Abnormal Psych Exam 3 Review

Factors that increase general risk for any anxiety disorder:

-behavioral conditioning -genetic vulnerability -disturbances in the activity in the fear circuit of brain -decreased functioning of GABA and serotonin; increased norepinephrine activity -increased cortisol awakening response -behavioral inhibition -neuroticism -cognitive factors, including sustained negative beliefs, perceived lack of control, over-attention to cues of threat, and intolerance of uncertainty

Mowrer's two-factor model of behavioral conditioning:

1. Phobias are a conditioned response to threat (classical conditioning) 2. Sustained by avoidant behavior (operant conditioning - negative reinforcement) *does not explain everything

Treatment of phobias and social anxiety:

1. social skills training 2. systematic desensitization 3. cognitive therapy

Karen reported a lack of energy, difficulty sleeping, eating less than usual, difficulty concentrating, and a loss of interest in activities she previously enjoyed. According to DSM-5, how long must she experience these symptoms to meet criteria for a major depressive episode?

2 weeks (1 week for manic)

In order to be diagnosed with Persistent Depressive disorder using the DSM-5, persons must be generally experience symptoms (more days than not) for a period of at least ______________.

2 years

More than ________ of people with one anxiety disorder meet the criteria for another anxiety disorder at some point in their lifetime.

50%

Symptoms for anxiety disorders must last for how many months in order to diagnose (except for panic disorder)?

6 months

Which of the following best describes hypomania?

A less severe form of mania.

What general conclusions can be reached based on available research on the effectiveness of anti-depression medications?

A. The effectiveness of different types of anti-depressants (e.g., SSRI, SNRI) are about the same D. This area of research is limited by a lack of long-term follow up and publication bias. (Both A and D)

Medications used to treat anxiety disorders:

Anxiolytics (minor tranquilizers - Benzodiazepines, can be addictive) and Antidepressants (SSRIs and SNRIs favored) (Antidepressants favored, psychotherapies favored over medications)

Which of the following is characteristic of a major depressive episode but not of a manic episode? A. Changes in activity or energy level B. Anhedonia (i.e., lack of interest in pleasurable activities) C. Changes in sleep patterns D. Problems with concentration (i.e., distractibility) E. Elevated, expansive mood

B. Anhedonia (i.e., lack of interest in pleasurable activities)

Which of the following statements is true of people with major depressive disorder (MDD) as compared to those without MDD?

B. They are more likely to have self-defeating attributional styles. C. They are more likely to be deprived of positive reinforcers that produce pleasure or positive emotions. (Both B and C) also MORE likely to engage in rumination

Which of the following has NOT been proposed as a way that the development of anxiety through conditioning (i.e., the extension of Mowrer's model) could take place? A. direct experience B. repressed memories C. seeing someone else harmed (modeling) D. verbal instruction

B. repressed memories

Safety behaviors

Behaviors used to avoid experiencing anxiety in feared situations, such as the tendency of people with social phobia to avoid looking at other people (so as to avoid perceiving negative feedback) or the tendency of people with panic disorder to avoid exercise (so as to avoid somatic arousal that could trigger a panic attack).

The DSM-5 recognizes which of the following forms of bipolar disorders?

Bipolar I, Bipolar II and Cyclothymia

Juan experiences symptoms of sad mood, increased sleep, agitation, poor appetite, and concentration difficulties most of the day. Julia, on the other hand, has symptoms of loss of interest in activities, lethargy, increased appetite, feelings of worthlessness, and recurrent thoughts of death. What can be concluded regarding Juan and Julia?

Both Juan and Julia have major depression.

Studies comparing the effectiveness of medication vs. cognitive therapy have resulted in several important findings. Which of the following is false regarding the conclusion presented in the textbook? A. Combining psychotherapy and antidepressant medications increases odds of recovery over either treatment alone by 10-20%. B. Medication tends to work more quickly in terms of symptom relief, but cognitive therapy has more long-lasting benefits (e.g., protecting against future relapse). C. For severe depression, cognitive therapy is not as effective (i.e., helpful) as medication. D. For severe depression, cognitive therapy is as effective as medication.

C. For severe depression, cognitive therapy is not as effective (i.e., helpful) as medication.

All of the following medications are used as mood stabilizers for Bipolar disorder except for ___________. A. Lithium B. Depakote C. Tofranil D. Tegretol E. Klonopin

C. Tofranil

Which of the following is a chronic enduring form of Bipolar disorder?

Cyclothymic disorder

Which of the following statements about ECT is false? A. The patient is given muscle relaxers and is heavily sedated. B. A seizure is induced by applying electric current to the brain. C. Side effects include confusion and memory problems. D. Typically only one treatment (i.e., seizure) is required. E. It is used sparingly, and only when severely depressed patients are not getting benefits from medications.

D. Typically only one treatment (i.e., seizure) is required.

As presented in the text, there are several diagnostic subtypes or qualifiers used to better describe the nature of the depressed and manic episodes. However, the term ___________ is only for describing episodes of depression. A. psychotic features B. catatonic features C. postpartum onset D. melancholic E. seasonal

D. melancholic

Common SNRIs

Effexor, Cymbalta

Common Tricyclics

Elavil, Tofranil

Esketamine

FDA approved this recently for treatment-resistant (tried at least 2 other medications without success) depression that is similar to the anesthetic ketamine (illegal use - "special K"), taken with an oral antidepressant

Which of the following is true about phobias?

Fear of blood, bodily injury and injections are more likely to run in families than other specific phobias (e.g., fear of snakes, fear of thunderstorms)

Josie has panic disorder, while Herbie does not have an anxiety disorder. They are both shown pictures of sad and angry faces. The researchers studying Josie and Herbie's brain responses while they look at the pictures will most likely note that...

Josie's amygdala is more active than Herbie's.

Common mood stabilizers used to treat mania

Lithium, Depakote, Tegretol, Klonopin (antipsychotic meds also used to arrest severe manic episodes)

Mary M. reported a lack of energy, difficulty sleeping, loss of appetite, difficulty concentrating, and a loss of interest in activities she previously enjoyed. From this information, which of the following is the most likely diagnosis for Mary M.?

Major depressive episode

Which form of psychotherapy incorporates the concept of awareness (i.e., being in the present moment) and the Buddhist concept of acceptance?

Mindfulness-Based Therapy

Depersonalization (a feeling of being outside one's body) and Derealization (a feeling as if things weren't real) are common symptoms for what disorder?

Panic Disorder

Jenny began to have unpredictable, sudden attacks of anxiety and dread, and thus began to avoid public situations. Which disorder did Jenny probably have?

Panic disorder

Common MAO inhibitors

Parnate, Nardil

Common SSRIs

Prozac, Zoloft, Celexa, Lexapro

The slowing of thoughts and movements by those experiencing depression is called...

Psychomotor retardation.

Which neurotransmitter is implicated in the regulation of mood, sleep, appetite and pain receptivity?

Serotonin

SSRIs (antidepressant)

Serotonin Selective Reuptake Inhibitors

SNRIs (antidepressant)

Serotonin and Norepinephrine Reuptake Inhibitors (much newer than tricyclics)

What was the rationale behind the DSM-5 change in the name of the diagnosis "social phobia" to "social anxiety disorder"?

Social phobias tend to be more pervasive and cause more interference with daily routines than other phobias. (It is also true that many people with social phobias also meet criteria for Avoidant Personality Disorder but this is not why the name changed)

DSM-5 Anxiety Disorders:

Specific Phobias, Social Anxiety Disorder, Panic Disorder, Agoraphobia, Generalized Anxiety Disorder

According to your textbook, Abramson, Metalsky and Alloy's (1989) Hopelessness Theory places emphasis on attributions. Which of the following best describe how depression results according to Hopelessness Theory?

Stable and Global attributions of stressors (negative life events) can result in hopelessness/depression

Common Atypicals

Wellbutrin, Desyrel

Which of the following medications is an SSRI type of antidepressant?

Zoloft

Social Anxiety Disorder

a fear of social situations that involve exposure to the focused scrutiny of others, onset often in adolescence

Anxiety Sensitivity Index

a test that measures the extent to which people respond fearfully to their bodily sensations, high scores predict onset of panic attacks and anxiety disorders

Structures in brain's hyperactive fear circuit related to fear and anxiety:

amygdala (increased activity) and medial prefrontal cortex (decreased activity)

Major categories of specific phobias:

animal, natural environment, blood/injection/injury, situational, other

The difference between anxiety and fear is that...

anxiety is apprehension over an anticipated problem, while fear is defined as a response to immediate danger.

The worries of people with GAD...

are similar to worries of most people, just more excessive.

Amygdala

assigns emotional significance to encounters and involved in the conditioning of fear

An individual diagnosed with social anxiety disorder...

becomes extremely anxious when in certain situations that involve activities done in the presence of other people.

The form of psychotherapy for depression that aims to increase participation in positively reinforcing activities in order to disrupt the spiral of depression, withdrawal and avoidance is called _______________.

behavioral activation

Which of the following disorders has the highest heritability estimates (e.g., highest MZ twin concordance)?

bipolar disorder

Pleasure, motivation, and energy decrease in depression and increase in mania. This suggests neurological changes in the

brain's reward system

Panic attacks...

can occur in people who do not have panic disorder.

Cognitive factor for panic disorder:

catastrophic misinterpretations of somatic changes interpreted as impending doom, which increases anxiety/arousal and creates vicious cycle

Panic Disorder

characterized by frequent UN-cued panic attacks (sudden, intense episode of apprehension, terror, feelings of impending doom, physical symptoms, depersonalization, derealization, fears of going crazy, losing control, or dying)

Animal phobias typically begin in...

childhood.

Which of the following is a chronic, milder form of bipolar disorder?

cyclothymic disorder

Atypicals (antidepressant)

do not conform to the mechanisms listed above (e.g., Wellbutrin - inhibits Dopamine reuptake)

Neuroimaging (PET) studies of individuals with major depressive episodes have found evidence for

elevated activity in the amygdala and diminished prefrontal, hippocampal and striatal functioning see table 5.5 pg 135

Generalized Anxiety Disorder (GAD)

excessive, uncontrollable, and long lasting worry about minor things (worry = cognitive tendency to chew on a problem and to be unable to let go of it, common worries include relationships, health, finances, daily hassles) also includes difficulty concentrating, restlessness, tiring easily, irritability, and muscle tension, sleep disturbance, and typically begins in adolescence

To improve performance, when preparing for a test it is best for people to...

experience a small degree of anxiety.

The principle cognitive explanation for the etiology of agoraphobia is the...

fear-of-fear hypothesis.

In the cognitive view, which anxiety disorder develops when anxiety is reinforced by distracting people from other, more powerful negative emotions and images?

generalized anxiety disorder (contrast avoidance model)

Which of the following is NOT an anxiety disorder?

generalized fear disorder

Agoraphobia is characterized by a fear of...

having a panic attack in places in which escape would be difficult or embarrassing. (however, not all people with agoraphobia suffer panic attacks)

Which of the following puts people at greater risk for developing anxiety disorders?

having a perception that they have no control over their environment

Benzodiazepines used to treat anxiety disorders:

includes Valium, Xanax, Ativan, Halcion, which are GABA agonists

People who experience major depressive episodes are more likely to experience ___________ as compared to those without major depressive episodes.

increased cortisol levels

Tricyclics (antidepressant)

inhibit the reuptake of serotonin and norepinephrine (3 rings in chemical structure give it the name)

Classical conditioning of panic attacks in response to bodily sensations is called ___________.

interoceptive conditioning

Scott has bipolar disorder. Which medication is the most likely to be prescribed?

lithium carbonate

Risk factors and etiology of GAD:

low GABA activity, high rate of co-morbidity with other anxiety disorders, environmental and many cognitive factors

The most common disorder comorbid with anxiety disorders is ________________.

major depression

GABA

major inhibitory neurotransmitter

Locus coeruleus

major source of norepinephrine, neurobiological factor in etiology of panic disorder

"agora" is Greek for:

marketplace

After viewing tapes of monkeys apparently showing fear of snakes, lambs, and flowers, monkeys who viewed these tapes were only fearful of snakes. This provides only partial support for __________ but better support for __________.

modeling; prepared learning

Women are more likely to be diagnosed with anxiety disorders because they are more...

more willing to report their symptoms.

To be diagnosed with bipolar I disorder, a person...

must have had at least one episode of mania at some point in their lifetime.

Fear-of-fear hypothesis

negative thoughts about the consequences of experiencing anxiety in public, catastrophic beliefs that anxiety will lead to socially unacceptable consequences

High levels of Neuroticism predicts:

onset of anxiety disorder and depression

Mowrer's two-factor model of anxiety disorders involves classical conditioning and _________.

operant conditioning

Contrast Avoidance Model

people with GAD find it highly aversive to experience shifts in emotions, to avoid shifts they prefer a constant state of worry

MAO-Is (antidepressant)

prevent the monoamine oxidase enzyme from deactivating serotonin, norepinephrine and dopamine dietary restrictions (tyramine)

During Systematic Desensitization Therapy someone is asked to imagine situations that normally provoke anxiety, but while they are deeply relaxed. Relaxation is typically achieved by...

progressive muscle relaxation

Flight of ideas refers to...

rapid shifts in topics while speaking.

Neuroticism is best defined as the tendency to...

react to events with greater than average negative affect.

To meet the diagnostic criteria for Panic Disorder, panic attacks must be _________.

recurrent and un-cued, and involve at least 1 month of concern/worry about future attacks

Medial Prefrontal Cortex

regulates amygdala activity, involved in extinguishing fears, and processes anxiety and fear

In regard to panic, the locus coeruleus...

shows increased activity.

Behavioral inhibition observed in infants as young as 4 months predicts:

social anxiety in adolescence

Regina has had social anxiety disorder for several years. She is now trying to overcome her fears, but she is awkward, doesn't know how to strike up a conversation, frequently commits faux pas by avoiding eye contact, and struggles to respond effectively when given compliments. This is an illustration of...

social skill deficits in social anxiety disorder.

Behavioral inhibition is defined as the...

tendency to become agitated and cry when faced with novel stimuli.

Which of the following statements in true about social anxiety disorder?

to be diagnosed with social anxiety disorder, symptoms must be present for at least 6 months False: -social anxiety disorder is less common than panic disorder and agoraphobia -despite high levels of anxiety at time, social anxiety disorder typically does not result in any employment difficulties -people with social anxiety disorder have a very low risk of alcohol abuse or other drugs