Abnormal Psych Test 2

Monoamine oxidase inhibitors; Tricyclic antidepressants; Selective serotonin reuptake inhibitors; Electroconvulsive Therapy

(more)Evidence Supported Treatments for Depressive Disorders: (medications) -_____ _____ _____ (MAOIs): first developed -_____ _____ (TCAs): older class -_____ _____ _____ _____ (SSRI): newer class (most antidepressant prescribed today are in this category) -•Similar rates of efficacy across drugs -•Side effects: dry mouth, blurred vision, constipation, diarrhea, drowsiness, headaches, increased sweating, weight gain (patients really struggle with this), sexual dysfunction, sleep disturbance, etc -•3-4 weeks to reach therapeutic levels (effect is not immediate--so patient will seek out psychotherapy during the delay) -•Studies submitted to Food and Drug Administration (FDA) 1987-2004: --38 studies found positive findings --36 studies had neutral or negative findings (these have been suppressed/ignored) --*for every study that shows a positive outcome, there is one that show no or a negative outcome _____ _____ (ECT): -Most controversial treatment for MDD. -Only used for treatment-resistant severe MDD. -More effective than medications for severe cases. -Memory loss, headache, nausea, muscle aches, etc. -Induce momentary seizure by passing a 70-103 volt current through brain. --Bilateral (electrodes on both sides of head) --Unilateral (electrodes placed on one side of head)

shorter

Acute Stress Disorder (ASD): -Symptoms similar to PTSD -Duration _____ •Symptoms occur between 3 days and 1 month after trauma. -As many as 90% of rape victims experience ASD. -ASD predicts high risk of PTSD

most; 4; Phobias; social anxiety

Anxiety Disorders -One of the _____ common types of psychiatric diagnosis. (some estimate that 1 in every ____ adults have an anxiety disorder) -in a study of 8,000 adults in the United States, approximately 28% had an anxiety disorder. -•_____ and _____ _____ are particularly common. -All anxiety disorders have excessively intense or frequent anxiety. (not all anxiety disorders have fear) -Panic Disorder, Phobias, and Social Anxiety are distinguished by high fear as well as anxiety. *PIC: Signs of Anxiety (*avoidance* in the behavioral column is very common)

adolescence

Anxiety Disorders: -Social Anxiety Disorder: •More intense and extensive than shyness. •Persistent, intense fear and avoidance of social situations. •Fear of negative evaluation or scrutiny. •Exposure leads to anxiety about being humiliated or embarrassed socially. *more a fear of people judging than a fear of people per se -12-month prevalence: 7%. -Slightly more common in women. -Typically begins in _____.

7-9; More; bad experiences

Anxiety Disorders: -Specific Phobias- disruptive fear of a particular object or situation that is *out of proportion to any danger posed*. (the challenge with anxiety disorders is the feared thing COULD HAPPEN but it is very unlikely--it's more about decatastraphizing (this is what the person needs to do) --they have to learn to be ok with the fact that the fear could happen) (phobias are very easy to diagnose because we all dislike things, but we have to be careful when diagnosing--have to be sure it is truly a phobia) •Person recognizes that the fear is excessive, but still goes to great lengths to avoid. •Symptoms cause distress or interfere with social or occupational activities. •Avoidance behaviors. -12-month prevalence: ___-___% -_____common in women than men -Less common in older individuals -People with situational, natural and animal phobias tend to experience activation of fight-flight-freeze response vs. people with blood-injection phobias tend to experience vasovagal fainting. -specific phobias often result from _____ _____ -phobias are more likely to develop for things that COULD pose a threat (they are real threats, people just blow them out of proportion)-- that's why it is so difficult/tricky to treat --people can always say "but it could happen" Specific Phobia DSM-5 Criteria: -Marked fear or anxiety about a specific object or situation. -Object or situation almost always provokes immediate fear or anxiety. -Phobic object or situation is actively avoided. -Fear or anxiety is out of proportion to the actual danger. -Lasting for 6 months or more -Causes clinically significant distress or impairment. -Not better explained by another mental disorder. *PIC: Types of Specific Phobias *PIC: Names of Highly Unlikely Phobias

Panic Attacks; Panic Disorder; 2-3; adulthood

Anxiety Disorders: -_____ _____- sudden attack of intense apprehension, terror, and feelings of impending doom. (has lost some of its meaning; used out of context--most people use term incorrectly; it is like the state of anxiety on steroids) -_____ _____- frequent panic attacks that are unrelated to specific situations, worry about future panic attacks. (have panic attacks and have fear and worry of future panic attacks) (other disorders in the DSM-5 can have panic attacks as a symptom (they can co-occur with other forms of anxiety--don't have to diagnose both) Panic Disorder DSM-5 Criteria: -Recurrent unexpected panic attacks (abrupt surge of intense fear that reaches a peak within minutes and is associated with at least 4 of following symptoms). •Palpitations •Sweating •Trembling •Shortness of breath •Feelings of choking •Chest pain •Nausea •Feeling dizzy •Chills or heat sensations •Paresthesias (numbness) •Derealization •Fear of losing control/going crazy •Fear of dying -At least one attack has been followed by a month of persistent concern about future attacks or maladaptive changes due to attacks. -Not attributable to substance or another mental disorder. -12-month prevalence: ___-___% -Women twice as likely than men. -Low rates during childhood, peak is during _____.

Anxiety; Fear; Fear; Anxiety

Anxiety Disorders: -_____- apprehension over anticipated problems. --•Future threat. --•Worry about test next week. -_____- a reaction to immediate danger. --•Threat happening now. --•Intense feelings during shark attack. **KNOW DIFFERENCE between anxiety and fear There is some overlap between them, but typically... -_____ involves -•Arousal (autonomic nervous system activation) -•Thoughts of immediate danger -•Escape behaviors -_____ involves -•Muscle tension -•Preparation for future danger -•Cautious or avoidant behaviors

Worry; adolescence; 3

Anxiety Disorders: Generalized Anxiety Disorder (GAD) -chronic, excessive, uncontrollable worry. (someone that is constantly worrying-- chronic, excessive, uncontrollable worry about MULTIPLE things (can't just be one thing) that is not adaptive) •_____- cognitive tendency to dwell on a problem. •Not adaptable worry (excessive, uncontrollable, and long-lasting). •Tends to begin in _____. ("I've always been this way.") -12 month prevalence: ____% -Women twice as likely. -Begins in _____ and maintains into middle age, and then declines into old age. GAD- DSM-5: •Excessive anxiety and worry occurring more days than not for at least 6 months. •The person finds it hard to control the worry. •The anxiety and worry are associated with at least 3 of the following: 1) Restlessness 2) Being easily fatigued 3) Difficulty concentrating 4) irritability 5) muscle tension 6) sleep disturbance •Clinical significant distress or impairment. •Not attributable to substance or another mental disorder.

80; 75

Anxiety Disorders: Comorbidity: -____% of those with anxiety disorder meet criteria for another anxiety disorder. (there is a ton of overlap--is there a flaw here?) •Causes of comorbidity --Symptoms overlap! --Common etiological factors? --Low validity of the DSM? (this is a good example that the DSM-5 probably has flaws) **do we need to reformulate the way we diagnose anxiety?---although it isn't just comorbidity with other anxiety disorders but with other disorders in general) -____% of those with anxiety disorder meet criteria for another psychological disorder. *PIC: graph: past year prevalence of any anxiety disorder among U.S. adults *PIC: pie graph: past year severity of any anxiety disorder among U.S. adults *PIC: prevalence rate of anxiety disorders in epidemiological surveys

Specific phobias; Social anxiety; Panic; Agoraphobia; Generalized anxiety; objects; situations

Anxiety Disorders: DSM-5 Anxiety Disorders •_____ _____ •_____ _____ disorder •_____ disorder •_____ •_____ _____ disorder -DSM-IV-TR anxiety-based disorders have been divided into three chapters in the DSM-5 (DSM-5 made a huge change--PTSD and OCD used to be considered anxiety disorders BUT DSM-5 moved them to their own chapters): --Anxiety Disorders --Obsessive-Compulsive and Related Disorders --Trauma- and Stressor-Related Disorders *PIC: shows where the division/categorizing of the disorders happened -DSM-5 disorders differ from one another in types of _____ or _____ that induce fear, anxiety, or avoidance behaviors, and associated thoughts.

Classical; Operant

Anxiety Disorders: Etiology: Conditioning: -Two-factor model •Pairing of stimulus with aversive UCS leads to fear (_____ Conditioning). •Avoidance maintained through negative reinforcement (_____ Conditioning). -classical conditioning: association of 2 stimuli; helps us understand the development of anxiety disorders -avoidance: leads to the maintenance of anxiety disorders (operant conditioning) through negative reinforcement (the anxiety is removed when the person avoids) **need to know how classical conditioning helps in developing an anxiety disorders (phobias are easiest to explain) and how operant conditioning plays a part in maintaining it *PIC: percent of people reporting conditioning experiences before the onset of a phobia Conditioning: Extensions of the two-factor model: •Modeling --Seeing another person harmed by the stimulus. •Verbal instruction --Parent warning a child about a danger. •Those with anxiety tend to acquire fear more readily and are also more resistant to extinction.

Behavioral inhibition; Neuroticism

Anxiety Disorders: Etiology: Personality: -_____ _____ -•Tendency to be agitated, distressed, and cry in unfamiliar or novel settings as a child. -•Observed in infants as young as 4 months -•Predicts anxiety in childhood and social anxiety in adolescence. -_____ -•React with negative affect . -•Linked to anxiety and depression . -•Higher levels double the likelihood of developing anxiety disorders. Cognitive: (some disorders don't develop out of specific events) -Sustained negative beliefs about future. (more common for GAD; have negatives) thoughts/perspective; feeling like they have no control) •Bad things will happen. •Engage in "safety" behaviors. -Belief that one lacks control over environment. •More vulnerable to developing anxiety disorders. --Childhood trauma or punitive parenting may foster beliefs. -Attention to threat. •Tendency to notice negative environmental cues. •Selective attention to signs of threat. Prepared Learning: -Evolutionary preparation to fear certain stimuli. --Easily acquired fears. --Resistant to extinction. --Potentially life-threatening (heights, snakes, etc.).

70-90; behavioral

Anxiety Disorders: Treatment: Exposure: -All (or almost all) effective/evidence-based psychotherapies for anxiety disorders involve *exposure* (want to limit their avoidance) (exposure is extremely effective--the issue is getting people to commit (takes a lot of psychoeducation) •Face the situation or object that triggers anxiety. •Should include as many features of the trigger as possible. •Should be conducted in many settings.•___-___% effective. •Specific treatments do exposure in different ways and have different theories on why exposure works. •In vivo (real life), imaginal, virtual reality Evidence Supported Treatment Medications: -Not typically first-line treatments for Anxiety Disorders. (it's not getting at the core of what's going on, it's just relieving the physical symptoms) -Do not "cure" anxiety, used to relieve symptoms. -Most common medications (mostly for GAD) •Benzodiazepines •Anti-depressants •Beta-Blockers (e.g., propranolol) Evidence Supported Treatment Psychotherapy: -Cognitive Behavioral Therapy (focuses more on the _____ part for anxiety treatment) •Must target specific source of anxiety or fear. •May lead to discomfort, typically short-lived. (main concern is drop-out so that's why psychoeducation plays an important role) •Can be used in individual or group therapy. (can get more people through treatment faster in a group session) •Includes psychoeducation and relaxation training.(relaxation training could be an issue; could be seen as a form of avoidance; whereas if you got them to ride it out, the anxiety will go down) •Main components (which can stand-alone) (some of this)--Cognitive therapy: identifying, challenging, and then neutralizing unhelpful thoughts. (mostly this)--Exposure therapy: confronting fears and stopping avoidance. **PICS: rationale for CBT to treat anxiety disorders (cognitions and avoidance (behavioral)) **PIC: relaxation instructions *PIC: avoidance/fear hierarchy **PIC: unhealthy thoughts

Mania; 1-2

Bipolar Disorders -_____: state (not their typical level of function (not typically a long-lasting period)) of intense elation or irritability -•Loud and incessant remarks (jokes) -•Rapidly shift topics(flight of ideas) -•Become more social/intrusive -•Overly confident/grandiose -•Decreased need for sleep (feel rested after 3 hours) -•Reckless behavior (noticed more by other people in their life and not so much by themselves): speeding, overspending, sexual promiscuity -Manic episodes •Comes on suddenly(not gradual--it's a quick shift) (over ___-___ days) •Can't be the result of substance use (this is important/an issue of differentiating diagnosis because a lot of people with bipolar use substances (maybe because they don't like fluctuation or because they like the high) Manic episode: •Symptoms last for 1 week or require hospitalization(main concern is suicidality). (so it's either length of time or severity) •Symptoms cause significant distress or functional impairment Hypomanic episode: •Symptoms last at least 4 days. (shorter period of time or less severe) •Clear change in functioning that are observable to others, but impairment is not marked or severe. -*when diagnosing BP, one of the first steps is to determine whether the patient is experiencing manic or hypomanic episodes

20s; depression; Bipolar I

Bipolar Disorders: -Bipolar I: 12 month prevalence is .6% •Bipolar II: 12 month prevalence is .8% •Cyclothymic: 12 month prevalence is .4-1% •Onset is in early _____ (for most people; this is pretty consistent particularly with BP 1), but increasing diagnoses among children and adolescents. (BP1 is actually extremely rare in kids and adolescents-- so they made a new disorder: DMDD): --New diagnosis: Disruptive Mood Dysregulation Disorder ***•Equally common among men and women. --Women experience more _____ than men. •_____ is among the most severe forms of mental illness. (it is considered a serious mental illness (SMI) -- schizophrenia also falls into this category) --Hospitalization --Suicide --Unemployment --Medical conditions/poor health --psychosis

manic symptoms; unipolar

Bipolar Disorders: -Defining feature is _____ _____, sometimes alternating with episodes of depression. -These disorders differ in how severe (severity) and long-lasting (length) the _____ _____ are. •Bipolar I disorder •Bipolar II disorder •Cyclothymic disorder Bipolar Disorders •Called this because most people who experience mania will also experience depression (opposite poles) (two poles-- *BI*polar). •MDD used to be called "_____" mood disorder.

Hippocrates; Freud

Conversion Disorder (Functional Neurological Disorder): -Sensory or motor function impaired but no known neurological cause. •Vision impairment or tunnel vision •Partial or complete paralysis of arms or legs •Seizures •Coordination problems -_____ •Believed disorder only occurred in women. •Attributed it to a wandering uterus. Originally known as Hysteria (Greek word for uterus). -_____ •Coined term conversion •Unconscious conflict converted into physical symptoms. -Onset typically adolescence or early adulthood. -Onset often follows life stress (typically trauma-level stress) -Exact prevalence unknown, thought to be less than 1%. •More common in women than men. DSM-5 Criteria for Conversion Disorder: -One or more symptoms of altered voluntary movement or sensory function. -Incompatibility between symptoms and recognized neurological disorders. -Symptom is not better explained by a medical condition or mental disorder. -Distress or impairment.

mania; 20s; 4

DSM-5 Criteria for Major Depressive Disorder (MDD): *-depressed mood OR loss of interest or pleasure --symptoms are present nearly every day, most of the day, for at least 2 weeks ---not due to normal bereavement (***this WAS in the DSM-4 but it is NOT in the DSM-5; this means we can now officially diagnose MDD in people who are grieving) *-PLUS 4 (or more) of the following symptoms: --sleeping too much or too little --psychomotor retardation or agitation --poor appetite and weight loss, or increased appetite and weight gain --fatigue or loss of energy --feelings of worthlessness or excessive guilt --difficulty concentrating, thinking, or making decisions --recurrent thoughts of death or suicide -Causes clinically significant distress or impairment -Not attributable to physiological effects of a substance or medical condition -**There has never been an episode of _____ (this rules out bipolar disorder--one of the main ways to diagnose MDD is to rule out BD) MDD: -onset: can occur at any age, but peaks in _____ -variable course (what is looks like over time): looks different in different people; for some, never experience remission while for some, symptoms dissipate over time (episodic) -recurrent: once depression occurs, future episodes are likely (average number of episodes is _____) -gender: much more common in women, but no gender differences in symptoms, course, treatment response, or functional consequences (more commonly DIAGNOSED in women--maybe we are overly "capturing" women or not "capturing" men that have it)

Premenstrual Dysphoric

DSM-5 Criteria for _____ _____ Disorder: -In most menstrual cycles during the past year, at least five of the following symptoms were present in the final week before menses and improved within a few days of menses onset: -One (or more of the following) -•Affective lability -•Irritability -•Depressed mood, hopelessness, or self-deprecating thoughts -•Anxiety -One (or more of the following): -•Diminished interest in usual activities -•Difficulty concentrating -•Lack of energy -•Changes in appetite, overeating, or food craving -•Sleeping too much or too little -•Subjective sense of being overwhelmed or out of control -•Physical symptoms such as breast tenderness or swelling, joint pain, or bloating -Clinically significant distress and interference. -Not an exacerbation of another disorder (MDD, personality disorder). -Not attributable to substance or medical condition. --this is new to the DSM-5; there is no scientific evidence that this is a thing (it is pathologizing the human experience); PMS (which is basically this) is normal (common), NOT abnormal---not a disorder!! -treatment: medication ---this is leading to inappropriate treatment/use of medication (which can have negative consequences)

Persistent Depressive

DSM-5 Criteria for _____ _____ Disorder: (milder, more chronic form of MDD) *-Depressed mood for at least 2 years (1 year for kids). *•PLUS 2 (or more) other symptoms: --Poor appetite or overeating. --Sleeping too much or too little. --Poor self-esteem. --Trouble concentrating or making decisions. --Feelings of hopelessness. ----*has many of the same symptoms as MDD •Never been without the symptoms for more than 2 months during the 2 years. •No manic episodes. (rule out bipolar) •Not better explained by other mental disorders, substance or medical condition. •Cause clinically significant distress and impairment.

Major Depressive; Persistent Depressive; Disruptive mood dysregulation; Premenstrual dysphoria

DSM-5 Depressive Disorders: -_____ _____ Disorder -_____ _____ Disorder -_____ _____ _____ -_____ _____ The main differences among the disorders: -duration -timing -presumed etiology (the assumed cause)

Derealization; Depersonalization; Depersonalization; Derealization

Depersonalization/Derealization Disorder: -Person's perceptions or experiences are altered. •_____- sense of reality of the outside world is temporarily lost. •_____- sense of one's own self is temporarily lost. -Unlike the other dissociative disorders, there is no disturbance of memory. _____: •Lose sense of self. •Unusual sensory experiences. --Limbs feel enlarged. --Voice sounds different. •Feelings of detachment or disconnection. --Observing yourself. _____: •World has become unreal. --World appears strange, peculiar, foreign, dream-like. --Objects appear different in size, at times flat. --Incapable of experiencing emotions. --Feeling as if they were dead, lifeless.

2/3

Depressive Disorders: Comorbidity -•Most common include anxiety disorders, substance-related disorders, sexual dysfunction, and personality disorders. -•_____ of people with MDD will meet criteria for an anxiety disorder at some point. (*if we need so many categories to capture all people, maybe the categories are flawed (issue with the DSM))

7; 3x

Depressive Disorders: Prevalence Rates: •Major Depressive Disorder --12-month: _____% --Women 1.5-3x higher rates (more likely to be diagnosed) --Young adults ____ higher than older adults •Persistent Depressive Disorder --12-month: 0.5-1.5% •Premenstrual Dysphoric Disorder --12-month: 1.8-5.8% (THIS IS AN ESTIMATE!! --this is almost positively an UNDERestimate)

Explicit; implicit; explicit; implicit

Dissociative Amnesia: -Partial or total inability to recall important personal information. (typically related to traumatic experiences) -Forgetting that is too extensive to be explained by forgetfulness. -Not due to physical injury. -May last hours or years. *-The information is not permanently lost. (they have the memory, they just can't recall it) -Typically the person only forgets aspects or specific parts of a traumatic event. -Other than the amnesia, the person's behaviors are typical. -Total amnesia- person does not recognize family and friends, but retains the ability to talk, read, reason and perform talents. (this is extremely rare; "memory of life" is gone) -Need to rule out other common causes of memory loss: •With dementia the memory loss occurs over slowly time and is not linked to stress (because of this, dementia is pretty easy to rule out; also because it is typically in older patients). •With substance abuse the memory loss occurs immediately after the substance use or with chronic substance use. (this is also pretty easy to rule out) •With PTSD, people may forget aspects of the trauma, but memory loss is restricted to only the time of the trauma. (this is harder to rule out) -_____ Memory •Conscious recall of experiences. •Describing a bicycle you had as a child. -_____ Memory •Underlies behaviors based on experiences that are not consciously recalled. •How to ride a bike. -Dissociative disorders is associated with deficits in _____, not _____ memory.

neuroses; Anxiety; Dissociative; Somatoform

Dissociative Disorders and Somatic Disorders: (these are very controversial disorders) Dissociative & Somatic Symptom: -All of these disorders were previously called _____. •_____ was thought to be the primary cause. -In DSM-III, these disorders were separated from the anxiety disorders and split into 2 categories (dissociative and somatic) --If these are two different diagnostic categories, then why are they in the same lecture? --•Onset of both related to stressful experience. (stress is not a requirement but it is a risk factor) -Differences: •_____- disruptions of consciousness. •_____- complaints of bodily symptoms. -We know the least about these disorders. -A lot of debate and controversy. (there's very little scientific evidence--this leaves more room for each clinician to have their own opinions) -Very little empirically based information (etiology, assessment, treatment).

Dissociative amnesia; With dissociative fugue; Depersonalization/derealizations; Dissociative identity disorder

Dissociative Disorders: -_____ _____- memory loss, typically (not always) of a stressful experience. •_____ _____ _____-accompanied by leaving home and establishing a new identity. -_____/_____- alteration in the experience of the self or of the world. -_____ _____ _____- two or more distinct identities that alternate taking control of the individual.

multiple personality disorder

Dissociative Identity Disorder (DID): (probably the most controversial disorder and one of the most controversial of all DSM disorders) -Patient manifests two or more distinct identities or personality states that alternate in taking control of person. -Formerly called _____ _____ _____. (the reason they moved away from this language is because personality is typically thought of as a more permanent thing) -The disorder usually starts in childhood. -•Is chronic and recurrent .•More severe than other dissociative disorders. •Recovery may be less complete. -More frequent in women (3-9 times). •Females have more average identities (15-18 identities). -Average of 6-7 years between first symptoms and diagnosis. (this stands out to many clinicians as fishy) •Not normally diagnosed until adulthood. -Failure to integrate various aspects of identity, memory, and consciousness. -Personalities may have distinct personal history, self-image, identity. •May include name, age, gender, vocabulary, general knowledge, predominant affect, interests, etc. -There is a primary identity. •Not typically aware of other personalities or their actions/thoughts. -How do the identities interact? •May be in conflict, deny existence of others, or be critical. •Aggressive personalities may interrupt other identities in uncomfortable situations. •"protector personalities" (usually have more complete memories/have access to more information). -Transitions between alters •Triggered by psychosocial stress. •Within matter of seconds. •Rapid blinking, facial changes, changes in voice or demeanor, disruption in train of thought. (might be some physical indication that the transition is happening) -May have from 2 to more than 100 personalities. •Half of cases have 10 or fewer. **BIGGEST QUESTION: What is it? Are we defining it properly?

Biological; Psychological

Etiology of Depressive and Bipolar Disorders: -What factors contribute to onset of mood disorders? •_____ •_____

Negative schema; Negative triad; Stable/global

Etiology of Depressive and Bipolar Disorders: Psychological Factors: -Stress (it's likely that this isn't causal, but it might increase risk) -•Loss of a loved one, relationship difficulties, etc. -•Not sure if stressors are result or cause of depression/mania. -•42-67% of people with depression report a serious stressor in the year before onset. -•Plays a role in mania and depression symptoms. -Cognitive theories: Beck's Theory (this is really the only risk factor that is consistently presented and it can be treated) --_____ _____: underlying tendency to see the world negatively --_____ _____: negative view of self, world, future --Attributional Style: *_____/_____* (this is what we worry about) attributions can cause hopelessness -**PIC: example of attributions: "Why I failed my GRE Math Exam"

anti-depressants; Depression; Mania; sensitivity

Etiology of Depressive and Bipolar Disorders: Biological Biological Factors -Neurotransmitters (this theory is driven by pharmaceutical companies because it helps them sell medication) •Norepinephrine, Serotonin, Dopamine •Monoamine theory of depression grew out of success of _____ (originally designed for tuberculosis). •Original models focused on absolute levels -_____: Low levels of norepinephrine, dopamine, and serotonin. -_____: High levels of norepinephrine and dopamine, low levels of serotonin. Newer models focus on _____ of postsynaptic receptors •Dopamine receptors may be overly sensitive in BD but lack sensitivity in MDD. •Individuals who are vulnerable to depression may have less sensitive serotonin receptors (Sobczak et al., 2002). •But the results are very mixed •Also, evidence suggests that these changes may occur in response to medications. **we don't know what's really happening; we are jumping to conclusions that shouldn't necessarily be drawn; be skeptical of this

37; 93

Etiology of Depressive and Bipolar Disorders: Biological Factors: -Genetic factors (can give us a sense of risk but isn't a guarantee) •Heritability estimates --____% MDD (not that big) --____% Bipolar Disorder (very big!; environment contributes to a very small part of risk; this is one of the most heritable mental health disorders; we don't know what genes cause it though) •Research to identify specific genes has not been replicated (Kato, 2007). •potential gene: Serotonin-transporter gene (involved in transmission and reuptake of serotonin) --research suggests: Two short alleles associated with increased risk of MDD compared to two long alleles or one short/one long alleles. (this is a correlation--not all people with this have BD and vice versa)

Medication; Mood stabilizers; anti-depressants; anti-anxiety

Evidence Supported Treatments for Bipolar Bipolar Disorders: -_____ is the first line of treatment. (_____ are the most effective approach for serious mental disorders) -•Psychotherapy often used as supplement. -•But increasing evidence points to vital role of psychological intervention. -Psychoeducational approaches -•Provide information about symptoms, course, triggers, and treatments. -Cognitive Behavioral therapy -Family-focused treatment (FFT) --Educate family about disorder, enhance family communication, improve problem solving. **a big part of the therapy is to reinforce the idea that the patient needs to take their medication Medication: -_____ _____ (lithium, anticonvulsants, atypical antipsychotics). (need to be careful that this doesn't push patients into a depressive state --they do this by also prescribing antidepressants) -Supplemented by _____ and _____ medications. (some people believe that BD is going up because anti-depressant use causes MDD patients to get manic episodes) -Key is to find a combination that reduces occurrence of depressive and manic episodes without increasing risk of mood cycling.

cognitions; behavioral; Challenge maladaptive; Behavior Activation; Interpersonal Therapy

Evidence Supported Treatments for Depressive Disorders: -Cognitive Behavioral Therapy (CBT) -•Emphasis on _____ (there is less emphasis on the _____ part for depressive disorders) -•Negatively biased information processing and dysfunctional beliefs. -•Goal: _____ _____ thinking. -_____ _____ (can be used in conjunction to CBT) -•Goal: increase frequency and quality of positive activities. (get them to commit to small things and little successes) -_____ _____ (IPT) (differs from CBT in that it focuses on relationships) -•Symptoms are caused and maintained by interpersonal difficulties. -•Goal: resolve one or more of delayed grief, role transitions, role disputes, or interpersonal deficits. **PIC: CBT Decasttrophizing Worksheet (to help show/example what we mean by identifying and changing negative thoughts; this isn't easy.) (you have them come up with solutions/healthier thoughts; make sure it's realistic) **PIC: Behavioral Activation Worksheet (activity should be more specific than in sample) **PIC: Interpersonal Psychotherapy Timeline Example

66

Hoarding Disorder: -Prevalence: 2-6% -Cannot part with acquired (mostly worthless) objects. -____% are *unaware* (this differs from pretty much all of the other disorders) of severity of problem. -33% engage in animal hoarding. (animals typically aren't taken care of) -Severe consequences •Dirty living conditions •Health and physical hazards •Negatively impacts relationships

depressive; Depressive; manic; Bipolar

Mood Disorders: -there are 2 broad types: --1. disorders that have only _____ symptoms (extraordinary sadness and hopelessness) (_____ Disorders) --2. disorders that include _____ symptoms (intense and unrealistic feelings of euphoria) (____ and Related Disorders)

20

Obsessive-Compulsive Disorder (OCD): -Obsessions •Intrusive, persistent, and uncontrollable thoughts or urges. •Experienced as irrational •Most common: Contamination (germs--this is very common), sexual urges, and aggressive impulses. *the obsessions lead to the compulsions -Compulsions •Impulse to repeat certain behaviors or mental acts to reduce distress. (e.g., cleaning, counting, touching, checking) •May involve elaborate behavioral rituals. -12-month prevalence: 1.2% (not very common but extremely resistant to recovery) -Develops during late adolescence/early adulthood -1.5 times more common in women -OCD often chronic --•Only ____% fully recover (treatment is only fairly effective in reducing but not fully recovering)

repetitive thoughts; response; Obsessive-Compulsive Disorder; Body Dysmorphic; Hoarding; Trichotillomania; Excoriation

Obsessive-Compulsive Related Disorders: (theme: _____ _____ followed by some kind of _____) -_____-_____ _____ (OCD) •Repetitive thoughts and urges (obsessions) •Repetitive behaviors and mental acts (compulsions) -_____ _____ Disorder •Repetitive thoughts and urges about personal appearance -_____ Disorder •Repetitive thoughts about possessions -_____ (Hair-Pulling Disorder) •Recurrent pulling out of one's hair -_____ (Skin-Picking) Disorder •Recurrent skin picking

event

Posttraumatic Stress Disorder (PTSD): -Extreme and prolonged response to a severe stressor. (this is the only disorder in the DSM-5 that requires a particular _____ that occurred--this makes it unique) -Exposure to a traumatic event that involves actual or threatened death or injury. •e.g., war, rape, natural disaster -Symptoms present for more than a month. -Men experience more traumas, women have higher rates of PTSD. (not entirely sure why this is the case; might have to do with the fact that the type of trauma matters) -70% report experiencing trauma. (this is people in general) -9% of trauma survivors develop PTSD. (only 9% of the 70%) -Symptoms typically occur during 3-months after trauma.

Somatic symptom; Illness anxiety; Conversion; Factitious

Somatic Symptom Disorders: (these are less controversial than dissociative disorders, but they are not controversy free) (often present through PCP's and specialists) -Excessive concerns about physical symptoms. -Patients tend to use a lot of medical services ($). -Patients become distressed when doctors are unable to help them. -May change doctors a lot or complain about care. -Become upset when referred for mental health services. (can be challenging to work with because of their recent experiences with doctors) Somatic Symptom Disorders: -_____ _____ disorder -_____ _____ disorder -_____ disorder -_____ disorder

50-90; 90; 4; 3; Guns; white men; 50

Suicide: -Suicide rates are underestimated because some deaths are ambiguous. -•Deaths that are ruled accidents may have been suicides. (because originally life insurance policies wouldn't pay if it was a suicide--and this is still true with some insurances today; so if it is ambiguous, they rule it as not suicide out of respect for the family) -___-___% of people who complete suicide do so during a depressive episode or in the recovery phase (___% have a mental disorder--so NOT everyone!!). -Often occurs when the patient starts to feel better. (as people start to feel better, that's when they are at their highest risk. They are still depressed but they have the ability to plan and have energy to do things) -U.S. suicide rate is 1 per 10,000 -1 in 20 suicide attempts result in death -10-20% report suicidal ideations at least once in their lives -3-5% make at least one suicide attempt *PIC: Annual Deaths due to Suicides per 100,000 people -Men are ____ times more likely (highest risk is in older age range) than women to kill themselves. (except at a young age, women are more likely) -Women are ____ times more likely than men to attempt suicide. (men tend to use more lethal things) -_____ are the most common means of suicide in the US (60%). -Men tend to use guns or hang themselves, women are more likely to use pills. -Suicide rate increases in old age. -•Highest suicide rate is _____ _____ over age _____. (***OLDER MEN are at the highest risk for committing suicide!!!***) -Rates of suicide for adolescents and children are increasing, but still below adults. (*this is an increasing concern in psychology*)

Posttraumatic Stress; Acute Stress; Adjustment

Types of Trauma-Related Disorders: -_____ _____ Disorder -_____ _____ Disorder -_____ Disorder (Reactive Attachment Disorder and Disinhibited Social Engagement Disorder -- these are typically diagnosed in children. We will discuss these disorders in the childhood chapter.)

Fear

a reaction to immediate danger

Anxiety

apprehension over anticipated problems

Suicide attempt/behavior/gesture

behavior intended to kill oneself

Non-suicidal self-injury

behaviors intended to injure oneself without intent to kill oneself

Panic Disorder

frequent panic attacks that are unrelated to specific situations; worry about future panic attacks

etiology

risk factors associated with onset (in psychology we don't really/usually know)

Psychosis

significant loss of contact with reality

Panic Attacks

sudden attack of intense apprehension, terror, and feelings of impending doom

Suicide

taking one's own life

Suicide ideation

thoughts of killing oneself (can be specific or vague)

catastrophize

to view or talk about (an event or situation) as worse than it actually is, or as if it were a catastrophe