all psychopathology and mental health unit 2 exam study flashcards

terms for depression

depression, major depressive disorder (MDD), unipolar depression

DSM-V criteria for a major depressive disorder

must meet at least 5 of the following during the same 2-week period. at least one must be 1) depressed mood or (2) loss of interest or pleasure (anhedonia)

1. depressed mood most of the day, nearly every day, as indicated by self report of observations made by others — NOTE (in children or adolescents an be irritable mood)

2. markedly diminished interest or pleasure in all, or almost all, activities most of the day, nearly every day

3. significant weight loss when not dieting or weight gain, or decrease or increase in appetite nearly every day. (a change of more than 5% of body weight in a month)

4. insomnia or hypersomnia nearly every day

5. psychomotor agitation or retardation nearly every day (observable by others)

6. fatigue or loss of energy nearly every day

7. feelings of worthlessness or excessive or inappropriate guilt (which may be delusional) nearly every day

8. diminished ability to think or concentrate, or indecisiveness, nearly every day

9. recurrent thoughts of death (not just fear of dying), recurrent suicidal ideation without a specific plan, or suicide attempt or a specific plan for committing suicide

major depressive disorder criteria:

• at least one major depressive episode

• no manic or unequivocal hypomanic episodes

dysthymic disorder

low level mood for an extended period of time:

• depressed mood for at least 2 years

• never without these symptoms for more than 2 months within this 2-year period

• no major depressive episode during the first 2 years

• lifetime prevalence = 3%

lifetime prevalence of dysthymic disorder

3%

premenstrual dysphoric disorder (PMDD) — new DSM-5 diagnosis

for most menstrual cycles over the past year; 5 or more symptoms present during luteal phase that begin to remit following menses

prolonged grief disorder — new DSM-5 diagnosis

continued presence, for at least 12 months after the death of a loved one, of impairing symptoms associated w grief

unspecified mood disorder — new DSM-5 diagnosis

a residual category for presentations of mood symptoms that don’t meet full criteria for any of the disorders in either the bipolar of the depressive disorders diagnostic classes

depression and additional mood disorder specifiers: “with psychotic features”

depression w psychotic features = hallucinations or delusions; mood congruent; only happens during depressive episodes

depression and additional mood disorder specifiers: “chronic major depressive disorder”

depression that does not remit for > 2 years

depression and additional mood disorder specifiers: “seasonal affective disorder”

recurrent episodes with a seasonal pattern

• common pattern = when days get shorter / less light —> more depression

depression epidemiology:

• lifetime prevalence of MDD = 16-17%

• 16-17 year olds (adolescents) have the highest rate of MDD

• major depression is the leading cause of disability (10%)

• age onset = adolescence and young adulthood

  • earlier onset = more severe

birth cohort trend for depression

prevalence is much higher in recent generations

why? we dont know. maybe awareness, technology, etc?

gender and depression

MDD: 2x as common in women relative to men

why?

• women more liekly to present at health clinics, disclose feelings, seek treatment

• men more likely to deal w in more externalizing ways (ex alcohol use). women externalize ore

• rumination vs distraction

depression across cultures

universal phenomenon, but each culture expresses differently

• ex: china and japan: more likely to be described in terms of somatic complaints (sleeping problems, headaches, loss of energy, stomach issues)

depression recovery

remission = period of recovery

• full remission = at least 2 months with no significant depressive symptoms

• partial remission = some symptoms, but no longer meet full criteria

relapse = return of active symptoms

statistic: 50% recover in 6 months

depression environmental factors

• stressful life events

• lack of social support

• chronic stress

depression biological factors

• HPA axis

• genetic vulnerability

• brain function

• neurochemicals

depression psychological factors

• information processing bias

• cognitive distortions

• rumination

• personality / temperament

effects of uncontrollable stress on rats — depression study

• induces a condition that resembles depression

• depletion of: norepinephrine, serotonin, dopamine

HPA axis: hypothalamic pituitary adrenal axis

individuals with depression: release a lot more CRF (corticotropin releasing factor) from their hypothalamus which stimulates more cotricotropin release form anterior pituitary which stimulates more cortisol release from adrenal cortex.

cortisol released into bloodstream and supports fight or flight responses.

gene x environment interaction in depression

• serotonin transporter gene = 5HTTLPR

  • short (s) allele = associated w increased risk of depression

  • long (l) allele not associated

  • homozygous for short allele at greatest risk for depression, especially if experience high stress event

• twin studies: 30% increase with severity

  • 1/3 of risk is attributed to genetics

brain regions associated with depression

decreased functioning of:

• orbital frontal cortex (OFC): related to reward functioning and how we respond to

• ventral striatum: decision making functions and motor control

• dorsolateral prefrontal cortex: cognitive control

• Anterior cingulate cortex: selective attention

• hippocampus (volume): learning and memory

increased functioning of:

• amygdala: emotion and threat, fear

depression and reward

depressed individuals reacted less to both penalties and reward stimulus when compared to a normal control group. Shows reward center hypoactivation.

cognitive vulnerability to depression — why some individuals become depressed after stressful life events and some do not

• pervasive and persistent negative thoughts about the self

• pessimistic view of the environment

• these thoughts are activated by the experience of negative life events

becks’ negative cognitive triad

triad of the self, the world, and the future

early negative life experiences —> formation of dysfunctional beliefs —> critical incidents —> beliefs activated —> negative automatic thoughts ←→ symptoms of depression

cognitive distortions (becks negative cognitive triad)

• negative attribution style: internal, global, stable way of thinking ab the world; consistently views world in negative way or think that world views u in negative way

• negative schemata: tend to view the world negatively and process info in negative ways as a result

• rumination

negative automatic thoughts (Beck’s negative cognitive triad)

• emerge automatically; rapid duration

• not fully conscious

• often occur in shorthand

• not a result of deliberation, reasoning, or reflection

• reflexive

• difficult to turn off

• validity is accepted without question

• often precede a powerful emotion

treatment of depression

• cognitive therapy / CBT

• interpersonal therapy

• behavioral activation treatement (CBT)

• antidepressant medication

  • SSRI

  • SNRI

  • MAOI

  • TCA

• alternative treatments

  • ketamine / psilocybin

  • deep brain stimulation

  • electroconvulsive therapy (ECT)

  • transcranial magnetic stimulation (TMS) — prelim data shows that increasing prefrontal cortex activity can help w depression. however TMS doesn’t reach deep brain structures well like ECT

  • bright light therapy for SAD — shown to be just as affective as fluoxetine

cognitive therapy for depression

• focuses on identifying and replacing self-defeating thoughts with rational statements

• deal w current experiences

• effective for unipolar depression

interpersonal therapy for depression

• focus on current relationships and attempts to improve these relationships via building communication and problem solving skills

• idea: improved support system may improve depressive symptoms

behavioral activation treatment for depression

• plan positive activities; force individual to get up and go

• for indivs. who are severely depressed, just do one thing a week (ex. get out of bed and take a shower)

• works very well with meds. not as affective without combination w meds tho.

four classes of antidepressant medication

SSRI: selective serotonin reuptake inhibitor (** current pref method)

SNRI: serotonin and norepinephrine reuptake inhibitor

MAOI: monamine oxidase inhibitors

• inhibit enzymes that break down serotonin and norepinephrine

TCA: tricyclic antidepressants

• inhibit norepinephrine reuptake (also serotonin tho lesser)

SSRI specifics

• positive response: 50% or larger reduction of symptoms

• remission: complete and sustained recovery

• 50% of patients show a pos response following 3-5 wks of treatment

• prozac, paxil, zoloft

• (also used for anxiety, OCD, bulimia, borderline personality disorder)

• issues: nausea, insomnia, sexual problems

suicide relation to mental disorders

• vast majority of ppl w mental disorders do not die by suicide

• sociodemographic characteristics and stressful life events better predictors of suicide than mental disorders

• risk factors: ppl experience crises, violence, abuse, loss, or isolation. also vulnerable groups that experience discrimination; refugees

• at least 50% of suicides occur in the context of clinical depression

• 15-20% of depressed patients eventually commit suicide

• many other disorders (schizophrenia, alcoholism) associated w higher suicide risk

active vs passive suicidal ideation

active: “I want to kill myself”

passive: “I don’t want to be alive. It would be better if I wasn’t here”

epidemiology of suicide

• suicide rate: 12/100,000

• highest completion rate: white men over 50

• suicide rate increasing for: adolescents

• between 1960 and 1980, completion rate tripled for males 15-24 (doubled for females)

suicide attempts vs completions statistics

in general: attempts to completions ratio = 10:1

among adolescents = 100:1

ages 15-19: females make 3 times as many attempts

male attempts use more lethal/destructive methods

Durkheim’s classifications: the 4 types of suicides

• egotistic: individuals feel alienated and lost

• altruistic: sacrifice for society (“im a burden, im doing this for others”)

• anomic: breakdown of social order (“society is falling apart. this is my reaction”)

• fatalistic: unbearable life circumstances (“life is unbearable, this is the only solution”)

Schneidman’s common elements of suicide

1. purpose: to seek a solution

2. goal: cessation of consciousness

3. Cognitive state: ambivalence

4. Perceptual state: constriction

5. Interpersonal act: communication of intention

   • Not always the case, especially for adolescents. Often an impulsive component

6. Pattern: consistency of lifelong styles

psychosocial factors associated with suicide

• impulsivity

  • one of the main predictors of a suicide attempt. strongly associated w increased attempts compared to ideation

• aggression

• pessimism

• family psychopathology or instability

• genetics

• sociocultural factors

prevalence of suicidal ideation

• 24% of high school girls and 15% of high school boys have serious suicidal thoughts

• suicidal thoughts especially common amongst depressed adolescents

warning signs for student suicide

• depressed and withdrawn

• lowered self esteem

• deterioration of personal hygiene

• loss of interest in studies

• communication of distress

• students who have completed suicide attempts:

  • tend to be doing well in school

  • have low self esteem if academics are involved

  • have compromised interpersonal relationships

  • some significant life event / stressor

predictors of suicidal ideation in students: sex specific effects

men and women:

• felt depressed and hopeless during the last year

men specifically:

• experienced assault in the last year

women:

• 30 days of alcohol consumption

• sexually assaulted

Klonsky’s Framework: From ideation to action (suicide)

• two stages of suicide: ideation, attempts

• different explanations for the two stages

  • pain, connectedness, and means

  • only when your have significant pain, significant loss of connectedness, and the means to do so, do you go from ideation to attempt

• most people (~40%) with suicide ideation do not attempt

• things that predict ideation do not always predict attempts

Thomas Joiner’s approach to suicide:

• “perceived burdensomeness”

• “thwarted belongingness” (social isolation)

• acquired ability to inflict lethal self injury

mood disorder

an umbrella term that encompasses unipolar and bipolar disorders

disorders made up of episodes:

• depressive episodes

• manic episodes

• hypomanic episodes

• mixed episodes

mood disorders are made up of episodes

• depressive episodes

• manic episodes

• hypomanic episodes

• mixed episodes

the manic-depressive spectrum

bipolar I criteria

• at least one full manic (or mixed) episode

bipolar II criteria

• at least one major depressive episode

• at least one hypomanic episode

  • no manic episodes

cyclothymia / cyclothymic disordercriteria

• no manic or major depressive episodes for at least 2 years

• rapid fluctuations in mood, but minor fluctuations (never the extremes of full manic or depressive episode)

• lacks severe symptoms and psychotic features of bipolar

• much less prevalent

criteria for a manic episode

• a period of elevated, expansive, or irritable mood

• lasts at least a week

• at least 3 of the following: DIG FAST mnemonic

  • Distractibility

  • Irresponsibility / irritability — excessive risky pleasure seeking

  • Grandiosity

  • Flight of ideas

  • Activity — goal directed / agitation

  • Sleep decreased

  • Talkativeness — disorganized

• characterized by significant distress or impairment

• often some psychotic symptoms — most often grandiosity

prevalence of mood disorders

• depression = 16-17%

  • dysthymia = ~3%

• bipolar = ~4%

  • bipolar I less prevalent than bipolar II

  • cyclothymia = ~1%

epidemiology of bipolar disorder

• occurs equally btwn males and females

• age of onset: 22 years old avg. ( adolescence or young adulthood )

• days depressed vs days manic: 3 times as many days are depressed as are manic/hypomanic

unipolar vs bipolar comparison

Unipolar:

• Later onset

• More prevalent in women

• Responds to psychotherapy alone, tricyclic or SSRI antidepressant drugs alone, or combination

Bipolar:

• Earlier onset

• Equal prevalence among men and women

• Responds best to lithium carbonate or other mood stabilizers; does NOT respond to psychotherapy alone

environmental risk factors — bipolar disorder

• Stressful life events (HPA axis alteration)

• Goal attainment (high)

• Schedule disruption

  • Very important risk factor for relapse.

• Lack of sleep -- more unique to manic.

  • Not only are they sleeping less. During manic episodes, also say that they require less sleep

  • Also common that prior to the manic episode, they notice they are getting less sleep

biological risk factors — bipolar disorder

• Genetic vulnerability

  • Bipolar is HIGHLY HERITABLE — even moreso than schizophrenia

• Brain function

psychological factors — bipolar disorder

• cognitive distortions

• grandiose thinking

genetics and bipolar disorder

• twin studies found bipolar to be highly heritable (High MZ concordance rates)

• genome-wide association study (GWAS) finds CACNA1C gene snp associated with bipolar

  • gene codes for subunit of the L-type calcium channel involved in general action potentials. associated w increased rates of bipolar

brain function associated with bipolar (reward circuitry)

• hypoactivation of reward circuit to small gains

• hyperactivated amygdala: heightened emotional state → mania

• hypoactivated hippocampus and prefrontal cortex: decrease in rational decision making

• ppl w mania require more stimulation to get activation of their reward system (Right ventral striatum)

treatment of bipolar disorders

lithium:

• effective for mania

• 40% do NOT improve

• side effects that lead to → noncompliance

anticonvulsants:

• tegretol, depakene

• ~50% respond

• used for rapid cycling

• less severe side effects (gastrointestinal)

psychotherapy:

• can supplement medication

• NOT effective alone

• cognitive therapy

• combo of psychotherapy and medication works better than medication alone!!

anxiety disorders

• specific phobias

• social phobia

• panic disorder and agoraphobia

• generalized anxiety disorder

• OCD and OCD related disorders

fear vs anxiety

fear = a normal, immediate reaction to an environmental stimulus

• rxn to real, experienced danger

• intensity builds quickly

• helps behav responses to threats

anxiety = not as immediate, more of a period of that feeling. can be irrational or unprovoked

• anticipation of future problems

• general / diffuse emotional reactions

• emotional experience is disproportionate to the threat

commonality across all anxiety disorders?

• failure to habituate: anxious feelings dont go away, person does not get used to situation. anxiety levels stay high even after much time has passed

lifetime prevalence of anxiety disorders

• any anxiety disorder = 28.8% lifetime prevalence

• most common disorders = social anxiety and specific phobia

social factors - anxiety disorders

• stressful life events

  • involving danger, deprivation of resources, insecurity, family, discord

  • in contrast, depression stressful life events involve LOSS

• childhood adversity

  • abuse, neglect

• exposed to more anxiety in parents

  • caregivers who are more anxious more likely to have kids that are more anxious (not necessarily genetics — behavior modeling)

biological factors — anxiety disorders

• genetics: nonspecific for mood and anxiety disorders

  • cant find lots of specifics. lots of comorbid btwn mood and anxiety disorders

• behavioral inhibition temperament

  • person has a more inhibited temperament

  • again, not v specific to anxiety

the amygdala — anxiety disorders

amygdala = fear and emotions

• increased amygdala activity associated w increased anxiety reaction, especially w specific phobia

the insula — anxiety disorders

• connected to autonomic nervous system

• critical for interoception: how we interpret our bodily sensations (bodily perception) — some ppl more sensitive/intuitive of these than others

• increased activity of this brain region in anxiety

phobia

• Persistent, irrational, narrowly defined fears that are associated with a specific object or situation

• Characterized by avoidance and reactions that are irrational and unreasonable to the situation/object

types of phobia disorders

• specific phobia

• social phobia

• agoraphobia (**considered under panic disorder bc highly linked)

specific phobia DSM-5 criteria:

• marked and persistent fear that is excessive or unreasonable cued by the presence of anticipation of a specific object or situation

• exposure tho the phobic stimulus = immediate anxiety response (possible panic attack)

• phobic situation is avoided (or endured w intense anxiety and distress)

• fear, anxiety, or avoidance is persistent, typically lasts 6 months or more

• *avoidance or distress interferes significantly w the persons routine, occupational functioning, or social activities

DSM-5 specific phobia subtypes

• animal

• natural environment

• blood-injection-injury

• situational

• other

specific phobia epidemiology

• very common

• lifetime prevalence = 12%

• 3x more common in women than in men

• blood-injection-injury phobia occurs in ab 3-4% of pop

• age of onset varies widely typically bc there is some triggering event

etiology of phobias (risk factors)

• evolutionary adaptation: phobias may have been adaptive at some point in human history/development

• classical conditioning: phobia may be a result of repeated pairing of stimulus

preparedness theory of phobias:

• we are biologically prepared for associations / anxious responses

• prepared associations learned in one trial and are very difficult to extinguish.

• easy to condition fear to fearful objects (snakes, spiders, etc), but more difficult to condition neutral objects.

phobia treatments

• exposure therapy

  • may be paired w SSRI or something for the anxiety

  • many different forms, but often in a fear hierarchy

  • imagination, observation, virtual reality, viewing, touching, experiencing, etc

Social anxiety disorder (SAD)

level of fear of social situations that leads to impairment

• in education, employment, family relationships, marriage/romantic relationships, and friendships

DSM-5 criteria:

• marked and persistent fear of one or more social or performance situations

• fear of being scrutinized or embarrassing oneself

• feared situations are avoided or endured with great distress

• fears significantly interfere with funcitoning

subtypes of social anxiety disorder

specific: 1-3 feared situations

• most common form is fear of public speaking

• ex: eating in public, performing in public, etc

generalized: 4+ feared situations

• ex: eating in public, using bathroom, parties, maintaining conversations, meeting strangers, etc

prevalence of Social anxiety disorder

• lifetime: 12.1%

• 12 month prevalence: 6.8%

• rates higher in women (15.5%) than men (11%)

• early age of onset: childhood to mid-adolescence

• high comorbidity w other anxiety disorders, and depression

etiology (risk factors) of Social anxiety disorder

genetic risk:

• tendency toward high negative affect or low positive affect (—or—) low extraversion and high neuroticism levels

environmental risk factors:

• bullying in childhood — directionality unknown

• childhood neglect / abuse

• parenting style: maternal overprotection

Cognitive behavioral theory of Social Anxiety Disorder (Rapee and Heimberg)

thoughts = “i’m not good enough”

feelings = sadness and loneliness

behaviors = avoidance of social situations

• beliefs: negative self-evaluation; being liked is fundamentally important

• behaviors of hyper-vigilance

hyper-vigilance in social anxiety disorder

• heightened attention to signs of social threat / cues in the social environment

• hyperaware

• eye-tracking studies show that ppl w generalized social anxiety disorder are constantly scanning ppls faces a lot more than others

treatment — social anxiety disorder

medication:

• SSRI often prescribed need a constant treatment for the anxiety

• sometimes benzodiazepines

psychotherapy:

• group or individual CBT is most supported

• attention bias retraining

cognitive behavioral therapy:

• cognitive restructuring

• social exposures

  • fear hierarchy

  • work up towards higher feared situations

panic attack symptoms

**note: symptoms must peak in 10 minutes

• palpitations

• sweating

• trembling or shaking

• sensations of shortness of breath

• feeling of choking

• chest pain

• nausea

• dizziness

• derealization

• fear of losing control

• numbness

• fear of dying

• chills / flushes

relationship between panic attack and panic disorder

• first attack frequently follows distress of highly stressful life circumstances

• many adults who experience a single panic attack do not develop a panic disorder

  • 20% of college students have attack, but don’t develop disorder

• how you respond to the initial attack dictates whether or not one develops the disorder

DSM-5 criteria for panic disorder

• recurrent, unexpected panic attacks

  • sudden, overwhelming experience of terror or fright

  • more focused than anxiety

  • “false alarm”

  • common in other anxiety disorders too

• at least one panic attack followed by 1 month (or more) of 1 (or more) of the following

  • persistent concern about having another attack

  • worry about the implications of the attack

  • significant change in behavior related to the attacks

DSM-5 criteria for agoraphobia — highly linked to panic disorder

• anxiety about being in situations from which escape might be difficult or in which help might not be available if panic like symptoms develop

• hallmark feature: these situations are avoided or else endured with distress

• 80-90% of diagnoses are female

• range of severity associated w disorder

prevalence and course of panic disorders

• lifetime prevalence = 3.5% of adult pop

• twice as prevalent in females

• chronic: 50% recover in 12 years

• average age of onset = 23-24 years old

catastrophic misinterpretation — cognitive factors in panic disorder

• panic attacks are triggered by internal stimuli

• anxious mood leads to physiological sensations

• narrowed attention and increased awareness of bodily sensations

• person misinterprets bodily sensations as catastrophic event

• “fear of fear”

the panic circle — cognitive factors in panic disorder

trigger stimulus → perceived threat → worry → bodily sensations → interpretation of sensations as catastrophic → go thru circle again

panic disorder treatment

• 85% of ppl w panic disorders show up repeatedly at emergency rooms

interoceptive exposure therapy: helps u revisit those feared internal stimuli that u experience in a panic attack —- (exposure to feared bodily sensations associated w panic)

cognitive therapy: target catastrophic automatic thoughts

psychoeducation

• with treatment, 70-90% recover

• ** benzodiazepines make relapse more frequent :(

General anxiety disorder DSM-5 criteria

• excessive anxiety and worry (apprehensive expectation) occurring more-days-than-not for at least 6 months, about a number of events or activities

• person finds it difficult to control the worry

• the anxiety and worry are associated with 3 or more of the following 6 symptoms (with at least some symptoms present for more-days-than-not for the past 6 months)

  • restlessness or feeling keyed up / on edge

  • being easily fatigued

  • difficulty concentrating or mind going blank

  • irritability

  • muscle tension

  • sleep disturbance (difficulty falling or staying asleep, or restless unsatisfying sleep)

• causes clinically significant distress or impairment in social, occupational, or other important areas of functioning

GAD vs MDD — differential diagnosis

• must have evidence that GAD exists outside of depressed episodes

• differential must be made, bc these two disorders are highly comorbid

GAD-specific symptoms (vs MDD)

• worry

• cognitive biases

• intolerance of uncertainty (difficulty w ambiguous and uncertain possiblilities)

• GABA / benzodiazepine receptor dysfunction

worry vs GAD

worry:

• uncontrollable

• negative emotional thoughts

• concerned with possible future threats or dangers

• usually verbal rather than visually expressed

when it becomes GAD:

• frequency

• control

• range of topics

• valence (how extreme it is)

prevalence and comorbidity of GAD

• lifetime prevalence = 5.7%

• age of onset: 31-33

• GAD and MDD correlate 0.59-0.70 ——> high correlation

Tri-Partite model of mood and anxiety disorders

relates mood and anxiety disorders to broad underlying traits of positive and negative affect as well as autonomic arousal

1. negative affect (mood and anxiety)

2. positive affect (MDD only)

3. physiological hyper-arousal (anxiety specific)

GAD etiology:

cognitive = “intolerance of uncertainty”

• difficulty with ambiguous and uncertain possibilities

biological:

• GABA / benzodiazepine receptor dysfunction

treatments for GAD

medications:

• SSRIs

• benzodiazepines — effective but rarely prescribed bc side effects and addictiveness

CBT: new treatments that target avoidance of emotion:

• self-monitoring

• interpersonal and emotional processing therapy

• antecedent cognitive reappraisal

  • target cognitive biases (overestimate likelihood of negative events and underestimate ability to cope)

• mindfulness-based CBT for GAD

• emotion regulation therapy

• emotional awareness training — prevention of emotional avoidance

  • staying in present moment, stop behavioral avoidance, engage w emotions as they come