PSY 242- Abnormal Psychology Final Exam

Which 2 disorders typically include major depressive episodes?

Major Depressive Disorder and Bipolar Disorder 2

Which other disorder is usually precipitated by environmental losses?

Major Depressive Disorder: MDD

What disorders are SSRI medications effective in treating?

Major depressive disorder, anxiety disorder, bulimia, PTSD

Global Differences in Substance Use

Rates of substance use disorders differ by country. The highest prevalences of substance use disorders have been found in Ukraine, Russia and other former Soviet states. Lowest prevalences have been found in Africa, East Asia, and Southern Europe (Spain, Italy, Greece)

Anorexia/Bulimia: Gender Differences

Recent findings indicate that both anorexia and bulimia are 3x more common among women than men

All of the following are evidence based treatments of substance abuse disorders except___

Psychoanalysis

Tolerance

the need for greatly increased amounts of the substance to achieve intoxication (or the desired effect) or a markedly diminished effect with continued use of the same amount of the substance. Ex: "Holding one's liquor"

Substance use disorder: Genetic Evidence

- Twin studies demonstrate a higher concordance among identical twins than fraternal twins (e.g., 26% vs. 16%) for substance use disorders - Family studies suggest increased risk when first degree relatives have a substance use disorder, but it is difficult to tease apart the impact of family environment, given that this can also influence likelihood of substance use disorder

Substance use disorder: Race Differences

-"Non-Hispanic Whites" have substantially higher rates of substance abuse/dependence than African-Americans; differences with Latinx individuals are less consistent. -substances with the exception of marijuana, which had a higher "current" prevalence among African-Americans (though no difference in "lifetime" prevalence)

Evidence supports that people with substance use disorders do not get better over time.

False

The criteria for PTSD require that one experiences flashbacks.

False

Typical of Substances of Concern

-Alcohol (most common substance- found in beer, wine, hard liquor, some cough medicines). -Benzodiazepines (such as Xanax, Valium, Ativan, and Klonopin). -Cannabis (marijuana and hashish) -Stimulants (cocaine and amphetamines) -Opioids (oxycodone, heroin, morphine, fentanyl, codeine, methadone) -Hallucinogens (LSD, "Ecstasy," PCP, "K2," "Club Drugs")

Eating Disorders: History

-Anorexia (Greek for "lack of appetite") was first described in late 1800's by French and British psychiatrists -Bulimia (Greek for "ravenous hunger") was described in the 1970's as a "variant" of anorexia; it became a distinct diagnostic entity in the DSM-III

Anorexia/Bulimia: Cultural Differences

-Evidence suggests that bulimia does not exist in non-Western settings that have not yet been exposed to Western cultural images, but it is becoming more common over time

Eating Disorder: Causes

-Genetic evidence tends to be stronger for anorexia -Concordances for identical twins are lower than for other disorders (e.g., roughly 10% for anorexia), but much higher than general population estimates of these rare disorders

Bulimia and BED: Treatment

-In contrast with anorexia, there is good evidence for the effectiveness of both medication psychosocial treatments for bulimia -SSRI antidepressants show good evidence for reducing binge and purge behavior -There is good evidence for the effectiveness of CBT in reducing binging and purging

Substance Use: 12-Step Programs

-Include Alcoholics Anonymous (AA) and Narcotics Anonymous (NA) -Supportive meetings convene in many locations at convenient times and are run by peers struggling to abstain from alcohol or drug use -Features of meetings include reading from the AA and NA books and having different attenders "tell their story" -Attenders exchange phone numbers and are encouraged to find a "sponsor" who has a longer record of abstinence who can provide support -The AA and NA books provide guidelines on recognizing triggers (e.g., HALT = hungry, angry, lonely, tired) and using coping skills ("don't pick of the drink, pick up the phone") that are similar in some ways to CBT approaches -Recovery is believed to proceed in "steps" beginning with acceptance ("surrender") that one cannot control use and has to abstain

Eating Disorder: Environmental Effects

-It is believed that eating disorders result from the proliferation of media images of the "thin ideal" in the post-war period -Several experimental studies have examined the impact of exposure to media images of the "thin ideal" on female college students; exposure to such images increase body-image concern

The obsessions that people with OCD experience are usually realistic worries about real-life problems.

False

Anorexia: Treatment

-Research has failed to support the effectiveness of any treatment for anorexia (either medication or psychosocial treatment) -Evidence for medication is poor -The only treatments that have any suggestion of effectiveness are family therapy with adolescents and CBT for relapse prevention with "weight-restored" adults -Currently, the recommended treatment approach is inpatient nutritional care for weight restoration followed by psychotherapy

Anorexia: Subtypes and Specifiers

-Restricting Type: during last 3 months, weight loss is accomplished primarily through dieting, fasting, or excessive exercise. -Binge-Eating/Purging Type: during last 3 months, individual has regularly engaged in binge eating or purging (or both) during the current episode.

Anorexia: DSM-5 Definition

-Restriction of energy intake relative to requirements, leading to a significantly low body weight in the context of age, sex, developmental trajectory and physical health. -Intense fear of gaining weight or becoming fat, or persistent behavior that interferes with weight gain, even though at significantly low weight. -Disturbance in the way in which one's body weight or shape is experienced, undue influence of body weight or shape on self-evaluation, or persistent lack of recognition of the seriousness of the current low body weight.

Substance use disorder: Environmental Factors

-Several studies support that family environmental factors such as child abuse/neglect and "family disruption" are associated with increased risk of developing a substance use disorder -Other environmental factors associated with increased risk of developing a substance abuse disorder include unemployment and low SES

Substance Use: Motivational Enhancement Therapy (Motivational Interviewing)

-This approach is recommended when clients are considering whether they would like to stop or reduce substance use but have not yet committed to change -This approach de-emphasizes confrontation ("you're in denial!") and instead focuses on listening to the client to help the client identify (on his or her own) the problematic consequences of substance use -The counselor uses "reflection" and associated questions to highlight how substance use is causing problems

Eating Disorders: three main types

-Three main types: anorexia nervosa, bulimia nervosa and binge eating disorder -Binge eating disorder was not a specific category in the DSM-IV; binge eating disorder cases were previously diagnosed with Eating Disorder NOS; it then was added into the DSM-5

CBT for Substance Abuse

-Treatment focuses on teaching client to identify emotional and situational "triggers" of substance use, and develop coping strategies to combat urges to use -Typical coping strategies taught include: relaxation exercises (breathing), cognitive self-talk (encouraging statements and affirmation), strategies for building alternate support networks (e.g., attending AA or NA meeting), and behavioral refusal skills -After abstinence has set in, relapse prevention strategies can be taught -An important concept in relapse prevention is the "abstinence violation effect," whereby clients who have slips become ashamed, decide that they have failed in their recovery and return to full-blown use

CBT for Bulimia

-Treatment includes three main features: behavioral strategies to modify eating behavior (e.g., self-monitoring and record keeping), cognitive restructuring, and relapse prevention -Behavioral strategies help the client identify and modify patterns of disordered eating behavior -changing attitudes regarding body image and replacing them with healthier attitudes -Relapse prevention focuses on examining "triggers" and "early warning signs" of relapse in a manner similar to work with substance use relapse

Family Treatment for Anorexia

-Work together with parents and children in therapy -Parents are enlisted to supervise the child's eating habits and food intake -Parents are enlisted to supervise the child's eating habits and food intake

Schizophrenia has been found to occur in roughly_____ of the general population:

1%

Which 3 disorders that we covered commonly include psychotic symptoms (delusion, hallucinations or disorganized symptoms)? Which 1 always includes psychotic symptoms?

1.Schizophrenia 2.Bipolar Disorder 1 3.MDD Always includes: Schizophrenia

What is the difference between avoidance related to agoraphobia and social anxiety disorder?

Agoraphobia: fear of panic attacks, avoidance helps stay away from having a panic attack Social anxiety: fear of judgement, avoidance helps prevent judgement

The most common substance use disorder in the US is:

Alcohol Abuse

Cognitive-behavioral therapy has been strongly demonstrated to be an effective treatment for all of the following except:

Anorexia

Even though both anorexia and bulimia can have binging and purging, only_____ can have abnormal weight.

Anorexia

Substance Abuse: DSM-IV Definition

A maladaptive pattern of substance use leading to clinically significant impairment or distress, as manifested by 1 (or more) of the following: 1. Failure to fulfill important obligations at work, home, or school as a result of substance abuse. 2. Repeated use of the substance in situations in which it is physically hazardous to do so. 3. Repeated legal problems as a result of substance use. 4. Confirmed use of the substance despite repeated social or legal problems as a result of use.

DSM-5 Criteria for Substance-Use Disorder

A maladaptive pattern of substance use, leading to clinically significant impairment or distress, as manifested by 2 (or more) of the following over a 12-month period: -the substance is often taken in larger amounts or over a longer period than was intended -there is a persistent desire or unsuccessful efforts to cut down or control substance use -a great deal of time is spent in activities necessary to obtain the substance, use the substance, or recover from its effects -Craving, or a strong desire or urge to use the substance -recurrent substance use resulting in a failure to fulfill major role obligations at work, school, or home -continued substance use despite having persistent or recurrent social or interpersonal problems caused or exacerbated by the effects of the substance -important social, occupational, or recreational activities are given up or reduced because of substance use -recurrent substance use in situations in which it is physically hazardous -the substance use is continued despite knowledge of having a persistent or recurrent physical or psychological problem that is likely to have been caused or exacerbated by the substance -tolerance -withdrawal

Substance Dependence: DSM-IV Definition

A maladaptive pattern of substance use, leading to clinically significant impairment or distress, as manifested by 3 (or more) of the following: - Tolerance - withdrawal - the substance is often taken in larger amounts or over a longer period than was intended - there is a persistent desire or unsuccessful efforts to cut down or control substance use - a great deal of time is spent in activities necessary to obtain the substance, use the substance, or recover from its effects - important social, occupational, or recreational activities are given up or reduced because of substance use - the substance use is continued despite knowledge of having a persistent or recurrent physical or psychological problem that is likely to have been caused or made worse by the substance

What Is a Substance?

A substance is any natural or synthesized product that has psychoactive effects—it changes perceptions, thoughts, emotions, and behaviors. This includes: illegal drugs (cocaine, heroin, marijuana [in this state]), prescribed medications (benzodiazepines), as well as legal substances (alcohol, nicotine, caffeine).

Eating Disorders: Development

Anorexia and Bulimia disorders tend to occur in adolescence or early adulthood, while BED tends to start in early adulthood -Average age of onset for anorexia: 18 (range from 16-22) -Average age of onset for bulimia: 19 (range from 14-22) -Mean age of onset for binge-eating disorder: 25 (range from 17-32)

What is the main difference between anorexia and bulimia? What do they have in common?

Anorexia: abnormally low weight, very low BMI Bulimia: Binging and compensatory actions (excessive eating with extreme purging, exercise etc.) Common: negative evaluation of oneself

For which disorder is illegal behavior and violence most characteristic?

Antisocial personality disorder

What disorders are not effectively treated by any medication?

Antisocial personality disorder, borderline personality disorder, autism

What disorders appear to have been getting more common in the last 20-30 years?

Autism, eating disorders

Why are psychosocial treatments recommended for schizophrenia and bipolar disorder even though medications are very effective?

Because medications don't do everything. It suppresses symptoms but we cant these people to get back to life, to work and have relationships.

Outcome (better vs. worse likelihood of good outcome)

Better likelihood: Every disorder has a chance of having good outcome Worse Likelihood: None

As discussed in class and supplemental reading, the Swiss psychiatrist who coined the term schizophrenia was named:

Bleuler

Substance Abuse/Dependence: Treatment

Both medication and psychosocial approaches have some evidence, although the strongest evidence is for psychosocial approaches Medications: research support include naltrexone and disulfiram; Naltrexone works by blocking the effect of the drug so the individual does not experience the intended "high" (is used for the treatment of heroin and alcohol); Disulfiram (commercial name Antabuse) works by making the individual have a aversive physical reaction (is used for alcohol) Therapy: Evidence-based psychosocial approaches include cognitive-behavioral therapy, motivational enhancement therapy, and 12-step approaches

Based on historical and cross-cultural research, there is stronger evidence that ______is a "culture-bound" syndrome

Bulimia

Substance-Induced Mood Disorder

Can occur as a result of intoxication or withdrawal Associated with intoxication for the following substances: alcohol (depression), amphetamines and other stimulants (mania), cocaine (mania), opiates (depression), phencyclidine (mania) Associated with withdrawal from following substances: alcohol (depression), amphetamine and other stimulants (depression), cocaine (depression)

Substance-Induced Psychosis

Can occur as a result of intoxication or withdrawal. Associated with intoxication for the following substances: alcohol, amphetamines and other stimulants, cannabis (marijuana and hashish), cocaine, hallucinogens (e.g., LSD), and phencyclidine (PCP or "Angel Dust") Associated with withdrawal from the following substances: alcohol, sedatives, and benzodiazepines (e.g., Xanax)

What do borderline personality disorder and dissociative identity disorder have in common? What is uniquely different about DID?

Common: Theres no multiple personality in borderline personality disorder; but there is potential dissociative experiences. Both BPD and DID are rooted in trauma. Different: DID has multiple personality disorder or alters

What does antisocial personality disorder have in common with psychopathy? How are they different?

Common: violence Different: Psychopathy applies to a small group of people, has to do with core ideas of lack of empathy and callousness; whereas Antisocial personality disorder is impulsive behavior, engaging in illegal behavior and deception.

Substance-Use Disorder: DSM-5 Changes

DSM-5 has done away with the distinction between abuse and dependence, and has created one disorder: "substance-use disorder," which lists a combination of the current criteria for abuse and dependence and which can be met by having at least 2 of the symptoms: -"legal problems" criterion has been deleted -"craving" symptom has been added -Severity specifiers, ranging from "mild" to "severe" have been added

Eating Disorders

Deviations from what is culturally acceptable- too much or too little, or using unhealthy means of weight control Eating disorders (especially anorexia) are associated with a substantially increased risk of death, so this is not just about deviation from culturally acceptable norms

What is the difference between major depressive disorder and persistent depressive disorder (dysthymia)? What do they have in common?

Different b/w MDD & PDD: MDD lasts for less time, PDD lasts longer. PDD has no melancholic, suicidal, loss of pleasure; only in MDD Common b/w MDD & PDD: depressed mood, loss of energy

What is the neurochemical theory for schizophrenia and how is it partly explained by what causes substance-induced psychosis?

Dopamine hypotheses: excess if dopamine that trigger schizophrenia and medications help this. Some of these substances that trigger psychotic symptoms are either dopamine agonist, they increase the domaine levels.

Causes (more environmental vs. more genetic)

Every disorder has some contribution of environmental and genetic factors

What Causes Substance Abuse/Dependence?

Evidence for a genetic contribution to the development of substance use disorders is a key component of the argument that they are "diseases" rather than "moral failings" , there is evidence from both family and twin studies that there is a genetic component which predisposes individuals who have been exposed to substances to develop abuse or dependence disorders

Symptom distinctions (e.g., panic disorder vs. social anxiety disorder)

Fear of fear (Panic disorder) vs. fear of judgement (social anxiety disorder)

What substances typically induce psychotic symptoms during intoxication?

Hallucinogens, cocaine, crystal meth

Eating Disorder: Integrative Theory

It has been proposed that, combining genetic, historical and cross-cultural evidence suggests that anorexia is more genetically-based, while bulimia is a "culture-bound" variant of anxiety and depressive disorders that can only develop in the context of the modern, Western, "thin ideal"

How Common are Anorexia and Bulimia?

Lifetime prevalence of DSM-IV anorexia US: .6% Lifetime prevalence of DSM-IV bulimia in US: 1% Lifetime prevalence of binge eating in US: 2.8% Bulimia prevalence will likely increase with broader DSM-5 criteria

Substance use disorder: Gender Differences

Men have considerably higher rates of substance abuse/dependence than women (roughly 2x greater) These differences hold for both alcohol and drug use

Prevalence (more common vs. more rare)

More Common: social anxiety, MDD & Substance use disorder More Rare: autism, schizophrenia, Bipolar 1, anorexia, OCD, all occur at 1% or less in the population

Gender differences (more common among women, men or no difference)

More common among women: Anxiety disorder, mood disorder, PTSD, social anxiety disorder, Major depressive disorder, eating disorders (exception of binge eating disorder) More common among men: Alcoholism, ADHD, Autism, Antisocial personality disorder No Difference: psychotic disorders

What disorders are effectively treated by cognitive-behavioral therapy?

Most of the disorders except for anorexia, antisocial personality disorder or autism

Examining the pros and cons of substance use (or "decisional balance") to help a person decide if they would like to change their behavior is a technique used in:

Motivational Enhancement Therapy

A medication that blocks the "high" a person gets from opiates is called:

Naltrexone

Which of the following disorders is most rare (that is, has the lowest prevalence in the general population):

OCD

Which of the following DSM-5 disorders is more common among women ( or girls) than men (or boys):

PTSD

What makes personality disorders different from other disorders?

Personality disorder differs from others in which they don't find their disorder as an illness but as a part of themselves; who they are.

Withdrawal

Physical or behavioral symptoms are experienced when the substance is withdrawn from the individual's system. Symptoms vary by substance.

Which disorder requires an environmental event as a trigger?

Post-Traumatic Stress Disorder: PTSD

Use and Abuse among US Adolescents

Recently published data indicates that, by age 17-18, 78% of US adolescents have used alcohol and 12% meet criteria for abuse, while roughly 3% meet criteria for dependence For "illicit drugs," 43% of 17-18 year olds had used drugs, while 13% met criteria for abuse and 4% for dependence

Bulimia: DSM-5 Definition

Recurrent episodes of binge eating. An episode of binge eating is characterized by both of the following: -eating, in a discrete period of time (e.g., within any 2-hour period), an amount of food that is definitely larger than most people would eat during a similar period of time and under similar circumstances -a sense of lack of control over eating during the episode (e.g., a feeling that one cannot stop eating or control what or how much one is eating) -Recurrent inappropriate compensatory behavior in order to prevent weight gain, such as self-induced vomiting; misuse of laxatives, diuretics, or other medications; fasting; or excessive exercise. -The binge eating and inappropriate compensatory behaviors both occur, on average, at least once a week for 3 months -Self-evaluation is unduly influenced by body shape and weight. -Rule-out Anorexia with binge eating/purging.

What disorders are antipsychotic medications effective in treating?

Schizophrenia, and Bipolar I

Bulimia: Specifiers

Severity specifiers range from mild to extreme based on frequency of episodes of "compensatory behaviors" (1-3/week = mild, 14+/week = extreme)

What is the best diagnosis?

Social anxiety disorder

A person drinks regularly and in large amounts, but usually does not appear to be affected by alcohol. He sometimes experiences "shakes" when he wakes up in the morning. It is likely that the person meets DSM-IV criteria for _____.

Substance Dependence

What is the main distinction between substance abuse and substance dependence? What do they have in common?

Substance abuse: consumption in large quantities, but not daily. Negative consequences from use. Substance dependence: uses substances daily, addiction, can't function without substance. common: any substances

Substance Use Disorders are More Common Among:

White Men

Substance Abuse/Dependence: Prevalence

The change in criteria from the DSM-IV to DSM-5 has led to an increase in the estimated prevalence of disorders in the US. Lifetime prevalence of any DSM-IV substance use disorder in US: roughly 15% -Alcohol abuse most common substance use disorder with lifetime prevalence of 13% -Drug abuse/dependence less common (8% and 3%) With DSM-5 criteria, the lifetime prevalence of "alcohol use" disorder increased to nearly 30%. -The lifetime prevalence of "drug use" disorder was roughly 10% and the current prevalence was roughly 4%.

Is there evidence that people with substance abuse problems get better with treatment? Without treatment?

They get better with treatment; they can also get better without treatment BUT the chances aren't as good.

What is the difference between a traumatic event and other stressful life events?

Traumatic event: life or death situations, actual or threatened death Stressful life events: death of a family, any stressful event that one dosen't witness physically Both: Sexual abuse

Substance Use Disorders: DSM-IV Categories

Two main types: abuse and dependence Abuse: there are problematic consequences associated with use, but there is no evidence of physiologic addiction Dependence: what is usually thought of as "addiction," i.e., there is evidence of a physiologic dependence on the substance

An example of a very disorganized symptom of schizophrenia would be:

Word Salad

Classes of medications approved for the treatment of bipolar I disorder include all of the following EXCEPT:

antidepressants

Which disorders have very little evidence for environmental causes?

autism

Which disorders are most rare?

autism, schizophrenia, Bipolar 1, anorexia, OCD, all occur at 1% or less in the population

All of the following were discussed as environmental factors that are linked to increased risk of Major Depressive Disorder except:

cannabis use

Which disorders are we unable to reliably estimate the prevalence for?

disorder that is predominately amongst children so we can't ask directly or evaluate them which makes estimating the prevalence it difficult. Also! it's hard to estimate for Social Personality Disorder as well because a lot of people who meet the criteria are in correctional settings.

What are some disorders for which vulnerability is impacted by child abuse and neglect?

dissociative identity disorder, schizophrenia, personality disorder

Which disorders are believed by many to be strongly influenced by media factors?

eating disorders (Bulimia), substance disorder, Dissociative identity disorder

"Mood congruent" psychotic symptoms that occur during a manic episode would likely have_______ themes.

grandiose

Traumatic events, as they are defined by the DSM-5, are experienced more frequently by:

men

What disorders are not effectively treated by any medication or psychosocial treatment (at the present)?

no evidence based treatment for anorexia or Antisocial personality disorder. But there is evidence that people get better over time

Which is NOT true of the DSM-5 diagnosis of persistent depressive disorder:

people with it cannot meet criteria for major depressive disorder

One difference between a manic and hypomanic episode as defined by the DSM-5 is that hypomania cannot have _______ features.

psychotic

Which disorders are most common?

social anxiety, MDD & Substance use disorder

An major concern with earlier or "first generation" antipsychotic medications was that they could cause a troubling condition called:

tardive dyskinesia