psychopathology

what are bipolar disorders

Involve the experience of a manic or hypomanic episode and must be accompanied by clinically significant distress or impairment. Includes bipolar I, bipolar II, and cyclothymic disorders

what are similar characteristics between manic and hypomanic episodes

both consist of the same symptoms and prerequisites for symptoms

what are the differences between manic and hypomanic episodes

manic lasts for at least one week, hypomanic lasts for at least 4 days, hypomanic symptoms not severe enough to cause marked impairment in social or occupational function and does not necessitate hospitalization or have psychotic features

manic episode requirements

distinct period of abnormally and persistently… elevated, expansive, or irritable mood… and increased activity or energy… lasting at least a week or more. also must include three or more symptoms

hypomanic episode requirements

distinct period of abnormally and persistently… elevated, expansive, or irritable mood… and increased activity or energy… lasting at least 4 consecutive days or more. also must include three or more symptoms

hypomanic and manic episode symptoms

inflated self-esteem or grandiosity, decreased need for sleep, flight of ideas or racing thoughts, pressured speech, increase in goal-directed activity or psychomotor agitation, excessive involvement in risky behaviors, distractibility

details about manic episode symptoms

causes marked impairment in social or occupational functioning, necessitates hospitalization, or has psychotic features

details about hypomanic episode symptoms

unequivocal change in functioning that is uncharacteristic of the person, disturbance in mood and change in functioning are observable by others, not severe enough to cause marked impairment in social or occupational functioning, does not necessitate hospitalization and does not have psychotic features

bipolar I disorder requirements

must have had 1 manic episode

bipolar II disorder requirements

must have had 1 hypomanic episode and 1 depressive episode; has never had a manic episode; depression symptoms or switching between depression and hypomanic symptoms must cause clinically significant distress or impairment

cyclothymic disorder requirements

for at least 2 years: numerous periods of hypomanic symptoms that do not meet criteria for an episode, numerous periods of depressive symptoms that do not meet criteria for a depressive disorder episode

bipolar I prevalence

approximately 17% lifetime, women and men are equally likely to get diagnosis

bipolar I development

first manic episode can happen at any point, but it is most common to have first age of onset in late teens to early 20’s

bipolar I course

episodic, almost all include depressive episodes, chronic, over half include psychotic features, more than 60% result in hospitalization, highest rate of suicide attempts and deaths

why are black patients more likely to get misdiagnosed with schizophrenia

less access to preventative care, provider bias, symptom presentation

why is studying bipolar disorder complicated

both manic and depressive episodes are included in the diagnosis, making it difficult to study and to understand the etiology and maintenance

genes and bipolar

60%-85% of differences in bipolar expression may be caused by genetics/heritability. likely contribute to underlying processes (ex: circadian rhythm disruption) rather than directly to bipolar.

neurotransmitters and bipolar

many, such as dopamine and serotonin, are likely involved

amygdala

negative emotion generation

prefrontal cortex

emotion regulation

brain structures and bipolar

overactive amygdala, underactive prefrontal cortex

putamen

reinforcement learning, decreased activity in people with bpd compared to mdd, unclear how related to bipolar but could possibly be due to reward and motivation in manic states

behavior and bipolar

disturbances in sleep and circadian rhythm may trigger manic episodes

cognition and bipolar

for depressive episodes, same as MDD

expressed emotion and bipolar

family members expressing critical comments and being emotionally overinvolved leads to stress that may trigger manic or depression episodes

lithium carbonate

made from lithium, has mood stabilizing effects and is used to primarily to prevent manic episodes (but may help prevent depressive episodes), unclear how it works, side effects and high potential for overdose, is less used than other medications

antipsychotics

used primarily for psychotic disorders (schizophrenia, etc) but also bipolar if psychotic symptoms are present, act as dopamine and serotonin receptor antagonists, helps treat manic episodes and (at lower doses) prevents manic and depressive episodes

why do you not use SSRIs for treatment of bipolar

increase the likelihood of manic and hypomanic episodes, no consistent evidence that pairing with mood stabilizers improves outcomes

anticonvulsants

initially created to prevent seizures, often called “mood stabilizers”, may partially work by blocking Na+ channels in neurons, helps prevent manic episodes

anticonvulsant medication names

Valproate (Depakote), Lamotrigine (Lamictal), Carbamazepine (Tegretol)

interpersonal and social rhythm therapy

helping client work through interpersonal problems, maintain daily routines including taking medication, helps prevent manic and depressive episodes

family-focused therapy

improving communication among family members, promoting problem-solving skills, designed to reduce critical comments by family members and emotional overinvolvement, helps prevent manic and depressive episodes

anxiety disorder types

panic disorder, agoraphobia, specific phobia, social anxiety disorder, selective mutism, generalized anxiety disorder

panic attack requirements

abrupt surge of intense fear or discomfort that reaches its peak within minutes, must have 4 or more symptoms

panic attack symptoms

at least 3: palpitations, pounding heart, accelerated heart rate; sweating; trembling or shaking; shortness of breath or smothering; feelings of choking; chest pain/discomfort; dizzy, unsteady, lightheaded, faint; chills or heat sensations; numbness or tingling; feelings of unreality (derealization) or detached (depersonalized); fear of losing control “going crazy”; fear of dying

panic disorder requirements

recurrent unexpected panic attacks, at least one or more symptoms following a panic attack, panic attacks do not occur only in the context of some other disorder

panic disorder symptoms

persistent concern or worry about additional attacks or consequences, significant maladaptive change in behavior related to the attacks

agoraphobia requirements

marked fear or anxiety about 2 or more symptoms, individuals avoid or fear these situations because of thoughts that escape might be difficult and fear of developing panic-like symptoms or other incapacity

agoraphobia symptoms

using public transit, being in open spaces (parking lots, bridges), being in enclosed spaces (shops, theaters), standing in a line or crowd, being outside of the home alone

specific phobia

marked fear or anxiety about a specific object or situation. i.e. flying, heights, closed spaces, animals, etc

social anxiety disorder

marked fear or anxiety about one or more social situations in which the individual is exposed to possible scrutiny by others, person fears they will act in a way or show anxiety symptoms that will be viewed negatively

common criteria between agoraphobia, specific phobia, and SAD

object or situation almost always provokes fear or anxiety, object or situation is actively avoided or endured with intense anxiety, anxiety/fear is out of proportion to the danger posed by situation, fear/anxiety/avoidance is persistent and lasts 6 months or more

separation anxiety disorder requirements

developmentally inappropriate and excessive fear or anxiety concerning separation from those to whom the individual is attached as evidenced by 3 or more symptoms, involves fear of separation from “major attachment figure”, at least 4 weeks in children/adolescents and 6 months in adults

separation anxiety disorder symptoms

3 or more of the following: distress at separation from home or MAF, worry about losing MAF, worry about event causing separation from MAF, refusal to go out because fear of separation, fear about being away from MAF, refusal to sleep away from or sleep without MAF, physical complaints when separated from MAF

selective mutism

consistent lack of speaking in situations where speaking is expected despite speaking elsewhere, not attributed to lack of knowledge, interference with educational or occupational achievement or with social communication, lasts at least a month other than the first month of school

generalized anxiety disorder requirements

excessive anxiety and worry about multiple events or activities occurring more days than not for at least 6 months, the person finds it difficult to control the worry, 3 or more symptoms

generalized anxiety disorder symptoms

restlessness or feeling on edge, easily fatigued, difficulty concentrating, irritability, muscle tension, insomnia or restless sleep

10%

specific phobia prevalence

7%

social anxiety disorder prevalence

3%

panic disorder prevalence

3%

generalized anxiety disorder prevalence

1.5%

agoraphobia prevalence

4%—1.5% children, 1% adults

separation anxiety disorder prevalence

1%

selective mutism prevalence

genetics and GAD

~30% difference in expression may be caused by genetics/heritability

genetics and specific phobia

~60% difference in expression may be caused by genetics/heritability

classical conditioning

certain stimuli produce reflexive behaviors. a neutral stimulus is paired with the stimulus that produces the reflexive behavior. after pairing, neutral stimulus will evoke the reflexive behavior.

stimulus generalization

things similar to the conditioned stimulus may evoke the conditioned response

operant conditioning

contributes to the maintenance of avoidance through negative reinforcement

information processing in anxiety

people with this disorder are vigilant for threat-relevant information, which helps maintenance

overestimation

believing that anxiety-inducing event is more likely to occur than realistic and that it will be way worse than realistic threat

interpretation

deeming neutral or ambiguous information as negative or threatening

adverse childhood experiences

physical, emotional, and sexual abuse, neglect, absent parent, substance use in home

medications that can be used for chronic anxiety

tricyclics, SSRIs SNRIs NDRIs SARIs SMSs, antihistamines

tricyclic medications

block reuptake of serotonin and norepinephrine, imipramine (Tofranil), clomipramine (Anafranil)

SSRIs, SNRIs, NDRIs, SARIs, SMSs

SNRIs are used less often for anxiety than depression, SSRIs may be more effective for treating anxiety, buspirone is a serotonin partial agonist

antihistamines

histamine is a neurotransmitter, antihistamines block this neurotransmitter which can help produce calming effects, hydroxyzine (Vistaril) is a histamine inverse agonist

benzodiazepines

increase the effects of GABA receptors, effective treating chronic and acute anxiety, intended for short-term use, addictive, diazepam (Valium), alprazolam (Xanax), lorazepam (Ativan), clonazepam (Klonopin)

beta blockers

initially intended to treat arrhythmias, beta adrenergic (epinephrine) receptor antagonist, primarily inhibits physiological effects of anxiety, propranolol (Inderal)

who might use beta blockers?

performers, people who need to limit physiological implications of anxiety

CBT

cognitive and behavioral components, most therapists combine both for the treatment of a variety of conditions, especially anxiety

exposure therapy

based on classical conditioning because over time, the person learns a new association. effective for all anxiety disorders but GAD

difficulty with exposure therapy

people do not want to expose themselves to things they fear

keys to exposure therapy

hierarchical exposure, staying in situation long enough for fear to go down, repetition, applying exposure to multiple objects and situations over different settings

cognitive therapy

most often applied with exposure therapy. for all anxiety disorders, it challenges the likelihood and severity of feared consequences. for social anxiety disorder, it challenges interpretations of other’s words and actions

trauma and stressor-related disorders

PTSD, acute stress disorder, adjustment disorder, prolonged grief disorder

post-traumatic stress disorder requirements

symptoms apply to people older than 6 years old, must meet all 5 symptoms

post-traumatic stress disorder symptoms

experiencing, witnessing, or being exposed to a traumatic event; intrusion symptoms; avoidance symptoms; alterations in cognition and mood; alterations in arousal and reactivity; must last more than 1 month and symptoms have happened or worsened since trauma

what classifies as a traumatic event

at least 1: directly experiencing the event, witnessing in person the event as it occurs, learning the event occurred to a close family member/friend, experiencing repeated or extreme exposure to aversive details of traumatic event

intrusion symptoms PTSD

at least 1: recurrent involuntary and intrusive distressing memories of the event, recurrent distressing dreams related to the event, flashbacks in which the person feels or acts as if the event were recurring, intense distress when exposed to cues related to event

avoidance symptoms PTSD

at least 1: avoidance of distressing memories thoughts or feelings about event, avoidance of external reminders bringing up distress aout event

cognition and mood symptoms PTSD

at least 2: inability to remember important aspects of event, persistent exaggerated negative beliefs about self, world, or others, persistent and distorted thoughts surrounding cause and consequences of event that led to self-blame, persistent and negative emotional state, markedly diminished interest or participation, feelings of detachment or estrangement, inability to experience positive emotions

arousal and reactivity symptoms PTSD

at least 2: irritable behavior and angry outbursts, reckless or self-destructive behavior, hypervigilance, exaggerated startle response, problems with concentration, insomnia or restless sleep

acute distress disorder

same criteria for traumatic event but lasts between 3 days to a month and has slightly different symptoms

adjustment disorders requirements

development of emotional or behavioral symptoms in response to an identifiable stressor, symptoms are clinically significant

adjustment disorders symptoms

at least 1: marked distress out of proportion to the severity or intensity of the stressor taking into account context and culture, significant impairment in functioning

prolonged grief disorder requirements

still experiencing grief after 12 months of the death of someone close, several symptoms go beyond typical grief, duration and severity of symptoms must exceed social, cultural, or religious norms

prolonged grief disorder symptoms

at least 1: intense yearning or longing for the deceased, preoccupation with thoughts or memories of the deceased

reactive attachment disorder (RAD)

a child experienced a pattern of extreme insufficient care that results in inhibited, emotionally withdrawn behavior towards adult caregivers

extreme insufficient care symptoms RAD

at least 1: social neglect and deprivation, changes in primary caregivers that limits opportunities to form stable attachments, being raised in unusual settings that severely limit opportunities to form attachments

inhibited withdrawn behavior to adult caregivers symptoms RAD

both symptoms: child rarely or minimally seeks comfort, child rarely or minimally responds to comfort

other symptoms RAD

at least 2: minimal social and emotional responsiveness, limited positive affect, episodes of unexplained irritability, sadness, or fearfulness

disinhibited social engagement disorder

a child experienced a pattern of extreme insufficient care that results in a pattern of behavior of approaching or interacting with unfamiliar adults

problems with interacting with adults symptoms—disinhibited social engagement disorder

at least 2 of these: reduced or absent hesitation in approaching and interacting with unfamiliar adults, overly familiar verbal or physical behavior, diminished or absent checking back with caregiver after venturing away in unfamiliar settings, willingness to go off with unfamiliar adults with minimal or no hesitation

extreme insufficient care symptoms—disinhibited social engagement disorder

same as RAD, at least 1: social neglect and deprivation, changes in primary caregivers that limits opportunities to form stable attachments, being raised in unusual settings that severely limit opportunities to form attachments

differences between RAD and disinhibited social engagement disorder

in one, children rarely and minimally seek comfort from adults and have minimal social responsiveness. in the other, children are overly active and craving attention from adults they do not know.

similarities between RAD and disinhibited social engagement disorder

both have experienced extreme insufficient care

how have the definitions for a traumatic event changed over time

pathological trauma originally tailored for war and combat but later expanded to include witnessing or experiencing other kinds of threatened or actual death. changes in DSM-V clarify trauma to be sexual violence and accidental/violent trauma happening to family or friend.

prevalence of PTSD

5% lifetime, 10% in military veterans, women 2x as likely

why are women more likely to experience PTSD

women are more susceptible to something traumatic like sexual violence