Abnormal Psych Exam 2

fear

CNS’s psychological and emotional response to a serious threat to one’s wellbeing

anxiety

CNS’s physiological and emotional response to a VAGUE sense of threat or danger

generalized anxiety disorder

disorder marked by persistent and excessive feelings of anxiety and worry about numerous events and activities

generalized anxiety symptoms

1. For 6 months or more, person experiences disproportionate, uncontrollable, and ongoing anxiety and worry about multiple matters

2. The symptoms include at least three of the following: edginess, fatigue, poor concentrations, irritability, muscle tension, and sleep problems

3. Significant distress or impairment

4. Excessive anxiety experienced under most circumstances

5. Worry about practically anything; free-floating anxiety

6. Reduced quality of life

separation anxiety

individuals with separation anxiety disorder feel extreme anxiety, often panic, whenever they are separated from key people in their lives

free association

the patient is encouraged to verbalize without censorship or selection whatever thoughts come to mind, no matter how embarrassing, illogical, or irrelevant

psychodynamic theories in GAD today

GAD can be traced to early parent child relationships

Humanistic perspective GAD

GAD arises when people stop looking at themselves honestly and acceptingly

client-centered therapy

used to show unconditional positive regard for clients and empathize with them

Sociocultural perspective on GAD

GAD is most likely to develop in people faced with dangerous ongoing social conditions or highly threatened environment

Freud’s Anxiety theory

all children experience some degree of anxiety and use ego mechanisms to control this; GAD occurs with high anxiety levels or inadequate defense mechanisms

Cognitive behavioral approach

problematic behaviors and dysfunctional thinking often cause psychological disorders

silent assumptions

beliefs about ourselves, other people, this life, and the world

phobia

intense and persistent fear, person will go to great lengths to avoid the object

specific phobia

an intense, irrational fear of something that poses little or no actual danger

agoraphobia

being out in open spaces and not being able to escape

specific phobia checklist

1. Marked persistent and disproportionate fear of a particular object or situation; usually lasting at least 6 months

2. Exposure to the object produces immediate fear

3. Avoidance of the fear situation

4. Significant distress or impairment

agoraphobia checklist

1. Pronounced, disproportionate, or repeated fear about being in at least two delineated situations

2. Avoidance of agoraphobia situations

3. Symptoms usually continue for at least 6 months

4. Significant distress or impairment

cognitive behavioral theory on phobias

1. Cognitive behavioral theories receive the most research support

2. Focus primarily on behavioral dimension

3. First fear of certain objects, situations, or events are learned through conditioning

4. Once fears are acquired, individuals avoid dreaded object or situation and permit fears to become entrenched

how are fears learned?

classical conditioning or modeling

research examples of classical conditioning on phobias

Little albert

research examples of modeling on phobias

bandura and rosenthal on bobo dolls

evolutionary view on phobias

1. Some phobias are much more common than others

2. Species-species biological predispositions to develop certain fears : preparedness

3. Explains why phobias (snakes, spiders) are more common

phobia treatments

systematic desensitization, flooding, modeling

systematic desensitization

relaxation training, fear hierchy, in vivo desensitization, overt desensitization

in vivo desensitization

live

overt desensitization

sending patient out into the world to experience their phobia (imagined of in reality)

flooding

1. Some fears need to be faced, whereas others aren’t as easy

2. Some fears become more intense with avoidance, flooding might help you understand how stupid the fear was

modeling

patient watches therapists confront the patient’s fear

agoraphobia treatments

exposure therapy

exposure therapy for agoraphobia

support groups, home-based self help programs

social anxiety disorder checklist

1. Pronounced, disproportionate, repeated anxiety about social situations in which the individual could be exposed to scrutiny by others; typically lasting 6 months or more

2. Fear of being negatively evaluated by or offensive to others

3. Exposure to social situations almost always produces anxiety

4. Avoidance of fear situations

5. Significant distress or impairment

cognitive behavioral view on SAD

1. Group of social realm dysfunctional beliefs and expectations held; anticipation of social disasters and dread of social situations

2. Avoidance and safety behaviors performed to reduce or prevent these disasters

3. Tied to genetic predisposition, trait tendencies, biological abnormalities, traumatic childhood experiences, overprotective parent-child interactions

treatments for SAD

medication (benzodiazepines or antidepressants)

cognitive behavioral therapy: exposure therapy and systematic therapy discussions

social skills and assertiveness training

panic disorder

experience panic attacks: periodic, short bouts of panic that occur suddenly, reach a peak within minutes, and gradually pass

panic attack features at lease 4 of the following symptoms:

1. Heart palpitations

2. Tingling in the hands or feet

3. Shortness of breath

4. Sweating

5. Hot and cold flashes

6. Trembling

7. Chest pains

8. Choking sensations

9. Faintness

10. Dizziness

11. Feeling of unreality

panic disorder checklist

1. Unforeseen panic attacks occur repeatedly

2. One or more of the attacks precede either of the following symptoms

   1. At least a month of continual concern about having additional attacks

   2. At least a month of dysfunctional behavior changes associated with the attacks (avoiding new experiences)

biological perspective on panic disorder

1. Initial theory: panic attacks caused by abnormal norepinephrine activity in locus coeruleus

2. More recent theory: brain circuits and amygdala are more complex root of the problem

3. May be inherited predisposition to abnormalities in these aras

4. Caused by hyperactive panic circuit

   1. Amygdala

   2. Hippocampus

   3. Ventromedial nucleus of hypothalamus

   4. Central gray matter

   5. Locus coeruleus

panic circuit

1. Amygdala

2. Hippocampus

3. Ventromedial nucleus of hypothalamus

4. Central gray matter

5. Locus coeruleus

cognitive behavioral perspective on panic disorder

Bodily sensations are misinterpreted as signs of medical catastrophe and controlled by avoidance and defy behaviors anxiety sensitivity may exist

OCD

obsessions and compulsions

obsessions

persistent thoughts, ideas, impulses, or images that seems to invade a person’s consciousness

compulsions

repetitive and rigid behaviors or mental acts that people feel they must perform or reduce anxiety

OCD checklist

1. Occurrence of repeated obsessions, compulsions or both

2. The obsessions or compulsions take up considerable time

3. Significant distress or impairment

themes in obsession

1. Violence and aggression

2. Orderliness

3. Religion

4. Sexuality

5. Dirt and contamination

themes in compulsions

1. Cleaning compulsions

2. Checking compulsions

3. Order or balance

4. Touching, verbalizing, and counting compulsions

OCD therapy

exposure therapy

stressor

an event that creates demand

stress response

persons reaction to demands

trauma and stress disorders

acute stress disorder and PTSD

fight or flight response

Features of arousal and fear are set in the hypothalamus

autonomic nervous system

an extensive network of nerve fibers that connect the CNA to all organs of the body

endocrine system

a network of glands that secrete hormones throughout the body

Two pathways where the ANS and the endocrine system produce arousal and fear reactions

1. Sympathetic NS

2. Hypothalamic pituitary adrenal pathway

sympathetic nervous system

activates to speed up your heart rate, deliver more blood to areas of your body that need more oxygen or other responses to help your get out of danger

HPA axis

mediates the effects of stressors by regulating numerous physiological processes, such as metabolism, immune responses, and the autonomic nervous system (ANS)

acute stress disorder

fear and related symptoms begin within four weeks of the event and last for less than one month

Symptoms of PTSD and acute stress disorder have almost identical symptoms (timing is what differentiates them)

1. Increased arousal, anxiety and guilt

2. Re-experiencing the traumatic event

3. Avoidance

4. Reduced responsiveness and dissociation

checklist for acute/PTSD

1. A person is exposed to a traumatic event

2. A person experiences at least one of the following symptoms

   1. repeated, uncontrolled, and distressing memories

   2. Repeated and upsetting trauma-linked dreams

   3. Dissociative experiences such as flashbacks

   4. Significant upset when exposed to trauma-linked cues

   5. Pronounced physical reaction when reminded of the event

3. The person continually avoids trauma-linked stimuli

4. The person experiences negative changes in trauma-linked cognitions and moods such as being able to remember key features of the event or experiencing repeated negative emotions

5. The person displays conspicuous changes in arousal or reactivity, such as excessive alertness, extreme startle responses or sleep disturbances

6. The person experiences significant distress or impairment with symptoms lasting more than a month

triggers for acute/PTSD

1. Combat: shell shock, combat fatigue

2. Disasters and accidents

3. Victimization: rape and sexual assault

4. Terrorism

5. Torture 

PTSD

fear and related symptoms may begin either shortly after the event or months or years afterward

biological factors of acute/PTSD

brain body stress routes, stress circuit, inherited predisposition

cognitive factors in acute/PTSD

Preexisting memory impairments, intolerance of uncertainty, inflexible coping style, and negative world view versus resilience

developmental psychopathology perspective on acute/PTSD

1.  the intersection of important variables at key points in someone's life

   1. Inherited biological predisposition for over-reactivity in brain-body stress routes and dysfunction in brain stress circuit

   2. Overactive stress routes can contribute to coping via protective factors 

treatment for acute/PTSD

1. About ⅓ of all PTSD cases improve within a year

2. General goals: end lingering stress reactions, gain perspective on painful experiences, return to constructive living

combat veterans

1. Antidepressants drug therapy

2. Cognitive behavioral therapy

   1. Cognitive processing therapy

   2. Mindfulness-based techniques

   3. Exposure techniques; prolonged exposure

   4. Eye movement desensitization and reprocessing

3. Couple or family therapy: for spouses and children

4. Group therapy: small veterans outreach programs

5. Community interventions: 

   1. psychological debriefing: crisis intervention in which victims of trauma talk extensively about their feelings and reactions within days of the critical incident

   2. psychological first aid 

dissociative disorder:

1. a group of disorders triggered by traumatic events

   1. When changes in memory lack a clear physical cause

   2. One part of the person's memory typically seems to be dissociated or separated from the rest

dissociative amnesia

Inability to recall information usually of an upsetting nature about one’s life; Often the amnesia episode is directly triggered by a specific upsetting event

dissociative fugue

a temporary state where a person has memory loss (amnesia) and ends up in an unexpected place; an extreme version of dissociative amnesia

1. People not only forget the personal identities and detail of their past, but also flee to an entirely different location

2. May be brief or more severe

checklist for dissocialtive amnesia

1. Person cannot recall important events in life typically stressful info

2. Leads to significant distress or impairment

3. Symptoms are not caused by a substance or medical condition

types of dissociative disorders

localized, selective, generalized, continuous

localized

Most common type; loss of all memory of events occurring within a limited period

selective

Loss of memory for some, but not all, events occurring within a period

generalized

Loss of memory beginning with an event, but extending back in time; may lose the sense of identity; may fail to recognize family and friends

continuous

Forgetting continues into the future; quite rare in cases of dissociative amnesia

dissociative identity disorder

(multiple personality disorder): subpersonalities, alternate personalities

DID checklist

1. Person experiences a disruption to his or her identity as reflected by at least two separate personality states or experiences of possession

2. Person repeatedly experiences memory gaps regarding daily events, key personal information, or traumatic events, beyond ordinary forgetfulness

3. Leads to significant distress or impairment

4. Symptoms are not caused by a substance or medical condition

symptoms of DID

1. Two or more district personalities

2. Each has a unique set of memories, behaviors, thoughts, and emotions

   1. Some sub-personalities can play instruments, some wear glasses, some have great talents

3. Sudden movement from one subpersonality to another (switching) is usually triggered by stress

4. Women are diagnosed more than 3x more than men

5. Subpersonality interaction/ differences

Mutually amnesic relation

identities are not aware of each other

Mutually cognizant patterns

all identities are aware of each other

One-way amnesic relation

certain personalities know of others, but some are unaware of the alternate identities, there is a main identity 

subpersonality differences

1. Identifying features

   1. Glasses 

2. Abilities and preferences

   1. Some can speak foreign languages and others can’t 

3. Physiological responses

   1. Blood pressure, heart rates, cholesterol levels

new theories on dissociative disorders

people self-hypnotize so they don't have to experience the trauma

psychodynamic theory on DID

1. dissociative disorders are caused by repression

   1. People fight off anxiety by unconsciously preventing painful memories, thoughts, or impulses from reaching awareness

   2. Dissociative amnesia and fugue are single episodes of massive repression

   3. DID results from a lifetime of excessive repression, motivated by very traumatic childhood experiences

treatments for DID

1. Psychodynamic therapists guide patients to search their unconscious and bring forgotten experiences into consciousness

2. In hypnotic therapy, patients are hypnotized and guided to recall forgotten events

3. In drug therapy, intravenous injections of barbiturates are sometimes used to help patients regain lost memories

depersonalization-derealization disorder

The central symptom is persistent and recurrent episodes of depersonalization and/or derealization

depersonalization-derealization disorder triggers

extreme fatigue, physical pain, intense stress, substance abuse recovery; survivors of a life-threatening situation

depersonalization

feeling separation from own body

seeing self from the inside out; doubling

having mechanical, dreamlike, dizzy feelings

awareness that perceptions are distorted

derealization

feeling external world is unreal and strange

changing object shape or size

may see other people as robots

depersonalization-derealization disorder symptoms

persistent or recurrent, may cause considerable stress, may impair social relationships and job performance

depression symptoms

1. Emotional: hopelessness, anhedonia, sadness

2. Motivational: lack of drive, less spontaneous

3. Behavioral: sleeping more/less than usual, eating more/less than usual, amount of social interaction

4. Cognitive: self blame, hopelessness thoughts 

5. Physical: headaches, fatigue, etc.. 

DSM-5-TR depression types

1. Major depressive disorder

2. Persistent depressive disorder

3. Prementrual dysphoric disorder

major depressive episode symptoms

1. For a 2 week period, person displays an increase in depressed mood for the majority of each day and or a decrease in enjoyment or interest across most activities for the majority of each day

2. For the same 2 weeks, person also has at least three or four of the following

   1. Considerable weight changes

   2. Daily insomnia or hypersomnia

   3. Daily agitation or decrease in motor activity

   4. Daily fatigue or lethargy

   5. Daily reduction in concentration or decisiveness

   6. Daily feelings of worthlessness or excessive guilt about things they have done/not done (ruminating on past)

3. Repeated focus on death and suicides, a suicide plan or attempt

4. Significant distress and impairment 

MDD

1. Presence of a major depressive episode

2. No pattern of mania or hypomania

3. Episodic: symptoms tend to dissipate over time

4. Recurrent: once depression occurs, future episodes are likely

   1. Among people with a first depressive episode

      1. 15% report persistent depressive symptoms

      2. Half report at least one additional episode

persistent depressive disorder symptoms

1. Person experiences the symptoms of major or mild depression for at least 2 years

2. During the 2 year period, symptoms not absent for more than 2 months at a time

3. No history of mania or hypomania

4. Significant distress or impairment

types of depression

1. Reactive (exogenous) depression: external; event causes 

2. Endogenous depression: internal; genetic predisposition

Reactive (exogenous) depression

external; event causes

Endogenous depression

internal; genetic predisposition

depression modifiers

1. Severity: mild, moderate, severe

2. With anxious distress

3. With melancholic

4. With physical features

5. With seasonal pattern

6. Peripartum onset

Postpartum (peripartum) depression

Extreme sadness, despair, tearfulness, insomnia, anxiety, intrusive thoughts, compulsions, panic attacks, inability to cope, suicidal thoughts 

Postpartum (peripartum) depression causes

triggered by hormones, genetic predisposition, psychological and social change