PSY-P 324 Exam 2

-onset for bipolar is usually between ages 18 and 22, getting younger -prevalence: ~__ % -onset equal between genders -first onset can be depression or mania -avg duration of manic episode is btw 2 and 3 months

1

____ of ideators (thoughts of suicide) attempt suicide

1/3

suicide attempt to suicide completed ratio

10 to 1

adolescent lifetime prevalence bipolar = _____%

11

___ % suffer from depression

16

adolescent life time risk for bipolar is a ____ to ____ sex difference (female:male)

2 to 1

depressed people _____ to _____ times greater risk for suicide

2 to 3

specific phobia: -prevalence: 10% -gender: 60-90% female -onset: often as child; adult typically early 20s -course: only ____% fully remit (without treatment)

20

_____% of people in psychotherapy do not have a diagnosed psychological disorder

25

prevalence of GAD (%)

3-5

adult lifetime risk of bipolar 1 and 2 combined is close to ___ %

4

depression heritability _____ % (concordance increases with severity - more severe, higher heritability)

40

ratio of prevalence? unipolar to bipolar disorders

5 to 1

____ % of leading causes of death in US are linked to behavioral/lifestyle patterns

50

_____% comorbidity w/ one another (anxiety disorders)

50

about ____ % remit within 6 months (mood disorders)

50

mood disorder suicide rate: 15-20 % -highest rate in US is white males over the age of _____ -men who have been occupationally successful are more likely to commit suicide

50

about ____ to _____ % of co-morbid mood/anxiety disorders

50 to 75

Avg episode in adolescence for bipolar is _______ months -40-70% reoccurrence within 5 years

6

depressive disorders -mean age of onset 32 -length of episodes vary widely -minimum duration is two weeks -typical course is remission and relapse -approx 50% of depressive patients spontaneously recover in ___ months

6

Best treatment for GAD: meds plus CBT combined with relaxation/meditation/acceptance of feelings -over ____ % effective

70

adolescent bipolar heritability: ______ %

80

___% of those developing PTSD have had previous psychiatric diagnosis

90

When assessing mood disorders, what are we looking for in interview?

ABCs, course, stressors

-time limited - less intense reaction to trauma, compared to PTSD - similar symptoms - plus (during or after event) 3 or more dissociative symptoms: numbing or detachment; being in a daze; derealization; depersonalization; or amnesia for aspects of the event - lasts more than 2 days; less than 4 weeks - People who experience _____ are more likely to develop PTSD than those who experience a traumatic event and do not.

ASD

_________ criteria: - The Traumatic Event - Negative emotional state/inability for positive emotions - Re-experiencing - Avoidance/Numbing Increased Arousal

ASD

Depression treatment: ______ o Therapist is coach o Works with client to identify old patterns, core belief, alternative explanations o Develop more realistic patterns of thinking o Teach/practice the skills (Barlow)

CBT

GAD treatment that has long-term positive effects goals: -identify automatic negative thoughts -retrain thinking -identify and acceptance of physical sensations and emotions

CBT

Panic disorder treatment with goal to replace the labeling of the symptoms as harmless

CBT

somatic disorders treatment: ________ therapy: incorporates operant techniques and cognitive restructuring to address the emotional and cognitive components of pain

CBT

therapy for adjustment disorder: -moment-to-moment interaction -exchange of positive and negative behaviors -style of communication

CBT couple therapy

-Existence of two or more personalities in a single individual (previous multiple personality disorder) -Controversial, iatrogenic (manufactured in treatment), other diagnoses more likely

DID

__________________: Internal, Global, Stable (beck)

Depressive Triad

Depression treatment: _______ -used for Depression, Melancholia, Bipolar when medication and therapy have not been effective -2-3 times a week, for 2 to 7 weeks -Electrodes placed on skull, muscle relaxers -Memory issues, stigma -75% marked improvement or complete remission

ECT

GAD etiology: Biological: -decreased ______ response

GABA

- Excessive anxiety and worry (apprehensive expectation) occurring more days than not for at least 6 months about a number of events/activities - Difficult to control the worry. -"Anxious worry" - attempt to control situations that cannot be controlled, worrying appears to the person to aid control o excessive, unrealistic about both serious and minor matters o unrealistic: overestimates potential threat -worry about the same things as everyone else, but routinely anticipate disastrous outcomes

GAD

heritability: relatives of GAD patients are at risk for specifically ________

GAD

Human Stress Response: Three stages of body's physiological reaction to stress 1. Alarm (shock) 2. Resistance (resistance rises) 3. Exhaustion (resistance goes down, leaves us depleted/compromised) -Firefighters die 10 years earlier -Stress --> unhealthy behaviors and body reactions --> coronary heart disease

General Adaptation Syndrome

Study of SAD in winter vs summer - __________ ______: in winter can't inhibit angry/sad faces successfully, suggests affective basis for cognitive function

Go no go task

etiology of mood disorders closely related to _______ ______ (greater vulnerability to stress)

HPA axis

-secretion of hormones -prepare for fight/flight but inhibit important cells that fight antigens

Hypothalamic Pituitary Adrenal axis

(Joiner) - Empirical evidence - Differentiates those who complete vs those who do not - Demonstrates suicide IS NOT associated with weakness and cowardice, as the public often perceives - According to the model, suicide risk begins with: o a sense of feeling disconnected from, and burdensome to, others o decreased fear of pain and death o the technical competence to kill oneself (available means)

Interpersonal theory of suicide

-severe episode at least 2 weeks duration

Major depressive disorder

- Occurs persistently and uncontrollably, nearly all the time - Characterized by: obsessions and compulsions (either or but most have both)

OCD

- Exposure to a traumatic event - Intrusive Re-experience: Repeated, distressing images or thoughts, flashbacks, horrifying dreams, often in a dissociative state - Avoidance of stimuli associated with the trauma: Attempts to avoid thoughts, feelings related to the event, people, places, or activities that remind them of the event - Increased Arousal or Reactivity (predicts a worse prognosis): Hypervigilance, Restlessness, agitation, irritability, exaggerated startle response - Negative Mood or Thoughts: Range of negative feelings, Inability to experience positive emotions, Persistent fear, anger, or guilt, or feelings of detachment from others, numbing of responsiveness/emotional anesthesia - Dissociative Symptoms: Dazed and act "spaced out", Depersonalization, Derealization, Dissociative amnesia

PTSD

treatment for _______ -broad spectrum light therapy 2 hrs daily, change location, both w/therapy

SAD

3rd gen depression meds: ________ -also treats anxiety symptoms o exp: Effexor, Cymbalta o exp: Wellbutrin o Ne and dopamine; used for smoking cessation, too: Most frequently used anti-depressant, 2 weeks to act -Easier to use than other anti-depressants -Few side effects; include weight gain insomnia, fatigue, sexual dysfunction, restlessness, anxiety, vivid dreams, flu-like symptoms on discontinuing) -Less dangerous in event of overdose

SNRIs

2nd gen depression med: _______ -ex: fluoxetine (prozac)

SSRIs

OCD Meds

SSRIs

Human Stress Response - who?

Selye

-originally Galen with psychological but Cannon) -Activated when stress response is present (fight or flight) -Increased Respiration -Increased blood pressure -Decreased blood flow to muscular activity -Curtails non-essential functioning

Sympathetic Nervous System

compulsion disorder: -recurrent hair-pulling -serious hair loss

Trichotillomania

disturbance (stressor) lasts less than 6 months

acute

symptoms: -occur in response to stressor (within 3 months) before any diagnosis -do not reach level of those that occur with PTSD or ASD

adjustment disorder

biological etiology of SAD: -temperament (shy) -sensitivity to faces (angry faces) -vulnerability increased during ____________, due to brain changes

adolescence

people with the first episode of bipolar are who?

adolescent women

pattern of observable behaviors, as facial expression, pitch of voice, body movements

affect

- Anxiety about being in situations from which escape might either be difficult or embarrassing - Often described as fear of public places; typically includes crowded streets, shops, public transportation, crowd events

agoraphobia

-deficit in capacity to recognize and express emotions signaled by physiological arousal -Misattribution of normal somatic symptoms -Tend to amplify somatic symptoms

alexithymia

heritability: relatives of patients with OCD are at risk for _____ types of anxiety disorders, especially GAD

all

adjustments required to maintain homeostasis

alloastasis

Mckewan is responsible for the concept that accumulation of stress over lifetime results in disease due to:

allostatic load

_____________ __________ is compromised for different autoimmune diseases

allostatic load

_________ suicide: sacrifice of one's life for the good of the group, or ritual suicide

altruistic

time/memory is lost, loss of awareness, conscious, or memory of time an events

amnesia

Depressive disorders: endocrine system -increased stress hormones, less effective in suppressing stress response Brain -greater activity in the _______ -less activity in prefrontal cortex, hippocampus -differences in REM sleep

amygdale

loss of pleasure

anhedonia

_________ suicide: diminished regulation, -breakdown in social order, lack of meaning

anomic

medications for rapid cycling bipolar (valproic acid, divalproex sodium, (depakene/depakote)) -more than 50% responds to these drugs -Undesirable Side effects include gastrointestinal distress, sedation

anticonvulsant

PTSD drug treatment: -_____________ and therapeutic re-exposure are first-line therapies -Effectiveness of SSRIs likely due to the high comorbidity between PTSD and depression; that is, treats the depression rather than the PTSD

antidepressants

__________ and _____________may be added with mood stabilizers for bipolar treatment

antipsychotics and antidepressants

Danger events lead to

anxiety

excessive worry; uncontrollable sequence of negative emotional thoughts, concerned with possible future threats or danger

anxiety

highest comorbidity with unipolar mood disorder

anxiety disorder

anti-anxiety drugs -risk for dementia

anxiolytics

high levels of diffuse negative emotions and thoughts, self-focus or preoccupation, and sense of uncontrollability

anxious apprehensive

A close relative with _____________ puts someone at risk for OCD

any anxiety disorder

____________ to, and low tolerance for, these physiological sensations (fight/flight), with increased motivation to avoid experiencing them

attention

-learned helplessness is a cognitive style characterized by depressed _____________ style: -Internal -Stable -Global this leads to learned helplessness which leads to perceived lack of control

attribution

avoid feared situation, so don't adapt

avoidance learning

behavioral etiology of SAD: -social skills deficit (no eye contact, not keeping up convo) -classical conditioning -operant conditioning = ____________ ____________

avoidance learning

- avoids thoughts, feelings, or conversations associated with the trauma - avoids activities, places or people that arouse recollections of the trauma - inability to recall important aspects of the trauma - markedly diminished interest in activities - feeling detached or being estranged from others - restricted emotions - sense of foreshortened future

avoidance/numbing

biological etiology of OCD: -injury/illness (tumors, Strep-PANDAS, postpartum women) -increased activity in frontal lobes (obsessions) and in ________ __________ (motor behavior, compulsions) -decreased levels of serotonin

basal ganglia

CBT (Barlow): ______________ ______________ ___ ___________ o Monitor and develop awareness of patterns of emotional responding (including physical sensations) o Identify patterns of emotional avoidance and maladaptive emotion- driven behaviors o Interoceptive and emotion exposure, toward increase tolerance of emotions (including physical sensations), allowing for new learning to occur

behavioral activation and exposure

infants born with inhibited temperament, don't like change, novelty, new people

behavioral inhibition

Generalized _________ vulnerability: tendency to be anxious or tense

biological

Suicide Vulnerabilities: __________: o Genetic predisposition -Reduced levels of serotonin relates to inefficient reward sensitivity o Disordered sleep - sleep reversal (day/night) -Leads to diminished cognitive control, greater impulsivity o Poor impulse control o Violent and aggressive behaviors o Reward-processing deficits -Can't differentiate high vs low value rewards -Mesolymbic abnormalities, putamen volume, blunted activation in Striatum prospectively predicts anhedonia

biological

stress-induced depression in lab rats indicates: -interaction btw ___________, ______________ phenomenon

biological; psychological

UNIPOLAR or BIPOLAR: -earlier onset -equal adult prevalence among men and women -greater genetic heritability

bipolar

-at least one manic episode (at least 1 week duration-more severe) with significant impaired functioning

bipolar i

-At least one hypomanic episode at least 4 days duration with no full blown manic episode (less severe) -at least one major depressive episode

bipolar ii

compulsion disorder: -Like OCD, all seem to be long-term, chronic conditions. All seem to involve maladaptive consequences of attempts to suppress unwanted/threatening thoughts, with rebound

body dysmorphic

negative changes in thoughts, emotions, and behavior as a result of prolonged stress/frustration

burnout

anxiolytic for GAD (2 weeks for effect) -non-sedating -non-addictive

buspirone

(clark) - internal physiological sensations are misinterpreted -classically conditioned learning based on first instance - panic attacks are triggered by internal stimuli (body sensations, thoughts, etc) - anxious mood leads to physiological sensations (heart rate, dizziness, etc) - narrowed attention and increased awareness of bodily sensations - person misinterprets bodily sensations as a catastrophic event (spin out of control)

catastrophic misinterpretation

Secretion of hormones (HPA): 1st: ___________ that initiate fight/flight within seconds (adrenalin, norepinephrine)

catecholamines

Depressive disorders: Caveat -_____________ ___________ is not clear for latter 3: is it cause or consequence of depression

causal ordering

chronic stress leads to __________ ________. -shortened telomeres, the "clock" in chromosome's DNA that prevent mutation in division

cellular aging

OCD treatment: -surgical lesion in the cingulate gyrus: connects limbic system and frontal lobes, for severe cases. o side effects: seizures, personality change

cingulotomy

3 types of Learning for etiology of phobias: - __________ conditioning: UCS (dog bite) leads to UCR (fear) o CS is signal paired with UCS (dog) leads to UCR (fear) - ____________ conditioning: avoidance learning o Avoid elevator due to fear (classically conditioned) o Take the stairs, never gets stuck, feel safe o Avoidance is reinforced (as w/agoraphobia) - Observational learning: social, indirect, vicarious, reinforcement, modeling o watch Jaws, learn to fear sharks o parent fears insects, child fears insects

classical; operant

-Depressed mood accompanied by other symptoms—loss of energy, loss of pleasure, fatigue, changes in sleep and appetite (ABCS) for at least one episode -Pervasive and persistent - May not have precipitating event - Impaired functioning - Additional symptoms (somatic, for example) o Sleep dysregulation, aches and pains - Nature and quality of mood change

clinical depression

a combination of emotional, cognitive, and behavioral symptoms

clinical syndrome

_________________ behaviorists focus on positive and negative reinforcement (learning)

cognitive

our thoughts about situation -relates to self-efficacy (bandura)

cognitive appraisal

CBT (Barlow) ______________ ________ ___ ___________ o Role of maladaptive, automatic appraisals in emotional experiences o Identify specific thoughts and patterns of thinking, practice modifying maladaptive ones, and increase flexibility in appraising situations

cognitive appraisal and reappraisal

(beck) -mental models underlie patterns of thinking

cognitive schema

(Beck) Cognitive Errors include: -Arbitrary inference : all about themselves, and overemphasize the negative -Overgeneralization and Catastrophizing: negative events apply to all situations -Selective recall of negative consequences -Dichotomous thinking - all or nothing/black or white -Personalization - references to self Treatment: Correct the errors (Cognitive approach, as in CBT)

cognitive theory of depression

ways in which people think about and remember events influence feelings

cognitive vulnerability

stress in a college student's life over a one-year period resulting from major life events

college undergrad stress scale

- Repetitive behaviors (hand washing, ordering, checking) or mental acts (praying, counting, repeating words) that the person feels driven to perform in response to an obsession: o According to rigidly-applied rules o Behaviors/mental acts are aimed at preventing or reducing distress or preventing some dreaded event/situation o behaviors /mental acts either not connected, in realistic way, with what they are designed to neutralize/prevent, or are clearly excessive o Recognizes that the obsessions or compulsions are excessive or unreasonable (insight varies) o Cause marked distress, are time consuming or significantly interfere with normal routine, occupational functioning, or social activities or relationships

compulsions

Recommendations for physicians treating patients with somatic symptom disorders: - Strong, consistent physician-patient relationship - Schedule routine appointments, conduct brief medical exams, and offer consistent emotional support and medical reassurance. - Convey a sense of ____________ o patients who do not receive this empathy are likely to ignore physician's advice and/or change doctors - Refer patients to mental health professionals with sensitivity

concern

_____________ disorder symptoms: - Includes weakness, paralysis, pseudoseizures, involuntary tremors sensory disturbances caused by unconscious perceptual blocking: deafness, blindness; may make no anatomical sense -Seen in present day; exp. Yazidi survivors -Frequently low anxiety, low inhibition, high impulsivity (externalizing), thrill seeking, dramatic -Often reported childhood sexual abuse -Possibly related to negative emotionality associated with Cluster B Personality Disorders ( Antisocial Personality Disorder, Borderline, Histrionic) -Rarer in modern times, due to better differential diagnosis

conversion

motor/sensory symptoms due to psychological distress -Fear or belief that one is suffering from a physical illness, but physical symptoms missing/minor o Disorder is preoccupying, enduring; leads to substantial impairment in life functioning.

conversion

actions to manage the effects of stressors (Lazarus and Folkman)

coping strategies

Secretion of hormones (HPA): 2nd: _____________ within minutes which includes reflexive actions/reflex of the gut (vasopressin, cortisol - saliva)

corticosteroids

-primary, easily measured stress hormone -Increase sugars in bloodstream (pancreas to liver) -Enhances brain use of glucose -Increases availability of substances that repair tissues -Curbs functions that would be nonessential a. Growth, tissue repair, lower immune system

cortisol

therapy for adjustment disorder: changing relationships not individuals Goal: -learn to voice disagreements -improve communication

couples therapy

ineffective treatment for PTSD (used to. be popular) o 1-4 hr group meeting 1-3 days after event. o No evidence it prevents PTSD o may be harmful, provoking too much emotion too soon -increasing stimulus and response, strengthening learning of fear

critical incident stress debriefing

- both depression and mania lack severity and duration -bipolar equivalent of persistent depressive disorder -episodes not severe enough to cause marked impairment in functioning -no psychotic features -numerous hypomanic and depressive episodes during a two-year period

cyclothymia

chronic stress causes atrophy in cortical neurons --> decreased number and length of _____________ ____________.

dendrite branches

sense or feeling of being detachment from self or surroundings, things seem "unreal", sense that you lack control of yourself or are outside of your self, observing your actions, feelings, thoughts and self from a distance as though watching a movie, out of body experience

depersonalization

-Feelings of being detached from oneself or the world; like living in a dream ("as if" feelings), or cut off from feelings

depersonalization disorder

leading cause of disability (10 years lost)

depression

loss events lead to

depression

Feeling detached from people or things around, foggy or dreamlike, time may be slowed down or sped up, and the world may seem unreal, or dreamlike, in a daze

derealization

social relationships suffer as a result of the sense of _______________/differentness/alienation

detachment

Levinson's psychological theory of life transitions: 3 major transitions between _________ _____ of adult life and smaller changes within

different eras

common depressive disorder in children

disruptive mood dysregulation disorder

- A feature shared by both traumatic stress disorders, and dissociative disorders - Disruption of normally integrated mental processes involved in memory, consciousness, identity, or perception. o May occur in response to extreme emotional or physical stress or distress.

dissociation

_________________ experience may include: -numbness/detachment -derealization -depersonalization -amnesia/fugue state

dissociative

Sudden inability to recall extensive and important personal information that exceeds normal forgetfulness

dissociative amnesia

-Shares features with fear and stress disorders, includes dissociation. -Traumatic stress disorders are not controversial; essentially an anxiety disorder, with dissociative features. -The other disorders present some challenges, and are more controversial... -______________ ______________are persistent, maladaptive disruptions in the integration of memory, consciousness or identity. Rare, some of these more controversial -exp: DID, Dissociative fugue

dissociative disorders

best predictors (moderate strength) of PTSD from events at the time or trauma are ___________________ ______________

dissociative experiences

includes purposeful travel with amnesia and identity amnesia (more serious)

dissociative fugue

PTSD predicted by ________ from traumatic event

distance

change outward expression or minimize emotional impact of emotion

distancing

directing attention to change emotions

distraction

-"s" allele (short version of serotonin transport) of 5-HTT increases risk of depression -allele for reduced sensitivity to reward (__________)

dopamine

GAD treatment that is useful for acute, short term stressors -dependence and discontinuance syndrome a concern (reliance)

drug therapy

- The view that dissociation is adaptive is a Freudian notion - There is nothing adaptive about dissociative disorders - These are psychological disorders, people with them are dysfunctional o Resilience is more adaptive than dysfunction, and is the goal of therapy

ego protection

_________ suicide: excessive individuation -not integrated in community, melancholia, meaningless, depression

egoistic

state of arousal defined by subjective states of feeling, as sadness, anger, disgust. Dynamic, changing

emotion

-Strategies that change impact of stressor by changing emotional reaction -Includes cognitive strategies to change thinking: -Reappraisal -Distancing/suppression/repression -Distraction/escape/avoidance techniques

emotion focused coping

PTSD Successful Recovery (Foa) based on ______________ ____________ - Emotionally engage with memories - Articulate and engage with the experience - Come to believe the world is an ok place o "Meaning making" is Foa's term o Personal growth after the trauma

emotional processing

understanding, comfort, caring

emotional support

-anxiety and depression rise during transition to adult life -Emotional conflicts because of uncertainty about relationships

emotional turmoil

discrete periods of time in which the person's behavior is dominated by either a depressed or manic mood.

episodes

mood disorders are characterized by __________

episodes

SAD: -prevalence: lifetime 3-13% -gender: _________ -typical age of onset: teenage -course: lifelong, increases when stressed

equal

adult life time risk for bipolar is ________ in men and women

equal

compulsion disorder: - Repeated skin picking o Produces skin lesions o Behaviors are unsuccessfully resisted

excoriation

OCD treatment: -patient is exposed to fearful situation

exposure

_________ _________ for PTSD: - Disclosure, Re-exposure to event, recording/reliving the situation, describing events, rewriting nightmares (imagery rehearsal therapy), prolonged exposure therapy - Rapid Eye Movement Therapy: some support, experimental research suggests the exposure is the key component that makes it work Decreased arousal = classical conditioning o avoidance -CBT plus social support (short term, effective ASD)

exposure therapies

best OCD treatment

exposure w response prevention and meds

exposure with response prevention results in __________ _____________: classical conditioning learning what happens when don't engage in behavior (avoidance of this maintains it) -75% experience improvement of symptoms

extinction learning

__________________ disorder symptoms: - Lying, exaggerating, feigned/creating medical conditions (secondary gain) - Motivated by a desire to assume the sick role - Formerly Munchausen syndrome - Measurement and detection of these disorders is difficult because they involve unconscious processes that cannot be observed directly - NOT Malingering: faking a disorder is not a psychological disorder, because motivation is to achieve a tangible benefit

factitious

- Formerly Munchausen by proxy - Typically a mother making a child ill - Child abuse, and a crime - Differs from typical abuse in that the child's physical condition is not hidden, relationship cultivated with professionals

factitious imposed

-desire to be ill for the sick role (rather than gain), to the extent of making themselves ill

factitous

T or F: the clinical levels of distress following trauma or stressor is the same for adjustment disorder as PTSD and ASD

false

___________ suicide: excessive regulation, repressive society, -living under unbearable circumstances

fatalistic

response to real, immediate danger, builds, helps deal with a real and present threat

fear

Gender of GAD 55-65% ________

female

males have ________ attempts but are more successful -completion rates are 4 times higher in males

fewer

anxiety onset is typically ______, then depression

first

Horney's psychological theory of life transitions: relationships difficulties come from conflicts among 3 basic competing needs: -to move __________ -to move __________ __________ -to move __________ _________

forward, away from, against others

what happens when people with ocd attempt to suppress disturbing/intrusive thoughts

frequency increases over time

conversion: ____________'s contribution: -Psychological conflicts are converted into physical symptoms, often mimicking those found in neurological diseases or disorders (neurological type disorders)

freud

amnesia with travel

fugue

Diathesis-Stress: -some disorders like panic may have greater _________ contribution with a stimulus or event triggering

genetic

one symptom of a manic episode

grandiosity

Diathesis-Stress: -ACES (adverse childhood experiences) can create _________ _______________ to stress (via attachment)

greater reactivity

Europe interprets reality of physical and emotional disorder as ________

guilt-despair

onset GAD: over ______ report as child/teen -in adulthood usually follows life stressor comorbidity: over ____ have other disorders

half

Stressor: daily annoyances -some may inoculate, more erode functioning

hassles

_____ cortisol: -less HDL cholesterol -weak immune system

high

Depression Vulnerability: Biological: -activation in/ connectivity between limbic and prefrontal areas, serotonergic activity, HPA axis reactivity to stressors Psychological/Behavioral: -state ___________ ________ (distress, sadness, anxiety, fear, anger, guilt); -Beck's Cognitive Triad, rumination (constantly reflecting); avoidant coping (escape strategies) -Traits: negative affectivity (neuroticism), sensitivity to punishment and social stimuli, limbic system is sensitive

high negative affect

- Neuroimaging studies find reduced volume of the _____________, reflecting the atrophy of dendrites in a select region of the hippocampus (corrosive effect of glucocoritsoids)

hippocampus

chronic stress damages cells in the ____________, maintaining loop -PTSD (reoccurring memories) -Dementia (cognitive impairment)

hippocampus

compulsion disorder: o Unrelenting trouble associated with getting rid of personal belongings o Person must feel a strong need to save these possessions. o Is extremely disruptive to person's life

hoarding

process thru which body maintains a steady state

homeostasis

In order to go to _________ (cannon), have to go thru ________ (McEwan)

homeostasis; allostasis

social anxiety has onset during adolescence because of ________________ changes

hormonal

suicide prevention: treatment for depression - ______________ for self-protection

hospitalization

shorter and less severe manic episode

hypomanic

chronic stress also causes ____________ (decline in growth) of neurons in amygdala and nucleus acumens; contribute to disrupted emotion, motivation and reward behaviors

hypotrophy

Issues with dissociative disorders: - very rare; high rates only among clinicians who advocate for the disorder, higher follow media - before 1980, only about 200 cases were reported worldwide; now thousands are reported annually. - misdiagnosis possible - alternatives include schizophrenia, substance use disorders, borderline personality disorder, etc. - mostly only in US and Canada - _____________ (caused by therapy/social role/expectations) o Easily hypnotized - patients are highly suggestable, hypnosis o child sexual abuse or other abuse may play a role in the etiology of many dissociative disorders § information comes from retrospective reports

iatrogenesis

Erikson's psychological theory of life transitions: central psychological conflict during transition to adult life

identity crisis

- DSM-5 estimates 5-7% of the population suffers from illness anxiety disorder - Comorbid with depression, anxiety, BPD - Antisocial personality disorder is often seen in family members of people with somatization disorder -more common among lower SES, more common in Latin America and Puerto Rico, African American -Cultural norms about the expression of emotion may play a large role in the development of somatization disorder.

illness anxiety

_________________ disorder symptoms: - persistent, intense, and disturbing fear or belief that one is suffering from a physical illness - physical symptoms cannot be explained by an organic impairment - Apparently nothing physically wrong with the patient, but the symptoms are not feigned - Long term (more diffuse) - Always feeling like something is wrong, chronic and pervasive - Etiology: o exposure to illness and death as a child - learned sick role, with gain o misinterpret body symptoms that are common o focus makes them worse

illness anxiety

o (was Hypochondriasis) -excessive worry, fear or belief of physical illness

illness anxiety

the only somatic symptom disorder that is equally common in men and women

illness anxiety

the defense system of cells, organs, and chemicals of body

immune system

atrophy in cortical neurons: -changes occur in as little as 1 week -gene allele mediated response (some vulnerable more than others - diathesis stress) -dendrite complexity and synaptic density can also be ___________ or effects of stress reversed by antidepressants, enriched environment, and exercise

increased

- difficulty falling or staying asleep - irritability or outbursts of anger - difficulty concentrating - hyper-vigilance - exaggerated startle response

increased arousal

goods, services, assistance we get/provide

instrumental support

____________ approach is most helpful, incorporating the Biopsychosocial model

integrative

bipolar: -long term course is often ________________ -long term prognosis is ___________

intermittent; mixed

anxiety disorders split and all are __________________, all have dysregulated and dysfunctional fear response at the basis

internalizing

Behavioral therapy toward extinction: (works with classical conditioning) -Exposure to own physical sensations o Not having a panic attack occur during treatment o experience shows having that somatic sensation won't hurt/kill

interoceptive exposure

Agoraphobia is the only type of anxiety disorder that begins in ______ ______

late life

Seligman: -When you condition animals something bad is coming, the CR is different from UCR (model of depression) -Tend to give up

learned helplessness

The longer the remission, the ____ chance of relapse

less

people who believe they are in control of events are _____ anxious

less

3 P's (three ways low-stress people respond to challenges) -make it ______ ___________ -see problem as ______ ______________ -remind themselves how problem is ______ _______________ -these can increase or decrease experience of stress

less personal, not pervasive, not permanent

Goal for suicide intervention: -reduce ____________ -provide support (replace tunnel vision with broader perspective)

lethality

mood stabilizers include ________ -40% of patients non-responders -non-compliance

lithium

-Where do you locate ability to control things? - Less control and more uncertainty --> more likely to feel stressed

locus of control

Depression Vulnerability: Biological: -diminished dopaminergic activity, diminished reactivity to rewards Psychological/Behavioral: -State ___________ _______ (anhedonia: lack of happiness, contentment, joy); withdrawal; reduced approach behaviors, trait positive affectivity (extraversion), hopelessness, sensitivity to reward

low positive affect

__________ (T cells and B cells) negatively affected by stress

lymphocytes

ECT treatment is used primarily for severe unremitting

major depressive disorder

Stressor that requires adjustment

major life events

anxiety is

maladaptive

OCD: -prevalence: 1.2-2.5% -Gender: nearly equal -onset: teens/early adulthood (earlier in _______) course: chronic, remission/relapse

males

somatic symptom disorders are NOT __________ (pretending for gain)

malingering

_______________ (antianxiety, antidepressant, and antipsychotic) are used to reduce distress, but do not cure the dissociative disorder

medications

(episode specifier) -more severe and resistant depression, different state -notable for anhedonia

melancholia

conditions that are most resistant to meds and therapy thus have higher risk for suicide

melancholia and anhedonia

somatization disorders: bio factors - ___________________ can be critical o 25% of patients diagnosed with a conversion disorder were later identified to have a neurological disease. - Diagnosis by exclusion o complaint is assumed to be a part of a somatic symptom o disorder only when various known physical causes are ruled out - Medically unexplained syndromes are sometimes used to describe somatic symptom disorders

misdiagnosis

OCD treatment: -social learning -therapist ignores the compulsion and patient witnesses the harmless result

modeling

1st gen of depression meds in late 50s-70s: MAOI's inhibit enzyme ____________ ___________ -which clears serotonin, norepinephrine, dopamine, thereby increasing levels

monoamine oxidase

PTSD: higher concordance with ________ twins

monozygotic

Pervasive, sustained emotional response that can color perception

mood

disturbances that either have one direction (unipolar) or two (bipolar)

mood disorders

bipolar main medication treatment:

mood stabilizers

course of major depression -average age of onset: 20s -short or long periods of remission -the more episodes, the ______ future episodes

more

panic disorder -incidence: 1.5-3.5 % -gender: more female -_____ females when paired with agoraphobia (2:1 w/o and 3:1 w/) -onset: late adolescence to mid 30s

more

Social/culture factors of illness anxiety disorder: - Expressing emotional concerns physically because of limited insight or social intolerance of psychological complaints - sadness, fearful, or uncertainty about life -____________ tolerance for being physically sick in many cultures, _____________ tolerance for experiencing psychological distress - More common in non-industrialized countries and among less-educated people in the U.S., -less opportunity or support for learning to describe inner turmoil in psychological terms.

more; less

cognitive etiology of SAD: -high standards -high self-monitoring (trait) -________ self-evals about their social ranking and dominance

negative

Depressive triad (beck) -characterized by ____________ ________: negative thoughts about -self -future -world

negative triad

________________ processes may be reaction to environmental stress/severe life events

neurochemical

- recurrent and persistent thoughts, impulses, or images that are experienced: o as intrusive and inappropriate o that cause marked anxiety or distress o thoughts/impulses/images are not simply excessive worries about real-life problems o attempts to ignore or suppress such thought/impulses/images or to neutralize them with some other thought or action o recognizes that the thoughts/impulses/images are a product of their own mind

obsessions

somatic disorders treatment: __________ approach: rewards successful coping and life adaptation instead of rewarding "pain behavior" and the sick role

operant

heritability: relatives of panic patients are at risk specifically for _________ disorder

panic

interoceptive exposure is for _____________ disorder

panic

- Itself not an individual diagnosis, but can be a central component of other disorders o May or may not have another anxiety disorder o Develops abruptly o usually reach their peak within 10 minute o Most end within 20 to 30 minutes Panic Attacks described in terms of the situations in which they occur Cued: expected or occurring only in the presence of a particular stimulus Unexpected: appear without warning or expectation, as if "out of the blue

panic attack

characterized by repeated panic attacks, combined with major changes in behavior or persistent anxiety over having further attacks

panic disorder

disturbance (stressor) lasts 6 months or longer

persistent

-does not meet criteria for Major Depressive Disorder -2 years duration more days than not

persistent depressive disorder (dysthymia)

Somatization disorder: - Unnecessary medical treatment as typically consult _____________, not mental health professionals -they perform unnecessary medical procedures because they do not recognize the nature of the patient's problems. -substantial percentage of patients consult physicians for which no organic cause can be found -highlights the fact that substantial use of the physical health care system may be related to psychological factors.

physicians

Reducing _____________ ___________ to gain control over stress response (Meditation, biofeedback, massage, exercise)

physiological activation

_____________ is a greater predictor than attempts of suicide for completors

planning

mood disorders are ___________, influenced by different genes, not one

polygenic

(somatization disorders) -sick role leads to positive attention (____________ reinforcement), removes responsibilities (_______________ reinforcement)

positive; negative

(episode specifier) -manic or depressed following pregnancy (postpartum depression and bipolar episode)

postpartum onset

key factors in lowering stress is by having:

predictability, controllability, and cognitive appraisal

-the fear response is normal and adaptive -acute fear response is innate, motivational -fear response focuses on __________ danger -short time frame (immediate)

present

___________ gain: -symptoms protect ego by expressing the psychological conflict unconsciously

primary

-the conversion of psychological distress into physical symptoms -Primary benefit to ego -The main deal

primary gain

-Strategies that try to eliminate source of stress or reduce impact through direct actions -Plan-full problem solving

problem focused coping

____________( Beta-Blocker) reduces rates of PTSD if given at the time of the incident -not reliable support for this -beta-adrenergic antagonists reduce fear response by decreasing arousal of SNS, thus inhibits emotional component in encoding memories; creates unstable memory encoding

propranolol

__________________ view/Freud: -primary and secondary gain

psychodynamic

Generalized ___________ vulnerability: worrying

psychological

Suicide Vulnerabilities: __________: o Maladaptive schemas o Self-referential o Cognitive triad o Negative self-image o Psychological pain o Social isolation o Feelings of being a burden o Previous attempts o Rumination and perseveration o Impulsivity Reward-processing deficits - Mesolymbic abnormalities, putamen volume, blunted activation in Striatum prospectively predicts anhedonia

psychological

well-functioning people seek treatment due to _____________ _______

psychological distress

developing a sense of control and self-efficacy (behavioral strategies, planning, and cognitive reappraisal)

psychological resilience

(episode specifier) -hallucinations or delusions (bipolar i)

psychotic features

(course specifier) for bipolar -more than 4 cycles per year -note: most show only a few episodes per year

rapid cycling bipolar

- recurrent and intrusive distressing recollections of the event - recurrent distressing dreams of the event - acting or feeling as if the traumatic event were recurring (such as hallucinations and flashbacks) - Often visual ("the slideshow) - intense distress at exposure to cues that resemble some aspect of the traumatic event - physiological reactivity on exposure to cues that resemble some aspect of the traumatic event

re experiencing

change interpretation to change emotions

reappraisal

attributions and appraisals ______ likelihood of ptsd developing -preparedness (training) -sense of purpose -control

reduce

Family conflict: Power struggles, intimacy struggles -children _________

regress

reoccurrence of the disorder

relapse

period of recovery

remission

50% of adults have experienced a traumatic event; most are ________

resilient

OCD treatment: -critical aspect: is not allowed to complete compulsions

response prevention

Ruminative or Distracting style more likely in women?

ruminative

-we recognize the feeling of sadness -There is a precipitating event -feelings are transient, or fleeting, and they pass, to be replaced by other feelings. -we can carry on with our normal routines relatively unimpaired

sadness

dysfunctional interaction pattern where one family member is blamed for all troubles

scapegoating

(course specifier) - mood disorders -seasonal affective disorder -presence of black=depression

seasonal pattern

_____________ gain: -symptoms may help a patient to avoid work or responsibility or gain attention

secondary

the benefits from being ill -Relieved from social responsibility

secondary gain

our belief/confidence in capability to cope with events

self efficacy

Who said this? -there are differences btw people with high and low stress levels -3 p's

seligman

Depressive disorders: neurotransmitters: receptors less sensitive to ______________ (sleep), norepinephrine, dopamine

serotonin

Dangers of MAOI: -Foods with tyramine (cheese, beer, red wine, chocolate) cause hypertensive crisis -MAOI's with other meds/supplements can cause dangerously high levels of serotonin, known as ______________ ____________: anxiety, agitation, sweating, confusion, tremors, restlessness, lack of coordination and rapid heart rate -Used in treatment of anxiety disorders, particularly agoraphobia and panic

serotonin syndrome

- Avoidance or distress associated with the phobia must interfere significantly with the person's normal activities, relationships with others; must be persistent. o Cause may be a conditioned response to a negative experience

severity threshold

Suicide is 2nd leading cause of death ages 13-18 yrs _______-________ risk factors: obesity, academic problems _______-________ risk factors: neurocognitive model (general reduced cognitive control, suicide specific bias, reward insensitivity)

short term; long term

Suicide Vulnerabilities: __________: Durkheim: social structure ( social integration and moral regulation) result in 4 types of suicide: -anomic -fatalistic -egoistic -altruistic -availability of guns -media attention -copy cats

social

- Like specific phobia; additional element of potential for humiliation, embarrassment or judgement. - Marked and persistent fear of one or more social or performance situations in which the person is exposed to unfamiliar people or possible scrutiny by others. - Fears they will act in an embarrassing way. Exp parties, conversations, work/school, eating, writing

social anxiety disorder

__________ _______________ shows activation in same region as physical pain

social exclusion

modeling, vicarious reinforcement from anxious parents

social learning

stress in a one-year period from major life events

social readjustment rating scale

Sapolsky research: Baboon health influenced by:

social status

china interprets reality of physical and emotional disorder as ________

somatic

- Complaints about physical symptoms either o in the absence of physical problems (conversion) -or o psychological distress out of proportion to physical problem

somatic symptom

- These are disorders where the primary feature are prominent physical symptoms, accompanied by impairing psychological distress. -Physical symptoms in the absence of medical evidence -The problem is very real in the mind, though not the body. -Usually numerous, constantly evolving complaints such as chronic pain, upset stomach, dizziness

somatic symptom

___________________ disorder symptoms: - At least one severe somatic symptom complaint accompanied by excessive worry about symptoms. - Excessive health concerns; thoughts/feelings/behaviors related to symptoms, anxiety about health, time and energy devoted to health/symptoms - Persistent; may not be continuous (more than 6 months typically) - Hard to tell prevalence -over-represented among doctor's visits/hospitalizations § 1-5%? § 6-16% of those in medical settings? - More of a focus (pancreatic cancer)

somatic symptom

o excessive concern about physical symptoms

somatic symptom

cultural considerations for major depression: -greater ______________ in some cultures (physiological complaints) as some cultures do not recognize mood disorders, only physical

somatization

-marked fear or anxiety about a specific object or situation that provokes immediate fear or anxiety -Exposure to phobic stimulus must be followed by an immediate fear response. -Persistent and dysfunctional

specific phobia

- learning that occurs in one cognitive/emotional state is best recalled in the same state. o In DID, repeated experience of trauma, dissociation, and state-dependent learning leads to independent personalities

state dependent learning

combination of emotional, cognitive, behavioral and somatic symptoms

syndrome

Taylor: -Nurture or seek social support when faced with dangerous situation -Used by females mostly -Research has been androcentric, neglecting females -Newer research shows affiliative response to stress results in stress reduction -Neuroendocrinology implicated: oxytocin, estrogen, endogenous opioids

tend and befriend

which of the following decreases the likelihood of someone developing PTSD?

training

emotions or feelings are _________ and they pass to be replaced by other feelings

transient

- experienced, witnessed, or was confronted with an event that involved actual or threatened death or serious injury, or threat to the physical integrity of self or others - person's response involved intense fear, helplessness, or horror - Initially, normal responses include belief that the world is a dangerous place, nightmares, heightened arousal, hypervigilance, numbing, etc. - Normally, folks can get past this. Some people, however, cannot

traumatic event

1st gen of depression meds in the 1950s: _____________ ________________ -Block the serotonin transporter (SERT) and the norepinephrine transporter (NET), elevate synaptic concentrations. Used today for treatment-resistant depression, have antihistamine properties Dangers: Discontinuance Syndrome, Overdose exp: Tofrinal (imipramine hydrochloride

tricyclic antidepressants

We need to classify ___________ ________________ not just individuals

troubled relationships

which personality is linked to stress because of high levels of anger, easily annoyed

type a

UNIPOLAR or BIPOLAR: -later onset -more prevalent among women

unipolar

1/3 to 1/2 of those with panic disorder have panic disorder ______ agoraphobia

with

prevalence for major depression: -2-3 times as likely in __________

women

10% of _______ and 5% of ________ experience PTSD

women; men

uncontrollable negative thoughts of possible future threats or dangers -self talk that is self initiated -not helpful

worry