psyc 337 midterm 2 content

Pharmacological approaches for BPD

70% treated with antipsychotics/antidepressants, 33% treated with anticonvulsants, 30% with benzodiazepines, 4% with lithium (not associated with improvement in mood or impulsivity).

SSRIs in BPD treatment

May help in decreasing mood shifts.

Olanzapine effects

Users reported decreases in levels of anxiety, paranoia, interpersonal sensitivity, and anger/hostility.

Mood stabilizers for BPD

Do not alleviate impulsivity, aggression, or suicidality.

Dialectical behavioral therapy (DBT)

Involves weekly individual psychotherapy sessions and weekly skills training in group format, correlated with lower suicidal outcomes, lower attrition, and lower hospital visits.

Mentalization based therapy

Based on attachment theory, helps patients develop skills to accurately understand their own and others' feelings/emotions.

Transference focused psychotherapy

Helps patients understand and correct distortions in their perceptions of others using clarification, confrontation, and interpretation as techniques.

Schema focused therapy

Uses cognitive, behavioral, and experiential techniques to explore and modify four schema modes in BPD, showing more improvements than patients with TFP.

Four schemas in BPD

Detached protector, punitive parent, abandoned/abused child, and angry/impulsive child modes.

General psychiatric management

Relies on active/nonreactive clinical style, support + validation, case management, and collaborative agreement.

STEPPS

Incorporates skills training, CBT, and systems approach.

Psychopathic offenders and therapeutic community programs

Did not appear to benefit from the programs.

Attrition in treatment programs for psychopathy

High attrition rates observed.

Cognitive remediation intervention

Training individuals in particular cognitive skills, e.g., paying attention to contextual cues.

Brief intervention for AUD

Focus on providing feedback and negotiating behavioral change.

Motivational interviewing

Enhances individuals' motivation and commitment to change by adopting a sympathetic therapeutic manner.

CBT for AUD

Focused on teaching skills for coping with drinking urges and identifying triggers.

Behavioral marital therapy for AUD

Treats abuser with spouse to ensure spousal support.

Community reinforcement approach

Posits that to decrease alcohol use, its reinforcing value must decrease while alternative sources of reinforcement must increase.

Cue exposure therapy

Repeated exposure to alcohol cues to decrease alcohol craving and increase self-efficacy for coping with urges.

Twelve step therapies

Based on philosophies of Alcoholics Anonymous, promote long-term complete abstinence and discourage use of psychiatric medications.

Mindfulness based therapies

Based on meditation/mindfulness techniques to increase awareness and cope with urges.

Pharmacological treatment for AUD

Naltrexone (attenuates effects of alcohol), ondansetron + topiramate (under study).

Polymorphism of the OPRM 1 gene

Individuals with this polymorphism had a stronger hedonic response to alcohol.

Stress definition (1936)

Non-specific response of the body to any demand for change, losing equilibrium.

Stressor vs stress

A stressor is an external demand that creates a challenge to an individual's equilibrium; stress is the response to the stressor.

Faster physiological stress response

Begins with hypothalamus stimulating SNS, leading to increased heart rate and slowed digestion.

Slower physiological stress response

Involves HPA Axis activation leading to cortisol release and inhibition of immune systems.

Allostatic load

Perpetual strain in the stress response system, not sustainable.

Cortisol effects on the brain

High levels are associated with damage to different brain regions, particularly the hippocampus.

Early life stress patterns in mental disorders

1) ELS is common, 2) increases risk for developing lifetime mental disorders, 3) associated with all forms of psychopathology.

Fetal programming

Maternal stress can be transmitted to the fetus via high levels of glucocorticoids.

COVID stress and neural responses

Study showed decreased neural response to reward after the pandemic compared to pre-COVID group.

Social support

Loneliness associated with high blood pressure and waking cortisol levels, recover faster.

Social buffering of stress study/TSST

Parent in the room buffers against stressors compared to if they are preparing speech with strangers, same effect with partner (only the case for women when physical touch involved).

TSST with pet vs friend vs alone

No buffering alone, some buffering with friends, extreme buffering with dog.

Exercise

Associated with reduced physiological reactivity to stressor, can improve mood (stronger effect for people starting with poorer health), protect against hippocampal degeneration associated with chronic stress.

TSST and exercise

Helped regulating stress response, exercise condition (how vigorous) didn't matter.

Mindfulness based stress reduction

Subjective appraisals matter, helps in reducing perceived stress, increase sleep quality, can help in recovering from stressful experiences, reduction of amygdala size.

Controlled breathing

A technique to manage stress and anxiety.

Sleep and stress

Deprivation increases allostatic load, increases evening cortisol levels, affects hippocampal volumes, alters mood, cognitive control, associated with lower life expectancy, illness, accidents.

Suicide

Death resulting from intentional self injurious behaviour, associated with any intent to die as a result of the behaviour.

Suicide attempt

Non fatal self directed potentially injurious behaviours with any intent to die as a result of the behaviour.

Interrupted attempt

Person takes steps towards making suicide attempt but is stopped by another person prior to any injury or potential injury.

Self-interrupted/aborted attempt

Person takes steps to injure self but stops self prior to any injury or potential for injury.

Preparatory acts of behaviour

Acts or preparation toward making suicide attempt.

Suicidal ideation

Thoughts of suicide, much more common than suicide rates, more common in women.

Non-suicidal self injurious behaviour

Behaviours that are self directed and deliberately result in injury or the potential for injury to oneself.

Suicide rates

More common in men, 9th leading cause of death in Canada (2016).

Key elements of suicidal attempts

1) Agency: something is self initiated but doesn't have to be self inflicted; 2) Intent: reflects some desire or intent for death; 3) Outcome: has to be actual or perceived potential for death.

Suicide and NSSI in DSM

Before DSM-5, only listed as symptoms of depression and BPD, not considered as independent concerns.

Challenges of research methods in suicidality

Rare event, low base rate across population (0.5% adults make an attempt each year), etiologically complex, difficult to study longitudinally, stigma associated with suicide.

Common research methods in suicide research

Archival research, psychological autopsy, big data.

Epidemiology of suicide

4% of North Americans have suicidal ideation but only 13% of those 4% attempted suicide.

Gender differences (suicide)

Women attempt suicide at higher rates than men in North America, but 77% of deaths by suicide are male.

Gender differences ratio (suicide)

For every 4.4 men who die by suicide, there is 1 death of a woman by suicide.

Suicide (race/ethnicity)

Highest in white and First Nation people, rates are similar and substantially lower in Black, Pacific Islander, Asian, non-Hispanic and Latino populations.

Suicide and indigenous populations

Canadian indigenous have highest rates in the world, more common in people living in reserves.

World rates of death by suicide

Rates in China declining, Japan + France and Germany as well from high, rates in US increasing.

Means of suicide mortality in North America

The most common attempt methods are poisoning, cutting, stabbing.

Risk and protective factors

Risk factors indicate person or group that are at greater risk, protective measures can help decrease suicide.

Etiology of suicide

Biological factors: twin studies show suicidal behaviours are genetically influenced.

Impulsivity (suicide)

Poor premeditation, sensation seeking, lack of perseverance, negative urgency.

Negative urgency

Higher in people with high ideation and people who have made attempts.

Poor premediation

Higher in people who have made attempts vs ideators as well as higher fearlessness.

Sensation seeking

Lack of perseverance isn't higher in ideators or attempters.

Acquired capability

Overtime, experiences can increase capacity to make an attempt.

Interpersonal psychological theory

Exposure to painful and fearsome stimuli reduces innate fear of pain and death.

3 step theory

Three elements to acquire suicide capability: practical (having access), dispositional (tendency to risk taking, less fearful), acquired (exposure).

Environmental influences on capability

Can increase through practice, habituation, experience, playing more violent video games.

Distinguishing attempters from ideators

More common to see depression, PTSD, and MDD in people with ideation compared to non-suicidal individuals.

NSSI onset peaks

Onset peaks in adolescence/young adults (13 years vs 16 years for suicide attempts).

Lifetime prevalence of NSSI

13 - 28%, in clinical samples as high as 80%.

Methods for NSSI

Use of low lethality behaviours that result in minimal damage (cutting, skin abrading, interfering with wound healing, banging, burning).

Endorsing NSSI vs suicide attempts

NSSI uses more than one method (4 on average), suicide attempts use the same method but increase lethality.

Gender differences in NSSI

Rates higher in LGBTQ+ populations, peak in coming out process, risk higher for LGBTQ+ men.

Intrapersonal functions of NSSI

Affect regulation (most common), anti-dissociation, anti-suicide, marking distress, self-punishment.

Interpersonal functions of NSSI

Autonomy, interpersonal boundaries, peer bonding, revenge, toughness, sensation seeking.

NSSI study in real time

In the hours preceding engagement in NSSI, positive affect decreases and negative affect increases.

EMA

Technique where you check on people repeatedly in their daily lives.

Relationship of NSSI to suicide

85% of people attempting suicide have a history of NSSI.

Personality disorder

Distinguishing longstanding maladaptive ways of relating to the world from phasic clinical syndromes.

Egosyntonic

Doesn't cause themselves distress since it is consistent with how they view themselves.

Egodystonic

Causes distress, no intrinsic pleasure.

Cluster A personality disorders

Odd/eccentric: paranoid, schizoid, and schizotypal, least well studied PD clusters.

Paranoid personality disorder

Pervasive suspiciousness, hold long term grudges, see themselves as blameless.

Schizoid personality disorder

Near total lack of interest in intimate involvement with others, limited emotional responsiveness.

Schizotypal PD

Cognitive perceptual distortions, eccentricity, contact with reality is maintained.

Cluster B personality disorders

Dramatic/emotional, erratic: antisocial personality disorder, BPD, narcissistic personality disorder, histrionic.

Histrionic PD

Highly dramatic, lively, extraverted, problems with maintaining stable relationships.

Narcissistic PD

Grandiosity, preoccupation with receiving attention from others, lack of empathy.

Avoidant PD

Avoiding interpersonal contact, afraid of intimacy due to fear of rejection.

Dependent PD

Inability to function independently, submissive, clingy behaviour.

OCPD

Preoccupation with rules, inflexibility and a desire for perfection.

Prevalence of personality disorders

4 - 15% in general population, higher in inpatient settings.

Diagnostic heterogeneity

Level of heterogeneity for PD diagnosis means nothing due to the extent of possibilities.

Suicide and BPD

Suicidal ideation very common, 70% have attempted suicide (average of 3-4 attempts).

Dissociation and BPD

75% experience paranoid ideas or episodes of dissociations, still have clear insight.

Dissociation in BPD

Reported even for low level of stress.

Group 1 (non labile type)

Low levels of effective instability and low levels of dissociative symptoms.