abnormal psych exam 2 prep

Worry

concerns about possible future threat

Anxiety

uncomfortable feeling you get when you are directly confronted with diffuse danger; normal

3 components of anxiety

1. Cognitive: expectation of specific harm, usually in immediate future

2. Somatic: body’s reaction to anxiety

   • internal: controlled by ANS

   • external: goose bumps, sweating, tense muscles

3. Behavioral

   • classical conditioning: involuntary reaction to fear → seeing bad accident on the bridge

   • operant conditioning: voluntarily try to do something about things are afraid of: fight or flight

     • escape responding: escape from frightening situation while it's occurring

     • avoidance responding: leave before harmful event occurs

• Biological Dimension of Anxiety

• hyperthyroidism

• cardiac arrhythmia

• stimulants

• asthma medications

Amygdala

• plays a central role in triggering state of fear or anxiety

Hypothalamic-Pituitary Adrenal (HPA)

• triggers fight-or-flight response

• is a complex set of direct influences and feedback interactions among hypothalamus, pituitary and adrenal glands

Psychological Dimension of Anxiety

• psychological characteristics interact with biological predispositions

• negative appraisal

• anxiety sensitivity

• sense of control / mastery

Negative appraisal

• interpreting events as threatening

Anxiety sensitivity

• tendency to interpret physiological changes as signs of danger → leads to anxiety

Sense of control / mastery

• reduces anxiety

Social & Sociocultural Dimensions of Anxiety

• daily environmental stress can produce anxiety

  • people with biological/psychological vulnerabilities are most likely to be affected

• factors:

  • poverty

  • traumatic events

  • limited social support

  • culture

Phobias

• strong, persistent, unwarranted fear of specific object or situation

  • extreme anxiety or panic is expressed when phobic stimulus is encountered

Types of phobias

• living creates (ex. spiders/insects/snakes)

• environmental conditions (heights/thunder/earthquakes)

• blood/injections or injury (needles/blood/medical procedures)

• situational factors (enclosed places/flying/the dark)

Social Anxiety Disorder (SAD)

• intense fear of being criticized or doing something embarrasipsing or humiliating in the presence of others

• often comorbis with major depressive disorder/substance use disorders

Agoraphobia

• intense fear of AT LEAST two of the following:

  • being outside of home ALONE

  • traveling on public transportation

  • being in open spaces

  • being in stores/theatres

  • standing in line or being in a crowd

• situations are feared because escape/help is not readily available

Panic Attacks

• people with agoraphobia sometimes fear having a panic attack

• is an episode of intense fear accompanied by physiological symptoms (sweating & heart palpitations)

Etiology of phobias

• phobia subtypes have moderate genetic contribution

• could be seen through psychological dimension (classical/operant conditioning & negative information & cognitive-behavioral response)

Social Dimension of Anxiety

• parental behaviors influence development of social anxiety in children due to overprotection, lack of support for independence, and punitive maternal parenting style

• negative family interactions & family stress

Sociocultural Dimension of Anxiety

• females are more likely to have phobias due to having higher disgust responses

• SAD is more common in collectivist cultures

Medication treatment for phobias

• benzodiazepines (Ativan, Xanax, Valium)

  • helpful in short term because it increases levels of GABA

  • can produce dependence on medication

• SSRIs

  • often prescribed for chronic forms of anxiety

  • increases levels of serotonin

• Beta-blockers

  • controls rapid heartbeat/shaking/trembling/blushing in anxious situations for few hours

  • block effects of norepinephrine

Cognitive-Behavioral treatments for Anxiety

• exposure therapy: gradual introductiom to the feared situation

• systematic desensitization: exposure techniques with relaxation

• cognitive restructuring: identifyimg and changing irrational thoughts

• modeling therapy: viewing smother person’s successful interactions with subject of phobia

Panic Disorder

• recurrent, unexpected panic attacks

  • combined with apprehension of having another attack or behavior changes designed to avoid having another attack

Etiology of panic disorder

• biological dimension → heritable, people woth panic disorder has fewer serotonin receptors, SSRIs are effective

• psychological dimension → individuals show heightened fear responses to bodily sensations

Sociocultural Dimensions of Panic Disorders

• factors: separation anxiety, family conflicts, school problems, loss of a loved one

• cultural differences: Asian Americans & Latino/Hispanic youth report higher anxiety sensitivity but are less likely to have panic attacks

Biological treatment of panic disorder

• benzodiazepines

• antidepressants

• beta-blockers

Cognitive-Behavioral treatment for Panic disorder

• promotes self-efficacy

• educate client about panic disorder

• identify & correct catastrophic thinking

• teach client to self-induce physiological symptoms in order to extinguish then conditioning

• encourage clients to face the symptoms

Generalized Anxiety Disorder (GAD)

• persistent, high levels of anxiety & excessive/hard to control worry over life circumstances

• symptoms must be present for 6 months for majority of days & cause significant impairment in life activities

• develops gradually (usually in childhood/adolescence)

Etiology of Generalized Anxiety Disorder (GAD)

• biological dimension: small chance but heritable & may disrupt prefrontal cortex modulation of response to threatening situations

• psychological dimension: cognitive theories → dysfunctional thinking & beliefs

Psychological Dimension of GAD

• negative schemas play a key role

  • ambiguous/positive situations might be viewed with a fear that something bad is going to happen

• asepcts of worrying

  • copes with stressful situations/events

  • constantly makes what-if scenarios

  • worry about worrying

Social & Sociocultural Dimension of GAD

• moms with anxiety may be less engaged their infants → the child MIGHT also develop GAD

• stressors: poverty, poor housing, prejudice/discrimination, and peer relationship conflicts

Treatment of GAD

• benzodiazepines (could become dependent on medication)

• antidepressants (has less risk of becoming dependent on medication)

• Cognitive-behavioral therapy → effective psychological treatment

Obsessive-compulsive Disorder (OCD)

• consistent, anxiety producing thoughts or images

• overwhelming need to engage in activities or mental acts to counteract anxiety or prevent occurrence of dreaded event

Hoarding Disorder

• inability to discard items regardless of their value

Body dysmorphic disorder

• preoccupation with a perceived physical defect (ex. minor blemishes)

• symptoms cause significant stress or impairment in life activities

Hair-pulling disorder

• recurrent and frquent hair-pulling despite repeated attempts to stop

Skin-picking disorder

• also knowns as excoriation

• results in skin lesions

Etiology of OCD and related disorders: Biological

• heredity is involved

• endophenotype characteristic for OCD: impairment in decision-making, planning, mental flexibility

• increased metabolic activity in orbitofrintal cortex of left hemisphere of the brain

Psychological Dimensions of OCD

• behavioral perspective: obsessive-compulsive behaviors develop because they reduce anxiety

• cognitive characteristics: exaggerated estimates of probability of harm, control, intolerance of uncertainty, thought-fusion, and disconfirmatory bias

Social & Sociocultural Dimensions of OCD

• family variables: controlling, overly critical parenting styles, low parental warmth, discouragement of autonomy

• reactions of family members to OCD can increase symptom severity

• culture may affect how symptoms are expressed

Treatment of OCD and related disorders

• SSRI antidepressants

  • ~60% respond to this therapy

  • result improved when combined with behavioral interventions

• behavioral treatments: flooding & response prevention

Stressors

• external events or situations that place physical pr psychological demands on a person

Stressors

• external events or situations that place physical pr psychological demands on a person

Adjustment Disorders

• difficulty coping with or adjusting to a specific life stressor

• DSM5 diagnostic criteria

  • exposure to identifiable stressor that results in onset of symptoms

  • symptoms are out of proportion to the severity of the stressor

  • symptoms persist no longer than 6 months after exposure to stressor has ended

Trauma-related Disorders

• typical outcomes after exposure to traumatic events

  • resilience

  • recovery: initial distress with symptom reduction over time

  • delayed symptoms: few initial symptoms & increaswd symptoms over time

  • chronic symptoms

Diagnosis of Acute & Post-Traumatic Stress Disorders

requirements foe diagnosis:

• exposure to traumatic event

• intrusion symptoms

• avoidance

• negative alterations in mood/cognition

• arousal and changes in reactivity

  • hypervigilance

Traumatic events associated with Acute Stress Disorder & PTSD (examples)

• combat

• sexual harassment/assault

• violent crime/domestic violence

• natural disasters

• car accidents

• work-related accidents

Etiology of ASD & PTSD

• factors associated with increased risk:

  • more severe physical injuries

  • stroke/injury to the head or extremities

  • major burn injuries

  • rape/sexual assault

  • intentional trauma

  • close relationship with perpetrator of sexual assault

Biological Dimension of ASD & PTSD

• body systems designed for homeostasis

• fear extinction: decline in fear responses associated with trauma

• SS genotype: two short alleles of serotonin transporter gene (5-HTTLPR)

• more prone to heightened anxoety reactions associated with PTSD

Psychological Dimension of ASD & PTSD

• risk factors: preexisting conditions like anxiety, depression, hostility, and anger & specific cognitive styles or dysfunctional thoughts (interpret stressors in a catastrophic manner)

• Social dimension: social support can diminsh PTSD symptoms

Sociocultural Dimension of ASD & PTSD

• ethnic differences: different exposure to previous trauma & cultural differences in responding to stress

Medication treatment for Trauma-related disorders

• certain antidepressants show some effect

  • effective in less than 60% of people & only 20~30% show full recovery

• D-cycloserine: has mixed results

• Prazosin (hypertension medication)

• Propranolol (beta-blocker): under study, may offer little benefit

Psychotherapy fir Trauma-related disorders

• prolonged exposure therapy (PE): involves exposure to trauma-related cues

• cognitive-behavioral therapy (CBT): involves identifying and challenging dysfunctional cognitions

• trauma-focused cognitive-behavioral therapy (TF-CBT): combines traditional CBT with trauma-sensitive strategies

• eye movement desensitization and reprocessing (EMDR): involves visualizing traumatic experience while following a therapist’s fingers moving side to side and replacing negative cognitions with positive ones

Psychological factors affecting medical conditions

• stress: causes multitude of physiological, psychological, and social changes that influence health

• psychophysiological disorder: physical disorder with strong psychological basis/component

Medical conditions influenced by psychological factors

• Actual tissue damage

• Disease process

• Physiological dysfunction

• Relative contributions of physical and psychological factors vary greaty

• Both medical treatment & psychotherapy may be required

Coronary heart disease

• cardiac arteries narrow → results in complete or partila blockage of flow of blood and oxygen to heart

• Risk factors: poor eating habits, obesity, lack of physical activity, hypertension, stress, depression

Hypertension

• normal blood pressure: systolic less than 120 & diastolic less than 80

• hypertension: systolic at or above 140 & eiastolic at or above 90

• prehypertension: blood pressure levels higher than normal but not meeting hypertension levels

Migraine headaches

• results from constriction of cranial arteries

• pressure on nearby nerves produces moderate to severe pain

• often accompanied by nausea & vomiting

Tension headaches

• stress creates a prolonged contraction of scalp and neck muscles

• results in vascular constriction and steady pain

Cluster headaches

• excruciating stabbing or burning sensations located in the eye or cheek

  • pain so severe that 55% report suicidal thoughts

• Attacks have rapid onset

  • 15 minutes to 1 hour duration

  • ends abruptly

• headaches preceded by aura in about 20% pf cases

Asthma

• chronic inflammatory disease of lungs

• stress or other triggers cause excessive mucus secretion

  • spasms and swelling of airways → reduces amount of air that can be inhaled

• symptoms range from mild to severe

Stress & Immune system

• stress itself doesn’t appear to cause infections

  • appears to decrease immune system’s efficiency → results in more susceptibility to disease

• stress response involves release of hormones that impair immune functioning

• chronic stress accelerates disease progression

Etiological influences on physical disorders

• biological dimension:

  • stress can dysregulate physiological processes in the brain and the body → releases norepinephrine/epinephrine/cortisol

• early environmental influences may produce changes and stress response systems

• Brief exposure to stressors enhances immune functioning

Psychological dimension of physical disorders

• Psychological and personality characteristics can influence health status

  • Positive emotions help regulate stress reactions

  • Negative emotion emotions accentuate the stress response

  • Commitment, control, and openness to challenge associated with thriving through stressful situations

Social dimensions of physical disorders

• risk factors for adverse health outcomes: Lack of social support & maltreatment in social relationships

• Good relationship relationships moderate the link between hostility and poor health

Sociocultural dimension of physical disorder

• Women are more likely to be impacted by stress due to caregiving role for children, parents and partners & More likely to live in poverty

• Exposure to racism and discrimination: Coping skills, resources, and social support mitigate vascular reactivity to racism

Treatment of stress related disorders

• Relaxation training: Learn to relax muscle muscles of the body under almost any circumstances

• Bio feedback training: Learn to voluntarily control, physiological processes in order to improve physical or mental health (examples: Heart rate and blood pressure)

Cognitive – behavior behavioral therapy

• Designed to improve coping skills and manage stress

• Shown to improve immune functioning and breast cancer patients

• Opportunities to talk about health situation help predict adjustment to cancer

Emotional symptoms in depression

• Depressed mood

• Sadness emptiness, hope hopelessness, worthlessness, or low self-esteem

• Limited enthusiasm for things that previously brought joy and pleasure

• Irritable, anxious or worried

Cognitive symptoms of depression

• Rumination: Continually thinking about certain topics or reviewing distressing events

• Inability to concentrate remember things or make decision decisions

  • Frustration over inability to handle tasks normally manage without difficulty

• Thoughts of suicide

Behavioral symptoms of depression

• Fatigue, social withdrawal, and reduced motivation → May appear to not care about grooming or personal cleanliness

• Possible agitation, and restlessness

• Daily activities, take immense effort, and feel overwhelming

• May cry for no particular reason or in reaction to sadness, frustration, or anger

Physiological symptoms of depression

• Appetite and weight changes

• Sleep disturbance

• Unexplained aches and pain

• Aversion to sexual activity → Dramatically reduced sexual interest in arousal

Persistent depressive disorder

• Symptoms are present most of the day for more days than not for a two year period

• Two or more of the following symptoms:

  • Feelings of hopeless

  • Low self-esteem

  • Poor appetite or over eating

  • Low energy or fatigue

  • Difficulty concentrating or making decision decisions

  • Sleeping too little or too much

Burden of illness

• Strongly associated with impaired interpersonal and marital functioning

• Leading cause of disability as measured by years lived with disability

• Fourth leading contributor to the global burden of disease

Etiology of depressive disorders biological dimension

• neurotransmitters and depressive disorders: Low levels of neurotransmitters (Noepinephrine, serotonin, and dopamine)

• Depression tends to run in families

• Jeans interact with environmental factors to produce depression (Short allele of the serotonin transporter gene)

• Overproduction of stress related hormones

• Higher levels of cortisol

• Circadian rhythms: Internal biological rhythms maintained by hormone melatonin

  • Plays a role in depression (Particularly seasonal depression)

  • Sleep disturbances, including irregularities in REM sleep strongly linked to depression

  • Insomnia doubles the risk of developing depression (Sleeping for more than 10 hours per night also increases risk)

Etiological factors: Psychological

• Insufficient social reinforcement

  • Participate in fewer reinforcing activities

  • Fewer reinforcements available in environment

  • Impaired social skills and behaviors

• Negative expectations and thinking

  • Pessimistic

  • Poor self-esteem

  • Rumination over negative experiences

• Stressful interpersonal events

• Insecure attachments

• Targeted rejection

Sociocultural dimension of depression

• Cultural difference and expression of symptoms

• Discrimination or perceived discrimination increases risk for depression

• More common in women

Biological dimension: Treatment: Pharmacotherapy

4 major classes of antidepressants:

• tricyclics: Tofranil, Elavil

• MAOIs

• SSRIs

• atypical antidepressants: Change levels of dopamine, serotonin, or norepinephrine

Augmentation strategies: Use second or third medication to augment one that's not working as well

ECT

• pass electric current through brain to induce seizure

• Give muscle relaxant and put to sleep

• Seizure changes neurochemical functioning of brain

• Most people receive 2 to 3 treatments a week for 5 to 10 treatments

• Side effects: Headache, headaches, jaw ache, fatigue, Short-term memory loss

• Is the most effective treatment for severe MDD, especially when person is unresponsive to medication or suicidal or is acute psychotic

Vagus nerve stimulation

• Implant device that stimulus Vegas nerve; Used to treat epilepsy and hard to treat depression

• Implant device under the skin of your chest and stimulates left vagus nerve

• May take several months to see improvement

• Side effects: Temporary hoarseness, cough, shortness of breath

Transcranial magnetic stimulation

• Non-invasive procedure that uses magnetic field to stimulate nerve cells in the brain; Used for hard to treat depression

• Side effects: weight gain, sexual dysfunction, nausea, sedation, dry mouth

Psychological and behavioral treatment treatments

Behavioral activation therapy

• Focus on increasing exposure to pleasurable event, events, and activities and social interactions

  • Steps:

    • Identify and rate activities in terms of pleasure and self-confidence

    • Perform some of the selected activities

    • Identified day-to-day problems and used behavior techniques to solve

    • Improve social and assertiveness skills

Interpersonal psychotherapy

• Evidence based treatments focused on current interpersonal problems; Short term; 12 to 16 weeks

• Goal: Improving communication, identifying role conflicts in increasing social skills

• Depression occurs within interpersonal context

• Focus is on problems/conflicts within these relationships

• Geared toward present, not past relationships

Cognitive behavioral therapy

• Altering negative patterns associated with depression

  • Identify thoughts associated with upsetting emotion

  • Distance itself from these thoughts

  • Examine accuracy for beliefs

• Individuals treated with cognitive behavioral therapy is less likely to relapse than dose treated with antidepressants alone

Mindfulness based cognitive therapy

• Calm awareness of one's present experience, thoughts, and feelings

• Attitude of acceptance, instead of judgmental, evaluative or ruminative

• Disrupt a cycle of negative sinking by focusing on present

Bipolar disorders

• Involve episodes of hypomania and mania

  • Alternate with episodes of depression

• Very strong, genetic component

• People with bipolar disorders respond to medications that have little effect with depressive disorders

• Peak age of onset is teens and early 20s

Hypomania

Increased levels of activity or energy

• Combined with self-importance, expansive, mood or irritable, agitated mood

• Impulsivity and risktaking may appear

• Person may talk excessively

  • Uncharacteristic of how person normally functions

Mania

• even more pronounced mood changed than hypomania

• Variety of behaviors from euphoria to extreme irritability

• Cause marked impairment and social or occupational functioning

• May involve loss of contact with reality

Emotional symptoms of hypomania/mania

Hypomania: Unusually in high spirits, Full of energy and enthusiasm, or uncharacteristically irritable & May overreact with hostility

Mania: Unstable and rapidly changing emotions & Grandiosity (over evaluation of one significance or importance)

Cognitive symptoms of hypomania/mania

• Energized, goal oriented behavior

• May talk excitedly without concerned about giving others an opportunity to speak

• Unaware of inappropriateness of action actions

• Pressured speech

• Flight of ideas

• Mania: Difficult difficulty maintaining focus (Changes topic frequently)

Behavioral symptoms of hypomania/mania

• Uninhibited

• Impulsivity and uncharacteristically risky behaviors

  • Failed to evaluate consequences of decisions

• energetic and productive or agitated and angry

• Rapid movement and incoherent speech

• May include psychotic symptoms

  
  

  
  

Physiological symptoms of hypomania/mania

• Decreased need for sleep (Often first sign of hypomanic or manic episode)

• High levels of physiological arousal

• Increased libido (May lead to reckless sexual activity)

• Weight loss due to high energy expenditure

Bipolar I

• Have at least one manic episode; Alternate between manic and depressive episodes

Mixed episode

• Experience, mania and depression at the same time or in rapid sequence

Rapid cycling

• frequently switching from manic to depressive episodes (At least four cycles per year); No period of normal mood

Bipolar II

• manic episodes are hypomanic, never reach full manic episode

Cyclothymic

• Milder symptoms of bipolar disorder

Etiology of Bipolar disorders

Biological dimension:

• Complex genetic basis involving interactions among multiple genes

  • Include several genes influenced by lithium & Genes influencing circadian cycle

• Neurological abnormalities

  • Brain dysregulation after reaching a goal or in response to obstructed goals

• Some SSRI and stimulants can trigger mania

• Hormonal influences

Treatment for bipolar disorders

Goal: eliminate symptoms to greatest degree possible & Prevent future episodes

• Combination of mood, stabilizing, medication's psychotherapy and psychoeducation

• Biomedical treatments: May involve multiple medications or multiple medication changes

• Lithium: Considered most effective medication for dose who respond to its effects

• Anti-convulsant drugs are also being used

• Antidepressants are added to deal with depressive symptoms, but they may exacerbate manic symptoms

• Failure to take medication a major issue

Psychosocial treatments for bipolar disorders

• Family focused therapy: Educating families reduces risk of relapse and hospitalization

• Interpersonal therapy

• Cognitive behavioral therapy

• Interventions focused on regulating sleep patterns

• Mindfulness interventions

School based suicide awareness curriculum

• Efficacy: mixed findings

• Effectiveness: most students aren't at high risk; Those who are tend to dislike programs; Minor increase in knowledge