardation
6. Fatigue or loss of energy
7. Feelings of worthlessness or excessive guilt
8. Difficulty concentrating or indecisiveness
9. Recurrent thoughts of death or suicidal ideation
44
What conditions must be met for an MDE diagnosis?
Symptoms must occur most of the day, nearly every day, and not result from substances or medical conditions like hypothyroidism.
45
What are the criteria for a manic or hypomanic episode, and how do they differ?
- A manic episode involves at least one week of abnormally euphoric, expansive, or irritable mood, plus increased goal-directed activity and three additional symptoms.
- Hypomania is similar but lasts at least four days and doesn’t cause significant impairment.
Symptoms include:
1. Inflated self-esteem or grandiosity
2. Increased activity or agitation
3. Reduced need for sleep
4. Racing thoughts or flight of ideas
5. Distractibility
6. Increased talkativeness
7. Risky behaviors
- Mania is more impairing and longer than hypomania.
46
What are the key differences and similarities between major depressive disorder (MDD) and persistent depressive disorder (PDD)?
- MDD is defined by one or more major depressive episodes (MDEs) without manic or hypomanic episodes.
- PDD (dysthymia) involves feeling depressed most of the day for at least two years, with at least two of these symptoms:
1. Poor appetite or overeating
2. Insomnia or hypersomnia
3. Low energy or fatigue
4. Low self-esteem
5. Poor concentration or indecisiveness
6. Feelings of hopelessness
- Both disorders require significant distress or impairment and cannot be caused by substance use or medical conditions.
- If someone experiences an MDE during PDD, they can be diagnosed with both MDD and PDD.
47
What are the major types of bipolar mood disorders (BDs) and their key features?
Bipolar I Disorder (BD I): Characterized by a single or recurrent manic episode. A depressive episode is common but not required.
Bipolar II Disorder: Involves single or recurrent hypomanic episodes and depressive episodes.
Cyclothymic Disorder: Characterized by numerous alternating periods of hypomania and depression for at least two years. Symptoms do not meet full criteria for an MDE, occur at least half the time, and cause significant distress or impairment.
48
What is the lifetime prevalence rate of major depressive disorder (MDD) and persistent depressive disorder (PDD)?
MDD: Lifetime prevalence is 16.6%, meaning nearly 1 in 5 Americans will experience it (Kessler et al., 2005).
PDD: 12-month prevalence is about 0.5% (APA, 2013).
49
What are some key risk factors and demographic differences for major depressive disorder (MDD)?
Gender: Women experience 2-3 times higher rates than men, with the difference emerging post-puberty.
Socioeconomic status (SES): MDD is more common in lower SES groups, especially in adults over 65 (Lorant et al., 2003).
Ethnicity: Native Americans have a higher prevalence of MDD than European Americans, African Americans, or Hispanic Americans (Hasin et al., 2005).
Age of onset: MDD typically begins in the mid-20s, with an earlier onset associated with a worse course.
50
What is the prevalence rate of bipolar spectrum disorders (BD) in the U.S. and worldwide?
U.S. prevalence: Approximately 4.4% for bipolar spectrum disorders, with BD I constituting about 1% (Merikangas et al., 2007).
Worldwide prevalence: 2.4%, with BD I constituting 0.6% (Merikangas et al., 2011).
Prevalence estimates can vary based on diagnostic methods and inclusion of sub-threshold forms.
51
How does bipolar disorder (BD) co-occur with other psychiatric disorders, and how does this affect the illness course?
Co-occurrence: About 65% of people with BD also meet criteria for at least one additional psychiatric disorder, commonly anxiety and substance use disorders (McElroy et al., 2001).
Impact: Co-occurrence is associated with poorer illness course, including higher rates of suicidality (Leverich et al., 2003).
52
How does the prevalence and course of bipolar disorder (BD) differ across ethnic groups?
Prevalence: Rates of BD are similar across European Americans, African Americans, and Hispanic Americans (Blazer et al., 1985; Breslau et al., 2005).
Ethnic disparities: African Americans are often underdiagnosed for BD and overdiagnosed for schizophrenia. Hispanic Americans receive fewer prescriptions and psychiatric visits (Gonzalez et al., 2007).
Course of illness: African Americans and Hispanic Americans with BD are more likely to remain persistently ill compared to European Americans (Breslau et al., 2005).
53
What role do genetics and environment play in the development of major depressive disorder (MDD)?
Genetics: Family and twin studies suggest that MDD is primarily influenced by genetic factors, though individual-specific environmental factors, such as romantic relationships, also play a role. Shared environmental effects (e.g., sibling influence) are minimal (Sullivan et al., 2000).
Environmental factors: Stressful life events, particularly severe ones like loss of a relationship or financial stability, are strongly related to MDD. Minor events may play a larger role in subsequent episodes (Brown & Harris, 1989; Monroe et al., 2009).
54
T or F: fMRI studies show that individuals with MDD have greater activation in brain regions related to stress response and reduced activation in areas associated with positive motivation when viewing negative stimuli.
True
55
What are some interpersonal and attributional factors associated with increased risk for MDD?
Interpersonal factors: Marital dissatisfaction, interpersonal stress, and living with critical, emotionally overinvolved relatives can increase the risk of MDD and relapse (Whisman & Uebelacker, 2009; Butzlaff & Hooley, 1998).
Attributional style: A pessimistic attributional style, where individuals blame themselves for negative events, see them as global and stable, can increase vulnerability to MDD (Gotlib & Joormann, 2010).
56
What is a persons attributional style?
The tendency by which a person infers the cause or meaning of behaviors or events.
57
What biological and genetic factors contribute to the onset and course of bipolar disorder (BD)?
BD is highly heritable, indicating a biological basis for the disorder (McGuffin et al., 2003). However, there is significant variability in its course both within individuals and across people (Johnson, 2005).
Psychosocial triggers, such as stressful life events, also play a role in BD onset and relapse (Johnson et al., 2008; Malkoff-Schwartz et al., 1998).
58
How does brain function relate to bipolar disorder (BD)?
MRI studies show that brain regions involved in emotional processing and regulation are activated differently in people with BD compared to healthy controls (Altshuler et al., 2008; Hassel et al., 2008).
There is no consensus on whether specific brain regions are more or less active in response to emotional stimuli, with mixed findings due to differences in illness phases and sample sizes.
59
How do environmental factors contribute to the course of bipolar disorder (BD)?
Severe life stressors, like relationship loss, can increase the risk of BD relapse and depressive symptoms (Ellicott et al., 1990; Johnson et al., 1999).
Positive life events, such as achieving a desired goal, can trigger manic symptoms (Johnson et al., 2008), suggesting hypersensitivity to rewards in people with BD.
60
What is social zeitgeber theory in the context of bipolar disorder (BD)?
- Zeitgeber is German for “time giver.” Social zeitgebers are environmental cues, such as meal times and interactions with other people, that entrain biological rhythms and thus sleep-wake cycle regularity.
Social zeitgeber theory suggests that disruptions in sleep and daily routines (e.g., meal times, travel) can trigger BD episode relapse due to circadian vulnerability.
Studies show that life events involving sleep disruption can increase BD symptoms
61
What are the main types of antidepressant medications used to treat major depressive disorder (MDD), and what are their mechanisms?
Monoamine oxidase inhibitors (MAOIs): Inhibit monoamine oxidase, which deactivates dopamine, norepinephrine, and serotonin. Can cause high blood pressure when combined with certain foods or drugs.
Tricyclics: Block reabsorption of norepinephrine, serotonin, or dopamine, increasing their availability. Effective for vegetative and somatic symptoms but can be cardiotoxic.
Selective serotonin reuptake inhibitors (SSRIs): Block serotonin reabsorption. Have fewer serious side effects, including lower cardiotoxicity and overdose risk.
Serotonin and norepinephrine reuptake inhibitors (SNRIs): Block the reabsorption of both serotonin and norepinephrine. Have fewer side effects than MAOIs and tricyclics.
62
What are some biological treatments for depression, and how do they work?
Electroconvulsive therapy (ECT): Induces a seizure while the patient is under general anesthesia, used for severe or treatment-resistant depression. Side effects may include confusion and short-term memory loss.
Transcranial magnetic stimulation (TMS): Non-invasive, uses magnetic fields to induce electrical activity in the brain. Shows promise for treatment-resistant depression, with fewer side effects than ECT.
Deep brain stimulation: Involves implanting an electrode in the brain to electrically stimulate a specific region. Shows some effectiveness for patients resistant to other treatments, but more research is needed.
63
What are the different psychosocial treatments for MDD, and what do they focus on?
Behavior therapy: Focuses on increasing pleasant or mastery-based experiences.
Cognitive therapy: Helps patients identify and change distorted thoughts and assumptions.
Cognitive-behavioral therapy (CBT): Focuses on the interrelationship between thoughts, behaviors, and emotions.
Interpersonal therapy (IPT): Targets interpersonal issues such as unresolved grief, role disputes, role transitions, and interpersonal deficits.
Short-Term Psychodynamic Therapy: Focuses on a limited number of issues and involves more active therapist engagement than traditional psychodynamic therapy.
64
What is the order of antidepressant medications from oldest to newest?
1. Monoamine Oxidase Inhibitors (MAOIs): The earliest antidepressants, inhibit monoamine oxidase to increase dopamine, norepinephrine, and serotonin levels.
2. Tricyclic Antidepressants (TCAs): The second-oldest class, block reabsorption of norepinephrine, serotonin, or dopamine to increase their availability.
3. Selective Serotonin Reuptake Inhibitors (SSRIs): Block serotonin reabsorption. Introduced as a safer alternative with fewer side effects.
4. Serotonin and Norepinephrine Reuptake Inhibitors (SNRIs): Block reabsorption of both serotonin and norepinephrine, introduced more recently.
65
What is the order of biological treatments for depression from oldest to newest?
1. Electroconvulsive Therapy (ECT): One of the oldest treatments, inducing seizures under anesthesia for severe or treatment-resistant depression.
2. Transcranial Magnetic Stimulation (TMS): A newer, non-invasive technique using magnetic fields to stimulate brain regions associated with depression.
3. Deep Brain Stimulation: A more recent and advanced treatment involving the implantation of electrodes to stimulate specific brain regions for treatment-resistant depression.
66
What are the primary treatments for depression and bipolar disorder (BD), and why is lithium preferred for BD?
SSRIs and SNRIs are the primary treatments for depression, while lithium is the first-line treatment for BD. Lithium is preferred because SSRIs and SNRIs can induce mania or hypomania in BD patients.
67
How does lithium work in treating bipolar disorder, and what are some common side effects?
Lithium reduces excitatory neurotransmission (dopamine and glutamate) and increases inhibitory neurotransmission (GABA).
Common side effects include impaired cognitive function, nausea, tremor, weight gain, and fatigue. Some side effects may improve with continued use, but medication noncompliance remains a concern.
68
What other medications are used to treat bipolar disorder?
Anticonvulsants like carbamazepine and valproate are also used, either alone or in combination with lithium.
69
What is interpersonal and social rhythm therapy (IPSRT), and how does it help patients with bipolar disorder?
IPSRT is a psychosocial intervention that addresses sleep disruption, a key factor in BD relapse. It helps patients maintain stable daily rhythms by balancing activity and stimulation, preventing them from becoming too active or inactive.
70
What is the evidence for the effectiveness of IPSRT in treating bipolar disorder?
IPSRT has been shown to reduce the risk of episode recurrence and help patients remain well, supporting its efficacy as a treatment for BD.
71
Recently, Zeb has lost his passion for sports. Invitations to play with his friends just don’t excite him. This loss of interest is an example of which symptom of a major depressive episode?
suicidal ideation.
hypersomnia.
loss of appetite.
anhedonia.
flat affect
anhedonia
72
Psychomotor ______refers to an increase in activity that is marked by restlessness and fidgeting, pacing, or tapping of the feet.
enhancement.
frenzy.
retardation.
agitation.
augmentation
agitation
73
How can you best distinguish between a manic episode and a hypomanic episode?
By looking at whether or not the symptoms have an identifiable trigger or came “out of the blue.”.
By determining whether the symptoms are a side effect of a medication..
By the duration and level of impairment..
By the presence or absence of depressive symptoms..
By the age at which the person experiences symptoms..
By the duration and level of impairment..
74
Dr. Scarcliff is seeing a patient with symptoms of euphoria and grandiosity. What question should he ask to determine if the correct diagnosis is bipolar I or bipolar II disorder?
a) Is there any indication that this patient is currently taking recreational substances?.
b) Has this patient suffered from these symptoms in the past?.
c) Has this patient had the symptoms for more or less than two weeks?.
d) Is this patient experiencing a manic episode or a hypomanic episode?.
e) Does there seem to be any recent history of a major depressive episode?
d) Is this patient experiencing a manic episode or a hypomanic episode?.
75
The way in which a person infers the cause or meaning of behaviors or events around them is called their ______style.
attributional
76
Karla takes antidepressants but has been advised that she should stay away from “anything that has tyramine” such as wine, soy sauce, and aged cheese. What kind of drugs does Karla take?
a) neuroleptic mood stabilizer (NMS.
b) a tricyclic antidepressant (TCA).
c) a monoamine oxidase inhibitor (MAOI).
d) a selective serotonin reuptake inhibitor (SSRI).
e) a tetracyclic antidepressant (TTCA)
c) a monoamine oxidase inhibitor (MAOI).
77
When someone with bipolar disorder is prescribed lithium, the expected changes include:
a) a decrease adrenaline and an increase in noradrenaline hormones..
b) an increase of dopamine and glutamate and a decrease of GABA neurotransmitters..
c) an increase in adrenaline and a decrease in the noradrenaline hormones..
d) the release of both agonist and antagonist enzymes in synaptic clefts..
e) a decrease of dopamine and glutamate and increase of GABA neurotransmitters
e) a decrease of dopamine and glutamate and increase of GABA neurotransmitters
78
What is some of the criticisms of the Diagnostic and Statistical Manual (DSM)?
- based on clinical and research finding from Western culture, primarily USA
- a medicalized categorical classificiation system that assumes disordered behavior does not differ in degree but in kind, as opposed to a dimensional classifiacation system that would plot disordered behaviour along the continuum
- the number of diagnosable disorders has 3x since it was first published, so that almost 1/2 of amaericans will have a diagnosable disorder in their lifetime, contributing to the continued concern of labeling and stigma
79
Difference between International Classigicatio of Diseases (ICD-11) and DSM?
DSM: Multiaxial classification system that attempts to take into account the entire individual rather than just the specific problem behaviour
ICD-11: created by WHO and provides a diagnostic classification standard for all health conditions, including mental health, for the purposes of clinical practice and research
Gender incongruence (a discordance between experienced gender and the assigned sex) is a major difference.
- Not listed as a mental health disorder in the ICD-11, but a condition related to sexual health.
- In the DSM 5, this phenomenom is termed "gender dysphoria" and is considered a mental disorder
80
What is generalized anxiety disorder (GAD)?
- excessive worry about everyday things that is at a level that is out of proportion to the specific causes of worry
- the DSM-5 criteria specify that at least 6 months of excessive anxiety and worry of this type must be ongoing, happening more days than not for a good proportion of hte day
81
What is Panic Disorder and Agoraphobia?
Panic Disorder: regular strong panic attacks, which may include significant levels of worry about future attacks
- when theres no reason for a flood of physical sensations, such as racing heart, shortness of breath, or tingling sensations, but we still have it
DSM says to receive a diagnosis of PD:
- person must not only have unexpected panic attacks but must also experience continued intense anxiety and avoidance related to the attack for at least 1 month, causing significant distress of interference in thier lives
Agoraphobia:
- an anxiety disorder distinguished by feelings that a place is uncomfortable or may be unsade because it is significantly open or crowded
82
What is a specific phobia, and what are the major subtypes?
to meet criteria for a specific phobia, there must be an irrational fear of a specific object or situation that substansially interferes with the person's ability to function.
4 major subtypes:
1. blood-injury-injection (BII) type
2. situational type (eg planes, elevators)
3. natural environment type (eg, heights, storms, water)
4. animal type
also an "other" category (eg, choking, vomiting, or contracting an illness)
One of the most common psychological disorders in USA
83
Is social anxiety disorder (social phobia) just discomfort in social situations?
NO. its acute fear of social situations whihc lead to worry and diminshed day to day functioning. must be so strong fear and anxiety that the event is avoided or endured with great deal of stress. must get in way of daily life or limit academic or occupational functioning.
One of the most common anxiety disorders
84
What is obsessive-compulsive disorder?
OCD
desire to engage in certain behaviours excessively or compulsively in hopes of reducing anxiety
engaging in obsessions and/or compulsions must take up a significant amount of the person's time, at least an hour per day, and must cause significant distress or impairment of functioning
85
What is congitive behavioural therapy (CBT)?
- individuals taught skills to help identify and change problematic thought processes, beliefs, and behaviours that tend to worsen symptoms of anxiety, and practice applying these skills to real-life situations through exposure exercises
- individuals learn how the automatic "appraisals" or thoughts they have about a situation affect both how they feel and behavve. Similarly, individuals learn how engaging in certain behaviours, such as avoiding situations, tens to strengthen the belief that the situation is osmething to be feared.
a key aspect is exposure exercises,that challenge their beliefs and learn new, less fearuful associations about these situations
86
What are biological vulnerabilities?
A specific genetic and neurobiological factor that might predispose someone to develop anxiety disorders.
87
What is specific vulnerability?
A specific genetic and neurobiological factor that might predispose someone to develop anxiety disorders.
88
What are psychological vulnerabilities?
Influences that our early experiences have on how we view the world.
89
What role do life stressors play in the development of anxiety disorders?
Life stressors, when combined with biological, psychological, and specific vulnerabilities, can trigger the onset of an anxiety disorder. No single vulnerability alone causes anxiety disorders, but their interaction can result in one.
90
What factors contribute to excessive worry in individuals with Generalized Anxiety Disorder (GAD)?
Research suggests that individuals with GAD are more sensitive and vigilant toward potential threats than non-anxious individuals
This heightened sensitivity may be linked to early stressful experiences, leading to a view of the world as unpredictable and dangerous. People with GAD may worry to gain control over these uncertainties or to avoid distress
However, this worry often doesn’t solve problems and can reinforce anxiety by preventing focus on the present moment (Borkovec et al., 1999).
91
What is interoceptive avoidance?
Avoidance of situations or activities that produce sensations of physical arousal similar to those occurring during a panic attack or intense fear response.
92
How can agoraphobia develop, and how does it impact individuals?
Agoraphobia often develops after a panic attack, where the individual experiences a strong urge to escape. This can lead to a fear of places or situations where escape may not be possible, making them external cues for panic. If a person avoids certain places or endures them with significant anxiety, they may develop agoraphobia (Barlow, 2002; Craske & Barlow, 1988; Craske & Barlow, 2008). Agoraphobia can severely disrupt daily life, causing individuals to avoid situations like public transportation or entering stores. In extreme cases, it can lead to staying confined to one area for many years. Although agoraphobia can occur without panic attacks, it often accompanies panic disorder.
93
What is unique about BII type phobias compared to other specific phobias, and how prevalent are specific phobias in the U.S.?
BII (Blood-Injection-Injury) type phobias differ from other phobias in their physiological response.
Instead of a surge in sympathetic nervous system activity, individuals with BII phobias experience a marked drop in heart rate and blood pressure, sometimes leading to fainting (
BII phobia is also more strongly familial than other phobic disorders
Specific phobias are common, with 12.5% of the U.S. population reporting a lifetime history of significant fears, and many individuals with specific phobias tend to have multiple types of phobias.
94
What defines "performance-only" social anxiety disorder (SAD)?
"Performance-only" social anxiety disorder (SAD) is diagnosed when the fear is limited to performance-based situations, such as public speaking. In this case, the individual experiences anxiety specifically in situations they perceive as requiring performance, rather than in all social interactions.
95
What causes social anxiety disorder (SAD), and how does childhood experience contribute to its development?
Social anxiety disorder (SAD) may develop when a person learns that social evaluation can be dangerous, creating psychological vulnerability.
- This can result from harsh criticism or punishment during childhood.
- Social trauma, such as being bullied or humiliated, can also have lasting effects; 92% of adults with social phobia reported severe teasing in childhood, compared to 35%-50% of those with other anxiety disorders
- Additionally, unexpected panic attacks in social situations can reinforce fear, as the individual associates panic with those situations, but the fear focuses on social evaluation rather than the panic attack itself.
SAD is common, affecting 12.1% of the population at some point in life (Kessler et al., 2005).
96
How does a conditioned response contribute to the development of social anxiety?
In the case of social anxiety, a conditioned response occurs when a person experiences anxiety or panic (unconditioned stimulus) during a social situation (neutral stimulus).
After repeated associations, the social situation itself becomes a trigger (conditioned stimulus) for the anxiety (conditioned response), even in the absence of the original anxiety-provoking event.
This learned fear of social evaluation can lead to avoidance of social situations, reinforcing the anxiety over time and contributing to the development and persistence of social anxiety disorder.
97
How does PTSD develop, and what are the key symptoms and triggers?
Causes:
- Exposure to traumatic events (death, injury, sexual violence)
- Direct experience, witnessing, learning about the event, or repeated exposure (e.g., first responders)
Symptoms:
- Intrusive memories and flashbacks
- Nightmares
- Emotional numbness and detachment
- Avoidance of trauma reminders (conversations, places, people)
- Hypervigilance (easily startled, quick to anger)
- Difficulty remembering parts of the event
- Sense of a foreshortened future
Triggers:
- Internal cues: emotional arousal, physical sensations associated with trauma
- External cues: sights, sounds, smells linked to the trauma (e.g., red shirts, gasoline smell)
- Hypervigilance and avoidance of potential future trauma
Prevalence:
6.8% of the population has experienced PTSD (Kessler et al., 2005)
Common precipitating traumas: combat and sexual assault
Reclassified as Trauma- and Stressor-Related Disorder in DSM-5.
98
What distinguishes obsessive-compulsive disorder (OCD) from normal, occasional strange thoughts or compulsive behaviors?
Normal Thoughts/Behaviors:
- Strange or intrusive thoughts are occasional and transient.
- Compulsive behaviors, such as fixing a crooked picture, are done without much thought or anxiety.
OCD:
- Intrusive thoughts are persistent and may be perceived as dangerous or significant.
- The urge to perform compulsive behaviors becomes overwhelming, causing anxiety if not acted on.
- Behaviors may be repeated several times, and the person feels compelled to complete them to feel "satisfied."
- The thoughts and actions are disruptive and not easily dismissed.
99
What is thought-action fusion in OCD, and how does it affect individuals?
Thought-Action Fusion:
- A person with OCD confuses having an intrusive thought with the potential to act on it.
- They may fear that having the thought is as bad as carrying it out.
- This leads to intense anxiety and preoccupation with the thought.
Example:
A person with OCD may have intrusive, terrifying thoughts of harming a loved one (e.g., throwing hot coffee on a child).
Despite no intention to act on the thought, the person may avoid physical contact or seek constant supervision to prevent any chance of "acting out" the thought.
The distress caused by the thought leads to behaviors that are meant to prevent the feared outcome, disrupting daily life.
100
What are the main treatments for anxiety disorders, and how do they work?
Medications:
- Anti-anxiety drugs and antidepressants are effective, but relapse rates are high after stopping.
- Some medications, like benzodiazepines, can be habit-forming.
Exposure-based Cognitive Behavioral Therapy (CBT):
- Focuses on changing problematic thoughts and behaviors in real-life situations.
- Patients practice exposure exercises to gradually approach feared situations, reducing anxiety over time.
- Teaches how automatic thoughts influence feelings and behaviors, and how avoidance strengthens fear.
Effectiveness:
50-80% of patients show good initial response to drugs or CBT.
CBT has more durable effects compared to medications.
New treatments are exploring medications to enhance CBT learning and transdiagnostic treatments.
Future Directions:
The goal is to make anxiety a useful and adaptive response, rather than a debilitating one.
101
______ is best thought of as a negative mood state that is marked by bodily symptoms, such as accelerated pulse, muscle tension, feeling uneasy, and worries about the future.
Anxiety
102
When Olivia was a child, she observed how her mother would count calories and restrict her eating. Now Olivia deals with her stressors by avoiding food and staying slender. Olivia’s early experiences being channeled into a food-related anxiety is an example of a(n) ______vulnerability.
- biological.
- psychological.
- specific.
- genetic.
- caloric.
biological, specific
103
Filomena has been seeing a therapist for two weeks. Based on the symptoms, Dr. Sharma believes that Filomena is suffering from generalized anxiety disorder. For how long will the symptoms need to have been present for this diagnosis to be appropriate?
6 months
104
From a behavioral perspective, the symptoms of generalized anxiety disorder may become inadvertently ______ when a person feels that their worry has led to some sort of positive outcome.
a) reinforced
b) generalized.
c) discriminated.
e) extinguished.
f) rechanneled
reinforced
105
Lamar has had panic attacks for some time, and when this happens he usually gets a feeling of tightness and squeezing in his chest. As a result he has stopped wearing compression t-shirts when he works out, and usually wears shirts that are one size too big. This attempt to avoid an internal sensation associated with a panic attack is called ______.
a) interoceptive avoidance.
b) physical dissociation.
c) somatic decatastrophizing.
d) internalized negative reinforcement.
e) body dysmorphia
a)
106
Anna is invited by her friends to go to a choir performance in a large recital hall. They do not know that she has a terrible fear of such places, because the crowds make her feel trapped. Anna declines to go, but does not tell her friends that she suffers from ______.
agoraphobia
107
Many children incorrectly believe that if they have angry wishes about a friend or relative, such wishes could amount to actual harm befalling that person. This overestimation of the relationship between one’s thoughts and actual actions is called thought-action ______.
fusion
108
What kind of treatments have been found to be as good as, if not better than, medication for dealing with a variety of anxiety disorders?
a) rational emotive behavior therapy.
b) electroconvulsive (“shock”) therapy.
c) non-directive humanistic therapy.
d) exposure-based cognitive behavioral therapies (CBT).
e) psychodynamic hypnotherapy
d) exposure-based cognitive behavioral therapies (CBT).
109
What are the primary features for schizophrenia and other psychotic disorders?
Psychotic Disorders Spectrum:
Includes schizophrenia, schizoaffective disorder, delusional disorder, schizotypal personality disorder, schizophreniform disorder, brief psychotic disorder, and psychosis associated with substance use or medical conditions.
Impact on Functioning:
Psychotic disorders are among the most impairing psychopathologies, affecting education, occupation, and social interactions.
They often emerge during the transition from adolescence to adulthood, a critical period for developing independence.
110
What are the main symptoms of schizophrenia and other psychotic disorders, and how are they often misrepresented?
Main Symptoms of Schizophrenia and Psychotic Disorders:
Positive Symptoms:
- Delusions: False beliefs (e.g., persecution, grandeur).
- Hallucinations: Perceptions without external stimuli, like hearing voices.
- Disorganized Speech and Behavior: Incoherent or nonsensical speech, erratic behavior.
- Abnormal Motor Behavior: Includes catatonia (lack of movement or excessive movement).
Negative Symptoms:
- Anhedonia/Amotivation: Loss of interest or inability to experience pleasure, reduced motivation.
- Blunted Affect/Reduced Speech: Limited emotional expression, minimal speech.
Stigma and Misrepresentation:
- Schizophrenia and psychotic disorders carry significant stigma.
- These disorders, especially schizophrenia, are often misrepresented and overrepresented in the media, perpetuating misconceptions and reinforcing negative stereotypes.
111
What is anhedonia/amotivation?
A reduction in the drive or ability to take the steps or engage in actions necessary to obtain the potentially positive outcome.
112
What is catatonia?
Behaviors that seem to reflect a reduction in responsiveness to the external environment. This can include holding unusual postures for long periods of time, failing to respond to verbal or motor prompts from another person, or excessive and seemingly purposeless motor activity.
113
What are delusions?
False beliefs that are often fixed, hard to change even in the presence of conflicting information, and often culturally influenced in their content.
114
What are the common types of delusions seen in psychotic disorders like schizophrenia?
Persecutory Delusions: The belief that individuals or groups are trying to harm or plot against the person (e.g., coworkers, family, government agencies like the FBI or CIA, or even aliens).
Grandiose Delusions: The belief that the person has special powers or abilities (e.g., thinking they are a famous figure like Buddha or a rock star).
Referential Delusions: The belief that events or objects in the environment have special meaning for the person (e.g., thinking a song on the radio is playing just for them).
Other Delusions:
- Thought Insertion/Control: Belief that others are controlling their thoughts or actions.
- Thought Broadcasting: Belief that their thoughts are being broadcast aloud.
- Mind Reading: Belief that they can read others’ minds or that others can read theirs.
115
What are hallucinations?
Perceptual experiences that occur even when there is no stimulus in the outside world generating the experiences. They can be auditory, visual, olfactory (smell), gustatory (taste), or somatic (touch).
116
What are some examples of disorganized speech, disorganized behavior, and abnormal motor behavior in schizophrenia?
Disorganized Speech:
- Answers that don’t logically flow from questions.
- Sentences that don’t follow a clear progression or seem disconnected.
- Can occur in both speech and writing.
Disorganized Behavior:
- Odd or inappropriate dress (e.g., mismatched clothing or exaggerated makeup).
- Unusual rituals (e.g., repetitive hand gestures, compulsive actions).
Abnormal Motor Behavior (Catatonia):
- Holding unusual postures for long periods of time.
- Failing to respond to verbal or motor prompts.
- Excessive, purposeless motor activity.
117
What are some examples of negative symptoms in schizophrenia?
Anhedonia & Amotivation:
- Lack of interest or drive to engage in social or recreational activities.
- Not reflecting a lack of enjoyment, but a reduced ability to take steps to engage in pleasurable activities.
- May result in physical immobility or lack of participation in events.
Flat Affect:
- Lack of emotional expression through facial expressions, gestures, or tone of voice.
Alogia (Reduced Speech):
- Reduced amount of speech.
- Increased pauses in speech, with long or frequent silences.
118
What is flat affect?
A reduction in the display of emotions through facial expressions, gestures, and speech intonation.
119
What is alogia?
A reduction in the display of emotions through facial expressions, gestures, and speech intonation.
120
What are the different types of psychotic disorders besides schizophrenia?
Schizophreniform Disorder:
A brief version of schizophrenia with similar symptoms but lasting less than six months.
Schizoaffective Disorder:
A combination of psychosis (schizophrenia-like symptoms) and mood disorder symptoms (depression/mania).
Delusional Disorder:
The presence of only delusions, without other features of schizophrenia such as hallucinations or disorganized speech.
Brief Psychotic Disorder:
Psychotic symptoms that last only a few days or weeks and are typically triggered by a stressful event.
121
What are some cognitive deficits associated with schizophrenia?
Episodic Memory:
Difficulty in learning and retrieving new information or personal life episodes.
Working Memory:
Difficulty in maintaining information over a short period, such as 30 seconds.
Behavioral Regulation:
Difficulty in tasks requiring the control or regulation of one’s behavior.
Processing Speed:
Slower performance on almost all tasks compared to healthy individuals.
These cognitive deficits are present prior to the onset of schizophrenia and are also seen in first-degree relatives, suggesting a genetic or risk-related link to the development of psychosis. Individuals with more severe cognitive problems often have more severe negative symptoms and poorer functioning in daily life.
122
What are some deficits in social cognition associated with schizophrenia?
Recognition of Emotional Expressions:
Difficulty identifying emotional expressions on others' faces.
Theory of Mind:
Problems with inferring the intentions or mental states of others.
Individuals with more severe social cognition deficits often exhibit more negative and disorganized symptoms, as well as worse functioning in community settings. It is unclear whether these social cognition problems are separate from general cognitive impairments or are a result of them.
123
connect theory of mind with schizophrenia
Theory of Mind for schizophrenic diagnosed ppl:
Problems with inferring the intentions or mental states of others.
124
What brain regions and mechanisms are associated with symptoms and cognitive impairments in schizophrenia?
Delusions:
Working memory & cognitive control deficits:
Episodic memory problems:
Delusions:
- Ventral Striatum & Anterior Prefrontal Cortex: Involved in "salience" detection (recognizing important events). Misfiring in these areas may lead to misattribution of importance to irrelevant or unconnected events.
Working Memory & Cognitive Control Deficits:
- Dorsolateral Prefrontal Cortex (DLPFC): Impairments in working memory and cognitive control are linked to dysfunction in the DLPFC. These problems also relate to connections with other brain regions like the posterior parietal cortex, anterior cingulate, and temporal cortex.
Episodic Memory Problems:
- Hippocampus (Medial Temporal Lobe): Critical for the creation of new memories.
- DLPFC: Contributes to episodic memory issues, likely due to its role in controlling memory usage.
125
What are the structural brain changes associated with schizophrenia, and how do they relate to genetics and environmental factors?
Structural Brain Changes in Schizophrenia:
- Changes in cellular architecture, white matter connectivity, and gray matter volume in regions like the prefrontal and temporal cortices.
- Reduced overall brain volume, with greater reduction seen with aging in people with schizophrenia compared to healthy individuals.
Environmental Factors:
- Antipsychotic medications and substance use (e.g., marijuana, alcohol, tobacco) can contribute to these structural changes, but they do not fully explain them.
Genetic Risk:
- Structural changes, including functional and structural brain differences, are also observed in first-degree relatives of individuals with schizophrenia, suggesting a genetic risk for the disorder.
126
Why is it difficult to identify specific genes associated with schizophrenia, despite strong evidence for genetic contributions to the disorder?
Identifying specific genes associated with schizophrenia is challenging because:
1. There is no single "schizophrenia gene"; rather, the genetic risk is likely due to the cumulative effect of many different genes.
2. Schizophrenia is highly heterogeneous, meaning individuals with the disorder can present with very different symptoms, complicating genetic studies.
3. Many genes linked to schizophrenia are also associated with other mental health conditions, such as bipolar disorder, depression, and autism, making it difficult to isolate genes specific to schizophrenia.
127
What are some environmental factors associated with an increased risk of developing schizophrenia, and why are they difficult to use in clinical prediction?
Environmental factors associated with increased schizophrenia risk include:
- Prenatal complications (e.g., maternal stress, infection, malnutrition, diabetes).
- Birth complications causing hypoxia (lack of oxygen).
- Older paternal age.
- Cannabis use, particularly in individuals with other risk factors.
- Growing up in urban environments.
- Belonging to certain minority ethnic groups, possibly due to social stress.
These factors are difficult to use in clinical prediction because no single factor is specific or deterministic—most individuals with these risk factors do not develop schizophrenia, and their effects likely interact with genetic vulnerabilities.
128
What is "Attenuated Psychotic Syndrome," and why was its inclusion in the DSM-5 controversial?
Attenuated Psychotic Syndrome (APS) is a diagnostic category in Section III of the DSM-5 for individuals experiencing milder psychotic symptoms that cause distress or impairment. Around 35% of these individuals go on to develop a full psychotic disorder, often schizophrenia.
The controversy surrounding its inclusion in the DSM-5 stems from concerns that:
- It may lead to overdiagnosis and pathologize normal experiences.
- Many individuals with APS already seek treatment for other issues.
- There is no clear evidence that existing treatments can reliably prevent psychosis.
However, proponents argue that APS identifies individuals at a significantly higher risk of psychosis, encouraging research and potential early interventions such as omega-3 fatty acids and intensive family support.
129
What are the two primary types of antipsychotic medications used to treat schizophrenia, and what are their key differences?
The two primary types of antipsychotic medications are:
1. Typical (first-generation) antipsychotics
- Strong D2 dopamine receptor blockers.
- Effective in reducing hallucinations, delusions, and disorganized speech.
- Limited impact on cognitive deficits and negative symptoms.
- Associated with distressing motor side effects (e.g., tardive dyskinesia).
2. Atypical (second-generation) antipsychotics
- Affect multiple receptor types, though still influence D2 receptors.
- Similar effectiveness in treating positive symptoms (hallucinations, delusions).
- Cause fewer motor side effects but increase the risk of metabolic syndrome (weight gain, cardiovascular issues, Type-2 diabetes).
130
What is Cognitive Enhancement Therapy (CET), and how does it help individuals with schizophrenia?
Cognitive Enhancement Therapy (CET) is a psychological intervention designed to improve cognitive function in individuals with schizophrenia. It has been shown to:
- Enhance cognitive abilities (e.g., memory, attention, problem-solving).
- Improve functional outcomes and social cognition.
- Protect against gray matter loss in the brain.
While no pharmacological treatments consistently improve cognition in schizophrenia, CET offers a promising non-drug approach to enhancing cognitive and social functioning in affected individuals.
131
Karl has been suffering from the symptoms of schizophrenia for about a year. He has a reduction in his responsiveness to events in his surroundings, and his motor behavior is often slow or aimless. Which of the following best describes these symptoms?
a) anhedonia.
b) delusions.
c) flat affect.
d) catatonia.
e) hallucinations
c) catatonia
132
Of the following, which type of delusion is most commonly experienced among those suffering from a psychotic disorder?
a) erotomanic delusions.
b) persecutory delusions.
c) thought control.
d) delusions of reference.
e) delusions of guilt
b) persecutory delusions.
133
What is one of the biggest problems with the negative symptoms of schizophrenia?
a) They are not seen frequently enough to be included in DSM-5..
b) They show up very suddenly..
c) They are always accompanied by severe mood symptoms..
d) The medications used to treat these symptoms have stronger side effects..
e) They may not be apparent to others and thus not get appropriate attention.
e) They may not be apparent to others and thus not get appropriate attention.
134
After she receives an acceptance letter to her top choice university, Brenda says, “I guess that’s good. I’ll go there.” This sort of absence of emotions is called ______.
flat affect
135
Which of the following parts of the brain normally activate when important, aka “salient,” events happen? (These areas may under-perform in those with schizophrenia.)
a) the anterior cingulate and the locus coeruleus.
b) the ventral striatum and the anterior prefrontal cortex.
c) the dorsal amygdala and the posterior postfrontal cortex.
d) the superior putamen and the lateral hypothalamus.
e) the ventromedial hippocampus and the inferior amygdala
b) the ventral striatum and the anterior prefrontal cortex.
136
Both “typical” and “atypical” antipsychotic medications work by blocking a specific type of ______receptor in the brain.
dopamine
137
Tyler, who suffers from schizophrenia, has recently developed a series of symptoms that his physician calls “metabolic syndrome.” What type of medication is he likely to be taking?
a) benzodiazepines.
b) beta blockers.
c) selective serotonin reuptake inhibitors.
d) tetracyclic antidepressants.
e) atypical antipsychotics
e) atypical antipsychotics
138
What are the targets/goals of each type of treatment for depressive disorders?
Antidepressant medications:
Electroconvulsive therapy (ECT):
Transcranial Magnetic Stimulation (TMS):
Deep brain stimulation:
Antidepressant medications: target one or more of the neurotransmitters implicated in depression
Electroconvulsive therapy (ECT):
- involves inducing a seizure after a patient takes muscle relaxants and is under general anasthesia.
- Viable for patients with severe depression/resistance to antidepressants.
- Mechanism by which it works is unkown
Transcranial Magnetic Stimulation (TMS):
- non invasive, administered while patient is awake
- brief pulsating magnetic fields are delivered to the cortex, inducing electrical activity
- fewer side effects than ECT
- evidence that it is a promising treatment for patients with MDD who have shown resistance to other treatments
Deep brain stimulation:
- being examined as an option to patients who didnt respond to other options
- involves implanting an electrode into the brain that is connected to an implanted neurostimulator, which electrically stimulates that particular brain region
- more research on effectiveness is needed
139
What are the targets/goals of each type of treatment for depressive disorders?
Behavior therapy:
Cognitive therapy:
Cognitive-behavioral therapies:
Interpersonal therapy:
Short-term psychodynamic therapy:
Behavior therapy: focus on increasing the frequency and quality of experiences that are pleasant or help the patient achieve mastery.
Cognitive therapy: primarily focus on helping patients identify and change distorted automatic thoughts and assumptions.
Cognitive-behavioral therapies: based on the rationale that thoughts, behaviours, and emotions affect and are affected by each other.
Interpersonal therapy: focuses largely on improving interpersonal relationships by targeting problem areas, specifically unresolved grief, interpersonal role disputes, role transitions, and interpersonal deficits.
Short-term psychodynamic therapy: some evidence for this approach: the short-term treatment focuses on a limited number of important issues, and the thereapist tends to be more actively involved than in more traditional psychodynamic therapy.
140
What are some reasons that there is little consensus as to whether a particular brain region becomes more or less active in response to an emotional stimulus among people with BD compared with healthy controls?
part due to:
- samples consisting of participants who are at various phases of illness at the time of testing (manic, despressed, inter-episode)
- sample sizes tend to be relatively small, making comparisons between subgroups difficult
- the use of a standardized stimulus (e.g. facial expression of anger) may not elicit a sufficiently strong response...personally engaging stimuli, such as recalling a memory, may be more effective in inducing strong emotions
141
What is the first choice for bipolar disorder pharmacotherapy?
Lithium
acts on several neurotransmitters
- some actions reduction of excitatory (dopamine and glutamate) neurotransmission, and increasing of inhibitory (GABA) neurotransmission.
- strong efficacy, but also can be accompanied with bad side effects like impaired cognitive function, nausea, tremor, weight gain, and fatigue. some can improve with continued use, but medication noncompliance is a concern
- anticonvulsant medications are commonly used to treat patients with BD, either alone or in conjunction with lithium
- SSRIs and SNRIs have the potential to induce mania or hypomania in patients with BD
142
A number of studies have suggested that delusions in psychosis may be associated with problems in "salience" detection mechanisms supported by the _____________
ventral striatum
143
What is the ventral striatum.
regions of the brain that normally increase thier activity when something important (aka "salient") happens in the environment
if they misfire, it could lead individuals with psychosis to mistakenly attribute importance to irrelevant or unconnected events.
144
there is also good evidence that problems in working memo and cogntivie control in schizoprenia are related to problems in the fucntion of a the ________________
dorsolateral prefrontal cortex (DLPFC)
145
In terms of understanding episodic memory problems in schizophrenia, many researchers ahve focused on medial temporal lobe deficits, with a specific focus on the ____________
hippocampus
146
Typical vs atypical antipsychotic meds:
Typical:
- share the common feature of being a strong block of the D2 type dopamine receptor
- can help reduce hallucinations, delusions, and disorganized speech, but do little to improve cognitive deficits or negative symptoms and can be associated with distressing motor side effects
Atypical:
- more mixed mchanisms, in terms of action, but most also influence D2 receptors
- newer
- not necessarily more helpful, but have fewer motor side effects
- however associated with side effects referred to as the "metabolic syndrome", which includes weight gain, increased risk for cardiovascular illness, type 2 diabetes, and mortality.
