Psychopathology of Everyday Life Exam PSY30014

What is the difference between fear and anxiety

Fear - source of harm is immediate and certain

Anxiety - feelings that occur when the source of harm or threat is uncertain or distance (anticipatory)

what are some brain areas involved in threat processing

amygdala, insular cortex, prefrontal cortex, hippocampus

What is significant about threat processing and anxiety disorder neural substrates

they use the same neural pathways

Inhibition of threat specific pathways is known as what pathway?

cognitive appraisal

Most common onset of anxiety disorder?

childhood, adolescence or early adulthood

is anxiety internalising or externalising?

internalising

Anxiety disorders social phobia, agoraphobia specific phobia and panic disorder are all under the Fear column in the HiTop model. What does GAD (generalised anxiety disorder) fall under?

distress

do males or females more commonly have an anxiety disorder

Females are 2x more likely to experience an anxiety disorder

What does the vicious cycle of anxiety refer to?

The process by which anxiety leads to hypervigilance of self and increased scanning of danger. The individual then escapes or avoids the situation which leads to short term relief and long term increase of physical symptoms of anxiety and decreased confidence.

What is the generic treatment for at risk of anxiety or mild anxiety?

waitful watching; CBT ( can be internet based) if worsening

What is the generic treatment for moderate anxiety?

CBT or pharmacotherapy, or both

What is the generic treatment for severe or treatment resistant anxiety??

CBT & pharmacotherapy

What is involved in the cognitive component of CBT for anxiety

psychoeducation

cognitive reappraisal

problem solving

what is involved in the behavioural component of CBT for anxiety

exposure

behavioural experiments

relaxation techniques

skills training

What is the best treatment for specific phobias?

Exposure therapy

Those that have panic disorder are likely to be comorbid with which 3 things?

agoraphobia

depression

substance dependence

What is the treatment for panic disorder

CBT and pharmacology

Which anxiety disorder is this?

fear about being in 2 or more of the following five situations:

- using public transport

- being in open spaces

- being in closed spaces

- standing in line or being in a crowd

- being outside of the home alone

individual fears or avoids these situations because escape might be difficult or help may not be available.

agoraphobia

Which anxiety disorder is this?

fear or anxiety about one or more social situations where the individual is exposed to possible scrutiny by others. Fears that they will be negatively judged due to anxiety symptoms

social anxiety disorder

what is social anxiety likely to have comorbidity with?

mood disorder

another anxiety disorder

substance use disorder

when is social anxiety likely to be developed

before 20

what are the 3 factors that contribute to social anxiety

genes/temperament

environmental factors

proximal factors (eg. behavioural/ cognitive)

what is treatment for social anxiety

CBT

what are the behavioural components of CBT for those with social anxiety

exposure therapy (safety behaviours)

applied relaxation

why can exposure therapy fail for those with social anxiety

"mental distancing" client knows the situation is simply role play

What is this diagnosis?

"excessive anxiety and worry about various events have occurred more days than not for at least 6 months.

worry is difficult to control

includes feelings like: restlessness, keyed up on 'on edge', easily fatigued, difficulty concentrating irritability, tension and sleep disturbance

anxiety, worry or physical symptoms cause distress in life.

generalised anxiety disorder

when is the typical onset of GAD

childhood or adolescence

which sex is more at risk of GAD

females

what is GAD likely comorbid with?

mood disorders

other anxiety disorders

GAD. What is the Avoidance model of worry (borkovec)

worry is an ineffective cognitive attempt to problem solve and thus remove a perceived threat while simultaneously avoiding the aversive somatic and emotional experiences

GAD. What is the intolerance of uncertainty model (Dugas & Ladouceur)

uncertain or ambiguous situations are stressful and upsetting. belief that worry will serve to either help cope with feared events more effectively or to prevent those events from occurring at all

What is the contrast avoidance model of GAD

using worry to avoid big shifts in affect. eg. if something bad might happen, it would make a big change in emotions. Yet if you always worry and have a negative emotionality you sustain that emotional state rather than big ups or downs.

worry does not facilitate avoidance of emotions

worry does sustain negative emotionality though (restricts affect)

What is the meta-cognitive model of GAD

people initially develop belief that worry helps (and perhaps it does), but subsequently begin to worry about their worrying (meta-worry). Efforts at thought control fail and people feel helpless.

what is the treatment of GAD? And what is the treatment response?

CBT and/or pharmacology. only 50% of clients respond to medication and/or CBT

When is combined psychological and psychopharmacological therapy recommended in GAD?

complex cases

What are the Mood disorders?

Major depressive disorder

Persistent Depressive disorder

Bipolar I

Bipolar II

What is the difference between mood and affect

mood = sustained emotion which colours an individual's experience of the world (longer term)

affect = moment-to-moment experience of emotional states and observable expression of emotion. (shorter term)

What is a mood disorder according to DSM-5

depression or elevation of mood as primary disturbance

What is the difference between unipolar and bipolar?

Unipolar is experiencing 'dysthymia' and depression - both negative emotionality whereas bipolar is experiencing hypomania to mania and the negative affect.

which groups are more vulnerable to mood disorder?

females, young people, LGB+, homeless, unemployed/not studing

Would depression be a unipolar or bipolar experience?

unipolar (only negative affect)

which categories do mood disorders fall into under the HiTop model?

Internalising -> distress or mania -> (bipolar under mania all other mood disorders under distress)

At what point would you consider grief to be considered clinically relevant to MDEccording to the DSM and why? What caveat do you understand in this time period

<2 months. Because grief can be a precipitant to MDe. 1-2 years is more realistic for grief to pass

What is the difference between sadness and clinically significant depression in terms of time and intensity?

mood change is persistent across contexts and impairs social and occupational function

What is the difference between sadness and clinically significant depression in terms of quality?

the mood change is different from normal sadness

What is the difference between sadness and clinically significant depression in terms of associated features?

mood change may be accompanied by cluster of signs and symptoms like somatic and cognitive features

What is the difference between sadness and clinically significant depression in terms of absence of precipitants?

no discernible reason for sadness or out of proportion to precipant/stressor that triggered depression

what is the time period that must be present for major depressive episode?

at or over 2 weeks

Bella shows at least 5 of these symptoms for 2 weeks now. What disorder is clinically relevant?

- depressed mood, anhedonia, decrease in appetite or significant weight loss or gain, persistent increased or decreased sleep, psychomotor agitation or retardation, fatigue or low energy, feelings of worthlessness or inappropriate guilt, decreased concentration or indecisiveness, recurrent thoughts of death, suicidal ideation or suicide attempt.

Major depressive episode

If a client has history of manic or hypomanic episodes can they meet the criteria for major depressive disorder?

no

what is the median age of onset for Major depressive disorder?

25 years

Which sex is at greater risk for major depressive disorder?

females

What is the course of MDD. (likelihood of stable recovery, relapse, recurrent course)

40-60% exhibit stable recovery

1/2 relapse in 5 years

30-60% have it pop up again and again over their life

What are some risk factors for suicide?

family history, early life adversity, mental health disorder, impulsivity, substance misuse, sense of hopelessness/helplessness

which sex is at increased risk of dying by suicide?

males

what groups are higher risk of suicidal ideation and suicide

LGBTQIA+ Aboriginal and Torres Strait Islander

Are depressive disorders heritable?

Yes - 40-70% first degree relatives increased risk of 5-25%

Neurobiology of depression. What is one neural region impacted in depression. What neurotransmitters have altered function?

hippocampus. dopamine, serotonin, noradrenaline

Immunological aetiology of depression. What is the role of immune system and inflammatory response in depression?

- some forms of depression may be related to immune activity.

- enhancing inflammatory response leads to depressive like experience

- may only be a subset of cases

Stress aetiology of depression. What is the role of stress in depression?

stressors very closely linked to depression. 80% of MDE's preceded by major life event. stress leads to more stress.

Personality aetiology of depression. What is the role of personality in depression

neuroticism and introversion linked to depression. negative self-esteem/poor self schema linked to depression. Interpersonal sensitivety may be a risk factor.

What model of depression is the below:

little activity performed by individual -> leads to low rate of positive enforcement which increases depressive symptoms -> which leads to less activity

Behavioural model of depression

What model of depression is the below:

depression -> low energy, fatigue and decreased interest -> decreased activity, neglect of responsibilities -> increased guilt, hopeessness and ineffectiveness which leads back to depression

Vicious cycle of depression

What model of depression is the below:

early experience -> formation of dysfunctional assumptions (ideas about the world schemas/core beliefs) -> critical incidents -> assumptions activate -> negative automatic thoughts (irrational ideas/negative views about self, other and the world) -> symptoms of depression

cognitive model of depression

What is the treatment for Major depressive disorder?

CBT, Behavioural activation therapy, psychodynamic therapy, problem-solving therapy, interpersonal therapy, mindfulness-based therapy, Pharmacology.

How much time does one have to have depressed mood for to have persistent depressive disorder

more days than not for 2 years.

Which sex is more at risk of persistent depressive disorder?

females

What was persistent depressive disorder (PDD) previously called and how can that help you think about the symptoms of PDD?

dysthymia - low level, chronic depression.

Symptoms include:

- change in appetite or weight

- change in sleep

- low energy or fatigue

- low self esteem

- poor concentration or difficulty making decisions

- feeling of hopelessness

What is the treatment for persistent depressive disorder. how effective is treatment?

same as MDD. more likely to be treatment resistant

What are some symptoms of mania?

-abnormal and persistent mood elevation,

- inflated self esteem

- less need for sleep

- pressured speech

- racing thoughts

- distractibility

- increase in goal-directed activities

- high-risk activities

- psychomotor agitation

what is the time period difference for diagnosis of manic episode vs hypomanic episode?

manic - last at least a week

hypomania - 4+ consecutive days

what is the difference between hypomanic episode and manic episode

manic is more severe and symptoms must be present to a significant degree.

- hypomania is not severe enough to cause marked impairment in social/occupational functioning. Does not require hospitalisation or include psychotic features

What are the conditions for diagnosis of bipolar 1

one or more manic episodes usually (not always) accompanied by major depressive episodes

what are the conditions for diagnosis of bipolar 2

one or more depressive episodes accompanied by at least on hypomanic episode

what are the conditions of cyclothymic disorder

at least 2 years of numerous periods of hypomanic and depressive symotoms that do not meet threshold for manic or depressive episodes

what is the age of onset of bipolar disorders?

~20 years

is it common for those with bipolar disorder to experience psychotic symptoms

yes 89% in Morgan et al 2005 sample

What happens if bipolar is left untreated?

- length of periods where mood returns to normal episodes decreases

- length of each episode increases

- depressed phases become more likely

- suicide big risk

What is the treatment for bipolar disorder

mood stabiliser or antipsychotics

CBT effective with psychopharmacological intervention

What is the term for the below type of therapy:

- operates on the premise that patterns of thinking influence the way we feel (emotionally and physically) and behave

- the general aim is to alter unhelpful thinking in order to alleviate unpleasant feelings and change maladaptive behaviour.

cognitive behaviour therapy

What are the common principles of CBT?

- problem focused & goal oriented

- emphasis of the "here and now"

therapist and client collaborate to identify problems and plan treatments

- therapist as a teacher

- client as therapist

What does the ABC Cognitive Model of Emotional and Behaviour refer to?

A - activating event

B - beliefs or thoughts about the activating event

C - consequence

is the ABC Cognitive Model of Emotional and Behaviour adaptive or maladaptive

can be both.

reading situation (A) as good or bad (B) determines the subjective feelings and behaviour (C)

What difference does Beck's Cognitive Model have from the ABC Cognitive Model of Emotional and Behaviour?

input of schemas on beliefs which is a culmination of experiences, culture and microcultures (friends, family)

ABC = simple event → belief → consequence chain. Beck's model = ABC + a layer explaining where the belief comes from

What is the first phase of CBT for depression? Why is this the first phase?

-psychoeducation - non-cognitive (behaviour) techniques.

- straightforward and structured so easier to achieve successes (people who are depressed experience difficulty initiating change.

What is the second phase of CBT for depression?

- focus on cognitive techniques and problem solving

what is the third phase of CBT for depression?

generalisation and relapse prevention

How do you work with an Automatic thought (CBT for depression?)

ask the client to rate their belief in the thought

evaluate the validity and utility of the thought by questioning it.

What does CBT for Bipolar disorder involve

education bout the disorder and own experiences (eg. triggers and stressors for individual)

- Cognitive and Behavioural intervention like maintaining routines, medication adherence, reframing thoughts as symptoms, delay a tion on thoughts

what does the following symptom configuration indicate?

delusions

hallucinations

disorganised thinking (speech)

grossly disorganised or abnormal motor behaviour

negative symptoms

psychosis

what are delusions? think of an example

fixed beliefs that are not amenable to change in light of conflicting evidence

eg. belief that one is going to be harmed by individual or group etc.

what are hallucinations

perceptual experiences that occur without external stimulus

what are examples of disorganised thinking or speech types?

clanging, cicumstantiality/tangentiality, flight of ideas, derailment, incoherence, pressure of speech

what is grossly disorganised or abnormal motor behaviour

manifests in alot of ways

- childlike siliness

- unpredictable agitation

- catatonia

what are negative symptoms (psychosis)

Flat affect, social withdrawal, lack of speech/thought, lack of motivation. feeling less and on the negative emotionality of scale

What work does the Hearing Voices Network do?

- accept that hearing voices is a human experience

- create safe space for people to share experiences

- belief in recovery

work with services

- increase self empowerment/determination

What is the duration criteria for a brief psychotic episode and how many symptoms do they need to present with

1 day to 1 month. 1+ major symptom

What is the duration criteria for delusional disorder and how many symptoms do they need to present with

1 month. Delusions only with no positive symptomology

What is the duration criteria for schizoaffective disorder and how many symptoms do they need to present with

2+ weeks of delusions/hallucination with no mood disturbance. 2+ major symptoms

What is the duration criteria for schizophreniform disorder and how many symptoms do they need to present with

1-6 months. 2+ major symptoms