abnormal psych- ex 2

major depressive episode

major depressive episode

chronic

most of the day, nearly every day

must have symptoms for at least 2 wks

avg episode resolves in 3 mths

anhedonia- loss of interest in things you used to enjoy

weight loss or gain, sig change in weight/ appetite, insomnia, hypersomnia, psychomotor agitation (restless), retardation (no energy to move), fatigue, feeling worthless or excessive guilt, suicidal ideation

^ not due to substance abuse or another condition

atypical- weight loss, psychomotor agitation, inc in energy

depressive episode

cognitive symptoms

disturbed physical fxn- loss of energy, can’t move etc

everything takes effort

loss of interest

inability to express pleasure

4-9 mths untreated, low positive affect, not just high negative affect

depression treatment/meds

SSRIs- block reuptake of serotonin

MAOi’s - inhibit MAO enzyme, tells it to not break down norepi and serotonin→ keep in synapse→ helpful for more atypical depression

tricyclics- blocck reuptake, worse side effects

relieve symptoms in 50%, eliminate in only abt 25-30%

microdosing psychedelics- LSD, make things more vibrant

magnets on brain

ECT

• treats really resistent depression

• safer

• memory loss and confusion side effects

• high relapse rates

mania

whenever you see depressive symptoms, assess for this

BPD pts do not come in during a manic episode

distinct period of abnormally and persistently elevate, expansive or irritable mood → lasts at least 1 wk

BPD higher rate of suicide→ manic episode consequences hit when in depressive episode

significant degree of at least 2: inflated self esteem, dec need for sleep, talking a lot, racing thoughts, distractibility, inc in goal directed activity, high risk behaviors

no sub use

mood stabilizers- if you give someone with BPD an antidepressant→ send them into manic episode

lithium is effective, dangerous

BPD pts do not like mood stabilizers

hypomania

at least 4 days of mania

BPD 2

major depressive disorder

one major depressive episode

absence of manic or hypomanic episodes before or during

2 or more MDE with 2 mth separation

persistent depressive disorder

may have fewer symptoms

personality disorder??

depressed mood that continues for at least 2 yrs where pt is not symptom free for more than 2 mths at a time

downs are not as bad as major depressive

SI not as common, but can still happen

double depression

both major and persistent depression with fewer symptoms

comorbid dx

bad sign for treatment and course, bad prognosis

pt not really coming back to normal, always in depressive state whether in persistent or having a MDE

early onset for depression

not good sign

genetic component can influence how early onset is

poor response to treatment, lots of comorbidity

becks cognitive triad

negative cognitions about self, world, and the future

interpret events in negative way

worry

chain of thoughts and images

uncontrollable

mental problem solving an issue that is uncertain

can be seen in depression, more in anxiety

living in future

rumination

behaviors and thoughts that passively focus ones attention on ones depressive symptoms and their implications

distraction helps

disruptive mood regulation disorder

dx btwn 6-18

severe temper outbursts occuring 3 or more times per wk for at least a yr

out of proportion in intensity or duration to the situation → inconsistent with developmental level

mood btwn temper outburst is persistently irritable most of the day nearly every day in at least 2 of 3 settings, severe in one setting

no mania

BPD 1

full manic episodes with depressive episodes

BPD 2

hypomanic states

depressive episodes

cyclothymic disorder

within 2 yrs, numerous periods with hypomanic symptoms and periods with depressive symptoms → do not meet criteria for MDE

person is not w/o sympt for more than 2 mths at a time

no MDE, manic or hypomanic episode present during 1st 2 yrs

like pervasive depresssive disroder

moody

depressive attributional style

internal- neg life events due to personal failure

stable- after bad event, addition bad things are my fault

global- extend across many issues

stressful early life events- more likely to develop neg attribution style, lead to later depression

also associated with anxiety

BPD meds

lithium (only abt 50% respond)

anticonvulsants

calcium channel blockers

70% relapse on lithium in 5 yrs

Personal reflections on manic-depressive illnesses- video

find stability within the emotions, you are you despite the emotions

3 reasons to break pt confidentiality

subpeonaed by court, abuse or neglect to minor/elder, homicidal or suicidal ideation

risk

direct verbal warning

• Direct statement of intention 

• Most useful predictor 

• Take statements seriously 

• Resist temptation to dismiss BPD pts-> may be seen as manipulative, but actually is serious risk  

plan

• Presence of plan inc the risk, the more specific, detailed, lethal and feasible the plan is, the greater the risk 

• Railings being put on bridges 

• usually act is impulsive-> more steps they have to take to complete act, the less likely they are to do it 

past attempts

• most completed suicides follow a prior attempt

indirect statements

• peeps planning to end their lives may communicate their intent directly through their words and actions→going away, speculation on what death would be like, acquiring lethal instruments

depression

• suicide rate is 20x greater for depressed peeps than gen pop

hopelessness

• more closely associated with suicidal intent than any other aspect of depression

intoxication

• btwn ¼ and 1/3 of all suicides are linked to alcohol as contributing factor

marital separation

• 4x higher than any other marital status

clinical syndromes

• People suffering from depression or alcoholism are at much higher risk for suicide. other clinical syndromes may also be linked to higher risk 

• Highest suicide rates exist among clients diagnosed as having primary mood disorders and psychoneuroses  with high rates among thouse having organic syndrome and schizophrenia 

• Big events 

  • Losing life savings, horrible event happens-> blows up life as you know it-> extreme emotional distress 

• Sex

  • Men rate is 3x higher than women 

• Race 

  • Caucasians tend to have the highest S rate

  • Native americans is greater than any other ethnic group 

• Religion 

  • Protestants higher than jews and catholics 

• Living alone 

  • The risk of suicide tends to be reduced if someone is not living alone. Reduced even more if he or she is living with a spouse and reduced even further if there are children 

• Bereavement

  • Tends to place survivors at inc risk 

• Health status 

  • Illness and somatic complaints are associated with inc suicidal risk, as are disturbances in patterns of sleeping and eating 

• Impulsivity 

  • Poor impulse control peeps are at inc risk 

• Rigid thinking

  • Suicidal individuals often display a rigid, all or nothing way of thinking  

• Stressful events 

  • Excessive numbers of undesirable events with neg outcomes have been associated with inc suicidal risk 

• Release from hospitalization

  • Suicidal risk is greatest during weekend leaves from hospital and shortly after discharge  

• Lack of a sense of belonging 

  • Suicidal individuals may experience interactions that do not satisfy their need to belong  or may not feel connected to others and cared about 

reducing risk

screen all pts for suicidal risk during initial contact

work with client to arrange an environment that will not offer easy access to whatever the pt might use to commit suicide

work with pt to create actively supportive environment

do not minimize probs

pts awareness of their strengths, resilience, and reasons to live can often help them regain perspective

communicate caring

realistic hope, discuss practical approaches

reevaluation abt waht suicide will and will not accomplish can be an impt step

self harm

have so much emotional distress that they create physical pain to make them feel grounded→ distraction

find something else that can gorund you

not actually suicide attempts

how to go into distressing situation

• Is it a situation worth going into? 

• If yes, Accept the difficulties your are going to face and find coping mechs 

• If no, asses whether you want to do that situation

physical disorders

can caouse psychological symptoms

diff from conversion disorders

actually a disease causing the psychological problems → psych probs can make physical disorder worse

good coping can make them better

COPD and anxiety→ comorbidity of breathing troubles

behavioral medicine

behavioral science applied to prevention, dx, treatment

health psych

-subfield of behavioral medicine

psychological factors that are impt to the promotion and maintenance of health

behaviors

lead to or prevent disease

impact management of disease, from dx, adherence to meds, further behaviors leading to worsening or improving health

• impact of psych

• psych impacts behaviors

  • behaviors impact psych

prevention and risk in disease

risky behaviros can lead to disease

stigma, guilt and shame

behaviors can make things better or worse

diabetes→ diet/exercise can work for or against you

CF- doing treatment→ better outcomes, dont do them- very sick

lifestyle

• In general- diet, physical activity etc lead to long term consequences 

• Being tired 

• Stress- alarm, resistance, exhaustion 

  • Stress hormones(cortisol)- cell death, immune system 

  • Predictability and controllability 

  • Diathesis stress model- can trigger psychological probs 

    • More likely to become sick 

similarities btwn stress, anxiety, depression, excitement

sense of control- can you cope with the upcoming threat or challenge?

stress vs anxiety vs depression

Sense of control

• Anxiety you have no control

• stress you do-takes a lot of effort to be in control

• Depression- no longer trying to cope

Self-efficacy- Our sense of control and confidence that we can cope with stress or challenges

• Phenomenon in high school- OMG I’m so stressed/nervous... wait a second..

stress and the immune system

• Chance of getting the cold directly related to amt of stress 

• Intensity of stress and negative affect linked to severity of cold 

• Social- socializing with friends relieves stress 

• Depression lowers immune system functioning 

  • Sense of uncontrollability

  • Poor self care 

  • Risky behaviors 

• Sense of control may be one of the most impt psychological contributions to good health 

orrthorexia

focus on healthy eating to the extreme, every food is villianized

continue to cut for diff reasons

obsessive

eating disorders

anxiety about food→ anxiety about how you look→ compare yourself to others

seeing growth of eating disorders in males and homosexual individuals

bulimia nervosa

recurrent binge eating- large amt of food within discrete period of time, lack of sense of control

recurrent inappropriate compensatory behavior (vomiting, laxative, excercising a lot) to prevent weight gain

once a week for 3 mths

self evaluation is unduly influenced by shape and weight

usually a lil overweight

diabulimia- type 1 diabetics

• restricting how much insulin you tkae bc you feel like it makes you gain weight

anorexia nervosa

restriction of energy intake relative to requirements leading to significantly low body fat and weight

intense fear of gaining weight or behavior that interferes with weight gain despite low weight

lack of recognition of seriousness of low body weight

two types:

restricting- does not engage in binge purge behavior

binge eating/purging- engages in recurrent episodes of binge eating or purging (small amts of food, purge more consistently

stimulants and amphetamines are appetite suppressants

binge eating disorder

recurrent episodes of binge eating

3 or more of the following- eating more rapidly, eating until uncomfortably full, eating large amts when not hungry, eating alone bc embarrassed by how much they are eating, disgusted by self

distress regarding binge eating

binging at least 1x per wk for 3 mths

not associated with compensatory behavior (vomiting)

commonalities of eating disorders

obsession/fixation on food

physical issues

treatment involved interdisciplinary approach

comorbidities- anxiety, depression, personality disorders

control and coping, self harm

substance use disorder

ingestion of psychoactive subs in moderate amts that does not significantly interfere with social, educational, or occupational functioning

drinking coffee, smoking cigs, having a drink

occasional ingestion of illegal drugs

intoxication

physiological rxn to ingested subs- being drunk, high

impaired judgement, mood changes, lowered motor ability

what subs can you not overdose on

LSD or other hallucinogens

substance abuse

not necessarily defined by how much

degree of interference→ significant , disrupts education, jobs, relationships, puts you in physcially dangerous situation

pattern of use

drug use can predict later job outcomes

addiction

substance dependance

physiological dependance on drug

requires inc greater amts of the drug to experience the same effect (tolerance)

will respond in a neg way when the sub is no longer ingested (withdrawal)

tolerance and withdrawal are physiological rxns to the chemicals being ingested

withdrawal

headaches with caffiene

alcohol can cause dilerium (hallucinations and tremors)

not all subs are physiologically addicting

you would not go through withdrawal when you stop taking LSD

cocaine- anxiety, lack of motivation, and boredom

cannabis- nervousness, appetite change, sleep disturbances

psychological dependance

repeated use, desperate need to ingest more

diff that physiological rxns

drug seeking behaviors

substance abuse and dependnce now combined in DSM 5

does drug use lead to addiction

• We cannot predict who may be more likely to lose control and abuse drugs/ likely to become dependent with passing use 

• Some people use occasionally and are fine (even “harder” drugs) 

• Some use only once/a few times and have an issue 

dependance vs abuse

• Dependence can be present without abuse 

  • Cancer pts may become dependent on morphine for pain, build up tolerance and go thru withdrawal if it is stopped

comorbity of drug abuse and other disorders

• ¾ of peeps in addiction treatment have an additional psychiatric disorder 

• More than 40% have mood disorders

• anxiety/ PTSD in more than 25% 

• Do they symptoms exist outside the realm of substance use- are symptoms seen during drug use or within withdrawal period or did they exist before use and cont after withdrawal period would have passed

types of subs

Depressants- behavioral sedation: alcohol, barbiturates, and benzos 

Stimulants- cause us to be more active/alert and elevate mood: amphetamines, cocaine, nicotine, caffeine 

Opiates- produce analgesia (pain reduction) and euphoria: heroin, opium, codeine and morphine 

Hallucinogens- alter sensory and perception and can produce delusions, paranoia and hallucinations, : cannabis and LSD 

Other drugs of abuse- psychoactive effects?: inhalants, anabolic steroids, other over the counter and prescriptions meds such as nitrous oxide

Gambling disorders- unable to resist urge causing neg consequences

depressants

dec CNS activation

reduce physiological arousal, helps us relax

Alcohol, sedative, hypnotic, and anxiolytic drugs (those prescribed for insomnia) 

Wernicke korsakoff syndrome- confusion, loss of muscle coordination, and unintelligible speech, thiamine deficiency which is a vitamin metabolized poorly by heavy features 

• Fetal alcohol syndrome - fetal growth retardation, cognitive deficits, behavior problems and learning difficulties; characteristic facial features

binge drinking

5 or more drinks on the same occasion (23% of the pop in the past month  

Tailgating 

42% of college students had gone on binge of heavy drinking once in the preceding 2 wks 

GPA of A- no more than 3 drinks per week 

GPA of d-F much higher

drinking alcohol

At early age predictive of later alcohol related disorders 

Individual who tend not to develop slurred speech, staggering and other sedative effects are more likely to abuse it in the future 

Mixing energy drinks may be problematic- reducing sedative effect may increase likelihood of later abuse 

Violent behavior-> chicken or the egg, reduced impulse control, impaired ability to consider consequences 

sedatives, hypnotic, anxiolytics

Barbiturates (amytal, conal, nembutal)  and benzos (valium , xanax, ativan) 

Influence GABA 

Barbs- helps peeps sleep and replace alcohol and opium 

Benzos touted as miracle cure for anxiety 

Benzos considered safer than barbs- less risk of abuse and dependence 

However- rohypnol (roofies) same effect as alcohol without odor

barbituates

relax muscles, feelings of well being

slurred speech, probs walking, concentrating, and working

diaphragm muscles can relax so much that they cause death by suffocation

common means of suicide

benzodiazapines

calm

induce sleep

muscle relaxants

anticonvulsants

pleasant high, reduction of inhibition

tolerance and dependance can develop

withdrawal like alcohol- anxiety insomnia, tremors, delirium

amphetamines

stimulant

elation and vigor

reduce fatigue

feel “up”

followed by “crash”- feeling depressed or tired

created in lab as asthma and nasal decongestant

weight loss due to reduced appetite

used for pulling all nighters , energy boost to stay awake (truck drivers, pilots, students)

ritalin, adderall

2/3 of college students in 4th yr had been offered illegal rx of stimulents, 31% used them

intoxication on stimulants

euphoria or emotional numbing

changes in sociability

interpersonal sensitivity

anxiety

tension

anger

stereotyped behaviors (repetitive body mvmts)

impaired behavior

impaire social/occupational fxning

physiological changes in stimulent use

HR and BP changes

perspiration or chills

nausea or vomiting

chest pain

seizures

coma

severe intoxication/overdose on stimulants

hallucinations, panic, agitation, paranoid delusions, tolerance builds quickly→ esp dangerous

withdrawal- apathy, prolonged periods of sleep, irritability, and depression

designer drugs

MDMA (appetite suppressant)

• now used recreationally (ecstacy)

• after meth, the drug that most often brings peeps to ER is MDMA

methamphetamine (crystal meth or ice)

• purified crystallized form of amphetamines ingested through smoking

• aggressive tendencies

• stays in system longer than cocaine making it particularly dangerous

potential for dependance is very high

MDMA can cause lasting memory probs

cocaine

Derived from leaves of coca plant 

Inc alertness 

Produces euphoria 

Inc bp and pulse 

Causes insomnia and loss of appetite

Short lived effect

Cocaine induced paranoia - ⅔ or more of users 

Causes heart beat to become rapid and irregular- can have fatal consequences 

Crack cocaine is a crystallized from of cocaine that is smoked 

Dependence sneaks up on you; though of as wonder drug as first; tolerance and withdrawal do happen

may result in premature aging of the brain

withdrawal- apathy and boredom→ very dangerous bc cocaine feels like you are coming back to life

tobacco

20% of all peeps in US smoke → down from 42% in 1965

Withdrawal- depressed mood, insomnia, irritability, anxiety, difficulty concentrating, restlessness, inc appetite and weight gain 

Nicotine stimulates CNS: can relieve stress and improve mood 

Can also cause high BP, inc the risk of heart disease and cancer 

High doses- blur vision, cause confusion, lead to convulsions, sometimes cause death 

Relapse equal among - alcohol, heroin and cigs

caffeine

most common of psychoactive substances → 90% of all americans

Gentle stimulant- least harmful of addictive drugs 

• Can still be problematic 

  • High levels in pills or energy drinks: some are banned in certain countries 

• Elevate mood, reduce fatigue 

• Large doses- jittery, insomnia

• Take abt 6 hrs to leave body- sleep disturbance

• Pregnancy - 1 cup a day is ok 

• withdrawal - headaches , drowsiness, unpleasant 

opioids

Natural opiates exist in body already

Synthetic (heroin, methadone (useful tool), hydrocodone, oxycodone 

Natural (enkephalins, beta endorphins, dnorphins ) 

Euphoria, drowsiness, slowed breathing 

Death if respiration is completely depressed 

Analgesics- releive pain 

Withdrawal very bad- makes stopping hard: 6-12 hours- yawning, nausea/vomiting, chills, muscle aches, diarrhea, and insomnia 

1-3 days , withdrawal process completed in about a week

heroin

½ a million people addicted in 2007

most common abused opiate

illicit use of opioid rxs has risen→ 12% of high school seniors used opioids for non medical reasons

cannabis

most routinely used illegal substance

5-15% of peeps in western countries reporting regular use 

Mood swings, normal experiences seem extremely funny, dreamlike state in which time seems to stand still, heightened sensory experiences, vivid colors 

Impairments in memory, concentration , relationships with others, employment 

Though what came first, psychological probs may precede use 

Synthetic marijuanca (K2, spice)- can be purchased legally- hallucinations, seizures, heart probs

medical marijuana

successful use of cannabis and by products for certain diseases→ chemo induced nausea and vomiting, HIV assocaited anorexia, neuropathic pain in MS, cancer pain

hallucinogens

LSD (acid): most common hallucinogens, synthetic 

Natural- psilocybin (shrooms), mescaline (peyote) 

Phencyclidine (PCP)- snorted smoked, injected; causes impulsivity and aggressiveness 

Perceptual changes such as subjective intensification of perceptions, depersonalization, hallucinations

Sensory experience is heightened 

Pupillary dilation, rapid heartbeat, sweating, blurred vision 

Can be dangerous-> jump off building 

Tolerance develops quickly; if repeat use over a period of days they lose effectiveness; sensitive returns a week after abstinence 

No withdrawal 

Psychotic rxns- ex, jump out windows bc think you can fly

“Bad trips” paranoia - trauma trip, almost gives you PTSD

Very suggestible- “my tongue is filling up my mouth”! Everyone starts feeling similar

Microdosing depression and PTSD treatment-> ptsd needs exposure, relive it more vividly -> make exposure more effective 

postive and negative reinforcement with drug use

• Gives pleasure, takes away pain and stress 

• Cope with unpleasant feelings 

• Opponent-process theory- motivation shifts once tolerance and withdrawal build: starts with trying to achieve a high, ends with trying to dec the neg consequences of “crash”: that is why the neg part doesn’t lead to dec

  • Originally you use drugs to feel good, then you are using it to make the withdrawal go away  

• The very drug that is making you feel bad is also the one thing that can take away the pain: enslaved by the cycle 

what influences cravings for drugs

• Availability- how easy is it to get 

• Contact with paraphernalia

• Moods 

• Small doses of drug-> can lead to cravings, only 1 cig, only 1 drink  

• Virtual Reality can be used, work on active coping

• Changes in the brain when we use (neuroplasticity) inc drive to obtain and use 

• Self- medication 

• Genetic influences; addictive personalities

treatments for drug addiction

• Biological treatment

  • Agonist substitution, binds to receptors and gives same response (methadone (does not give high, and binds to same receptors) and buprenorphine); nicotine gum, patch , etc -> tapered off

  • Antagonist drugs- block the effects of the drug , produces withdrawal (must be free from withdrawal before starting naltrexone), removes high so must be motivated

  • Aversive treatment- antabuse: causes nausea, vomiting, and elevated heart rate and respiration if you drink “punishment”, pairing vomiting with alcohol abuse

• Psychosocial treatment 

  • Inpatient 

  • Absence only and harm reduction 

  • Absence only- AA, 12 step program, alcoholism is a disease, more powerful than individual, higher power needed to overcome (religous), destigmatixing, social support, total abstinence 

  • Controlled use - trying to reduce use, when they do not want to quit cold turkey, HR 

  • Component treatment- package- covert sensitization, contingency management, community reinforcement

  • Motivational enhancement therapy- empathetic and optimistic counseling, core values, positive outcomes expectancies 

  • CBT 

biological treatment for drug addiction

• Biological treatment

  • Agonist substitution, binds to receptors and gives same response (methadone (does not give high, and binds to same receptors) and buprenorphine); nicotine gum, patch , etc -> tapered off

  • Antagonist drugs- block the effects of the drug , produces withdrawal (must be free from withdrawal before starting naltrexone), removes high so must be motivated

  • Aversive treatment- antabuse: causes nausea, vomiting, and elevated heart rate and respiration if you drink “punishment”, pairing vomiting with alcohol abuse

psychosocial treatment for drug abuse

• Psychosocial treatment 

  • Inpatient 

  • Absence only and harm reduction 

  • Absence only- AA, 12 step program, alcoholism is a disease, more powerful than individual, higher power needed to overcome (religous), destigmatixing, social support, total abstinence 

  • Controlled use - trying to reduce use, when they do not want to quit cold turkey, HR 

  • Component treatment- package- covert sensitization, contingency management, community reinforcement

  • Motivational enhancement therapy- empathetic and optimistic counseling, core values, positive outcomes expectancies 

  • CBT