Week 8

Question 1

Assumption/theory of psychodynamic therapy

Answer 1

unconscious reasons underly action. Past experiences determine perception. Patterns develop from mind’s desire to “replay”/”master” old pain (repetition compulsion)

Question 2

Outcome data of PDT and CBT

Answer 2

long term PDT most effective. Short term, PDT and CBT equally effective

Question 3

Conceptual framework of ego psychology

Answer 3

Impulse (drive) –> Prohibition (fear) –> Defense (coping) –> compromise (behavior)

Question 4

Projection

Answer 4

Defense mechanism: false attribution of feelings onto another

Question 5

Idealization

Answer 5

Defense for feelings of powerlessness, unimportance: attribute exaggerated positive qualities to people that they associate with

Question 6

Devaluation

Answer 6

Defense for feelings of powerlessness: exaggerate negative qualities of others

Question 7

Intellectualization

Answer 7

Defense for disturbing feelings: excessive use of abstract generalization or 3rd person.

Question 8

Repression

Answer 8

defense for unwanted instincts/emotions/ideas: expel from consciousness, often break through (ie panic attacks). Is not Denial (disavow reality) or Suppression (conscious decision to disavow emotions–more “mature”)

Question 9

Core problems

Answer 9

Things exposed by therapist/patient underlying

Question 10

Transference

Answer 10

Replay of patterns from old relationships on

Question 11

Theory of CBT

Answer 11

Emotional disorders involve systematic biases/distortions of thinking

Question 12

Standard techniques of CBT

Answer 12

Rational Responding (how else can I view this situation)
Self-monitoring (Take stock)
Behavioral "experiments"
Role-playing
Metaphors
Guided imagery
Homework

Question 13

Yerkes-Dodson Law

Answer 13

inverse U shaped curve (performance vs arousal)

Question 14

Areas implicated in anxiety

Answer 14

ACC, insula, amygdala (repsonds to fearful stimuli even when below level of consciousness)

Question 15

Phases of anxiety/General Adaptation Syndrome

Answer 15

Alarm: “fight or flight.” glucose mobilized
Resistance: glucose preserved
Exhaustion: collapse (exhaustion of reserves, failure of electrolyte balance, structural/funcional damage)

Question 16

Learning theory of anxiety

Answer 16

Formed by Classical conditioning, maintained by operant conditioning.
Safety learning competes with fear learning.
Extinction (inhibiting CR) is context dependent, so conduct extinction in multiple contexts!

Question 17

Generalized Anxiety Disorder Criteria

Answer 17

Excessive and uncontrollable worry >6mos + Additional problems (sleep, muscle, concentration)

Question 18

GAD neurobio/genetics

Answer 18

distinct mechanism from panic (functional deficiency in GABA). Genetic factors; strongly related to neuroticism and depression

Question 19

PTSD criteria

Answer 19

A. Experience: actual or threatened injury, response of intense fear, helplessness, horror
B:Re-experience. Intrusive recollections, nightmares, flashbacks, emotional/physical reactions to reminders
C: Avoidance of trauma-related stimuli and numbing
D: Increase arousal (hypervigilance, difficulty sleeping, outbursts, etc). Foreshortened horizon
E: Duration >1month
F: distress/impairment

Question 20

Neural basis of PTSD

Answer 20

impaired extinction of fear response. Lesioned vmPFC

Hippocampus reduced –> overgeneralized fear response

Question 21

Tx for PTSD

Answer 21

SSRIs, exposure therapy improve hippocampus size and amygdala disfunction

Question 22

Hallucination vs Illusion vs Flashback vs Delusion

Answer 22

Hallucination: perception w/o stimulus
Illusion: mis-interpretation of stimulus
Flashback: re-experiencing/re-living, including sensory perception (~waking dream)
Delusion: Fixed false belief. Specific.

Question 23

Panic Disorder criteria

Answer 23

Attacks + preoccupation (w or w/o agoraphobia)

Question 24

Social phobia criteria

Answer 24

fear of embarrassment + fear of scrutiny (can also have panic attacks)

Question 25

ECT (indications, contra-indications)

Answer 25

Indications: MDD, BPD, Catatonia, severe autism, PD. Contra: CVD, craniotomy/skull fracture, cognitive impairment, seizure disorder, substance abuse

Question 26

ECT electrode placement

Answer 26

Start right unilateral (fewest side effects), progress to bi-temporal, left uni

Question 27

Factors determining ECT quality

Answer 27

1) Quality of seizure 2) Length of seizure 3) degree of suppression

Question 28

TMS benefits, indications, downsides

Answer 28

geographically specific, excitation and inhibition. Approved for depression (as effective as anti-depressants). Expensive!

Question 29

Vagal nerve stimulation

Answer 29

initially for epilepsy, works for treatment-resistant depression

Question 30

Conceptual underpinnings of treatment for suicide

Answer 30

suicide as primary problem: inappropriate coping behavior

Question 31

Effective treatment for suicidality

Answer 31

Reaching out, Cognitive Therapy: "safety plan" (replacing coping mechanism)

Question 32

OCD Criteria

Answer 32

Obsessions (unwanted thoughts/impulses that are egodystonic, with attempts to suppress/ignore) Compulsions: Repetitive behavior/mental act aimed at reducing distress or preventing feared event. Neutralizing!

Question 33

brain areas for OCD

Answer 33

orbital cortex: caudate

Question 34

Learning theory of OCD and treatment implications

Answer 34

Obsessions --> Distress --> compulsions --> relief --> reinforcement of compulsions Tx: Break Distress --> compulsions link! (with exposure therapy)

Question 35

Therapies for OCD

Answer 35

Combined treatment does not impede monotherapy, better than med alone but week evidence for superiority to CBT alone. big site/implementation effect for CBT

Question 36

frequency of non-medical use of Rx

Answer 36

opioid > sedative > stimulants

Question 37

benzo MOA

Answer 37

binds GABA-A

Question 38

pseudo-addiction (opioids)

Answer 38

looks like addiction but disappears with adequate meds

Question 39

Most common illicit drug in ER reports

Answer 39

Cocaine

Question 40

MOA cocaine

Answer 40

blocks DA reuptake

Question 41

How drugs act on mesocorticolimbic dopamine system

Answer 41

Alcohol: indirect, partly through opioid receptors Heroin: VTA neurons, results in stimulating NAc cocaine/nicotine: directly on NAc neurons

Question 42

CNS toxicity of cocaine

Answer 42

Seizures, stroke

Question 43

Cardiac complications of cocaine

Answer 43

Chest pain, MI, cardiomyopathy, myocarditis | Especially when combined with alcohol --> cocethelene

Question 44

Sensitization with cocaine

Answer 44

paradoxical (not tolerance). LTP in VTA cells (via NMDARs)

Question 45

Neuro effects of long-term use

Answer 45

Frontal lobe activity dec --> impulse control ---> more use (cycle)

Question 46

Tx cocaine dependence

Answer 46

very difficult to treat. Voucher programs short-term. CBT long term. No effective medications. Topiramate (GABA inc on VTA) and disulfiram work OK. Vaccine could be promising

Question 47

Marijuana and addiction

Answer 47

Long-term using now getting addicted (difficult to treat. Block CBs-->depression)

Question 48

Marijuana impairment

Answer 48

high: ~2hrs. impairment ~10hrs (implications for driving)

Question 49

Cannabinoids and psychosis

Answer 49

endogenous are anti-psychotic. But marijuana use as a teenager increases risk for schizophrenia

Question 50

Cannabinoid subtypes

Answer 50

CB1: all over brain, especially emotion/reward areas CB2: lymphocytes, macrophages, etc.

Question 51

OCD vs OCPD

Answer 51

OCPD is egosyntonic

Question 52

OCD epi

Answer 52

women > men (except in Munich)