PSY 350 SDSU Exam #3

Mood

state that includes: cognitive, motivational and physical aspects

3 different types of mood "episodes"

Major depressive episodes

Manic episodes

Hypomanic episodes

Major depressive episode

-Lasts most of the day, nearly every day for at least two weeks

-anhedonia (extremely depressed mood and/or loss of pleasure)

-At least 4 additional physical or cognitive symptoms: E.g., indecisiveness, feelings of worthlessness, fatigue, appetite change (can be increase or decrease but is usually a decrease in appetite), restlessness or feeling slowed down, sleep disturbance

anhedonia

Extremely depressed mood and/or loss of pleasure

Manic episode

-expansive mood for at least 1 week; Unpredictable; Judgment low, energy high. Impairment in normal functioning

-Symptoms: inflated self esteem, decreased need for sleep, excessive talkativeness, flight of ideas or sense that thoughts are racing, easily distracted, increase in goal directed activity, involvement in pleasurable but risky behaviors

Hypomanic Episode

-shorter (Lasts at least 4 days), less severe version of manic episodes

-Fewer and milder symptoms

-Associated with less impairment than manic episodes (e.g., less risky behavior)

-May not necessarily be problematic but is a part of other behaviors such as (bipolar II)

Mixed Features

-term for a mood episode with some elements reflecting the opposite mood

-Example: Depressive episode with some manic features

-Example: Manic episode with some depressed/anxious features

Major depressive disorder (single vs. recurrent)

-Mood disorder involving one major depressive episode; mood disorder involving multiple (separated by at least 2 months without depression) major depressive episodes.

-Single episode - highly unusual

-Recurrent episodes - more common

-Onset at 30, 5-10% prevalence, lifetime risk of 17%

Median lifetime # of depressive episodes for major depressive disorder

(4-7); 4-5 months in duration

Persistent Depressive Disorder

low level depression; depressed mood most of the day on more than 50% of the days; longer lasting (minimum of two years and can go for >20 years, symptoms cannot disappear for more than 2 months)

Bipolar I

-alternate between full manic episodes & major depressive episodes

-Greatest suicide risk

-Chronic condition

-Onset 15-18 years old

-Can begin in childhood

Bipolar II

-alternate between hypomanic episodes & major depressive episodes

-Can progress to Bipolar I if not treated

-Later onset than Bipolar I

-Average onset is 19-22 years, and tends to be chronic

Cyclothymic Disorder

-(alternate between mild depressive & mild hypomanic symptoms)

-Must last minimum of two years (one year for children and adolescents)

-One third to one half develop full blown bipolar

-Onset between 12-4 years

What is the prevalence of major depressive disorder

-16% for major depression

-females are twice as likely to have major depression

Prevalence of bipolar disorder

-equally affect males and females

-Affects 2.5 million americans in any given year

Permissive hypothese

low levels of serotonin "permit" NE and dopamine to fluctuate wildly, increasing vulnerability to depression

Stress hypothesis

Individuals prone to depression/anxiety will likely have elevated cortisol, which is produced by the adrenal gland

Sleep and Depression

-(more intense and longer REM activity; decreased deep stage sleep

-Sleep deprivation may improve depressive symptoms in those who are depressed

-Sleep loss may bring on feelings of depression in non-depressed individuals

Reciprocal-Gene Environment Model

essentially states that some people have a genetic predisposition that leads to certain situations which end up contributing to the development of depression/etc.

People who are vulnerable to depression might be more likely to enter situation that will lead to stress. Ex) shy person excludes self from others leading to depression.

Learned-Helplessness

A lack of perceived control over life events leads to decreased attempts to improve own situation? "Why should i even try" mentality?

When you are depressed, what are the three ways you think (aka Depressive Attributional Style)

Internal, Stable, Global

Internal way of thinking

the individual attributes negative events to personal failings ("it was my fault"). when negative outcomes are one's own fault

Stable way of thinking

even after particular negative events passes, the attribution that "additional bad things will always be my fault" remains. believing future negative outcomes will be one's own fault,

Global way of thinking

the attribution extended across a variety of issues. believing negative events will disrupt many life activities ways.

What do the three Depressive attributional styles all lead to?

a person having a sense of hopelessness

The tendency to interpret life events negatively

Cognitive errors

Arbitrary interference

assess negatives more over positive for any given situations

When a student sleeps in class and the teacher thinks it is because her lecture is boring

What describes a person who applies negatives to all situation?

Overgeneralization

What are the 4 antidepressents

-Selective serotonin reuptake inhibitors(SSRI's)

-tricyclic antidepressants

-monoamine oxidase inhibitors

-Mixed reuptake inhibitors

SSRIs

prevents reuptake of Serotonin

suicide risk in teens

Ex: prozac

Tricyclic

prevents reuptake of norepinephrine and other neurotransmitters

negative side effects common- which is why discontinuation is popular, can be lethal in excess

MAO-inhibitor

(inhibits activity of the enzyme monoamine oxidase, which breaks down norepinephrine/Sero)

fewer side effects but as effective as tricyclics

dietary restrictions

Mixed-Reuptake Inhibitors

prevents reuptake of serotonin and norepinephrine

fewer side effects than SSRIs

Ex: venlafaxine (SNRI)

How effective are antidepressants?

50% of patients benefit

low to moderate depression - no more effective then a placebo

What is the treatment of choice for Bipolar disorders?

Lithium Carbonate. Dosage is strictly regulated due to potential toxicity. Used to treat bipolar disorder. Many patients abandon this treatment to be able to experience manic episodes.

Lithium Carbonate is considered a mood stabilizer because it treats what?

depressive and manic symptoms

How prevalent is suicide among teenagers?

3rd leading cause of death

How prevalent is suicide among college students?

2nd leading cause of death

What nationalities are suicide most common in

Caucasian and Native American

What are some risk factors for suicide

Family history

Low levels of Serotonin

Alcohol abuse

Pre-existing psychological disorder

Stressful life event, especially humiliation

Contagion: ie, famous person commits suicide so I want to do it now too apparently

Double Depression

individuals who suffer from both major depressive episodes and persistent depression with fewer symptoms are said to have double depression.

Premenstrual Dysphoric Disorder

A mood disorder in women characterized by marked depressive, anxious or irritable symptoms, regularly occurring around the time of menstruation.

Disruptive Mood Dysregulation Disorder

In children, a mental disorder characterized by recurrent temper outbursts occurring against a background of irritable mood.

At what ages can you diagnose someone with disruptive mood regulation disorder?

Between the ages 6 and 18

Anorexia Nervosa

-An eating disorder characterized by calorie restriction relative to expenditure, leading to dangerously low body weight.

-nervous loss of appetite, at least 15% below ideal body weight without any other medical explanation, often begins with dieting

-Extreme caloric restriction brought on by intense fear of weight gain

-Typically comorbid with OCD (and other psych disorders)

Where is anorexia nervosa most prevalent?

Western Cultures

Among which groups of people is anorexia nervosa most prevalent?

white, middle/upper class females, and socially competitive environments

Better or worse prognosis than bulimia

worse

What is the most deadly mental disorder and why

-anorexia

-Because starving body borrows energy from internal organs

Most serious consequence is cardiac damage which can lead to heart attack and death

Bulimia Nervosa

-An eating disorder involving recurrent episodes of uncontrolled excessive (binge) eating followed by compensatory actions to remove the food (for example, deliberate vomiting, laxative abuse, and excessive exercise).

- Binge eating with compensatory behaviors ,

What are some compensatory behaviors for bulimia nervosa, starting with the most common?

Purging

diuretics or laxatives

excessive exercising

fasting

What are some consequences of purging due to bulimia

-Erosion of dental enamel can occur, electrolyte imbalance

-Kidney failure, cardiac arrhythmia, seizures... etc

Prevalence of bulimia

Majority are female 90%+ between 18-21

Facts about bulimia

-Hide behavior from others

-Food consumed often high in fat, sugar, carbohydrates

-Food consumed is usually soft and easy to consume so they can eat it fast such as (donuts,ice cream, pudding etc.)

-Most are within range of normal weight

-Later onset than anorexia

-Low Sero, can be treated with anti-depressants concern with body shape and fear of gaining weight

-Comorbidity with other psych disorders- 80% will develop anxiety in their lifetime

Binge eating disorder

rapid eating even when not hungry, with NO compensatory behaviors?

Occurs average at least once a week for 3 months

What is the most common eating disorder in the US?

Binge eating disorder

Deficits in what hormone may contribute to binging?

Sorotonin

Differences from bulimia or anorexia

Many are obese, often older than bulimics and anorexics

Not necessarily concerned about body image

What are some Sociocultural contributions to eating disorders;

-Media & cultural considerations

-Families

media and cultural contributions to eating disorders

Strongest contributions- thinness linked to success, emphasis on dieting, standards of body size

Family's contribution to eating disorders

Families with patients of anorexia are concerned with: high achievement, perfectionism, concern with external appearance, and lack of open communication

Biological contributions to eating disorders

Partial genetic contribution

Lateral hypothalamus

-brings on hunger;

-stimulation would result in eating even if full;

-destruction would result in not eating

Ventromedial hypothalamus

suppresses hunger;

Stimulation stops hunger;

destruction results in eating even if full

polysomnographic (PSG) evaluation

An assessment of sleep disorders in which a client sleeping in the lab is monitored for heart, muscle, respiration, brain wave, and other functions.

-EEG

-EOG

-EMG

electroencephalograph (EEG)

Brain wave activity

electrooculograph (EOG)

eye movements, indicative of amount of REM sleep

electromyography (EMG)

muscle activity (myo- means muscle)

Sleep efficiency (SE)

The percentage of time actually spent sleeping of the total time spent in bed. This is essentially the amount of sleep achieved divided by the amount of sleep attempted. Ex: try to sleep for 8 hours but only sleep for 6 hours. SE = 75%

Dyssomnias

is a broad type of sleep disorders involving difficulty falling or remaining asleep, which can lead to excessive sleepiness during the day due to the reduced quantity, quality or timing of sleep.

-insomnia

-hypersomnolence

-narcolepsy

-

Insomnia

-(problem initiating or maintaining sleep

Prevalence of insomnia

-1/3 of population in a given year

-females twice as likely

Treatment for insomnia

treated with benzodiazepines

Often associated with medical and or psychological condition

Unrealistic expectations about sleep

Hypersomnolence

excessive sleeping and causes sleepiness throughout the day

A person with this condition falls asleep several times a day.

Narcolepsy

(sudden onset of REM): Sleep disorder involving sudden and irresistible sleep attacks. Rare, equally distributed between males and females

part of narcolepsy, Cataplexy and what can help treat it

Sudden loss of muscle tone (helped by antidepressants/stimulants);

I.e: "sleep paralysis"

Could be brought on by a positive emotion

associated feature of narcolepsy, Sleep paralysis

an associated feature of Narcolepsy which is a brief period after awakening when they can't move or speak that is often frightening to those who go through it?

associated feature of narcolepsy, hypnagogic hallucinations

vivid and often terrifying experiences that begin at the start of sleep and are said to be unbelievably realistic because they include not only visual aspects but also touch, hearing, and even the sensation of body movement

What are some psychological treatment for sleep disorders?

CBT, relaxation and stress reduction, and improved sleep hygiene

Cognitive behavioral therapy for insomnia

-Changing beliefs about sleep

-Extensive monitoring using sleep diary

-Practicing better sleep-related habits

Relaxation and stress reduction

Reduces stress and assists with sleep

Modify unrealistic expectations about sleep

What medications are used to treat hypersomnia and narcolepsy

stimulants (modafinil/provigil)

What medications are used to treat insomnia

benzodiazepines and over-the-counter sleep medications, best as a short term solution

Parasomnias

abnormal behavioral and physiological events during sleep

Which parasomnias occur during non-REM sleep?

sleep terrors and somnambulism

Somnambulism

-Sleep walking

may be accompanied by night eating, or dangerous situations

Sleep terrors

recurrent episodes of panic like symptoms during non-REM sleep

more common in children, child has little memory of it the next day

Can wake child at specific time to prevent

Which parasomnia occurs during REM sleep

Nightmares

Nightmares

-all are more common in children (10-50%)

Often awaken from slumber

-CBT/may involve antidepressants and or relaxation training can help

-All three will typically resolve on their own without any extensive intervention

What are two forms of maladaptive eating patterns in a person who is obese?

Binge eating and night eating syndrome

What describes getting out of bed at least once during the night and consuming a third or more of ones daily food intake?

Night eating syndrome

What did Henderson and Brownell find about contributions to the obesity epidemic?

Obesity is related to the spread of modernization.

promotion of inactive and sedentary lifestyle and consumption of high fat energy dense diet

Breathing-related Sleep Disorders

-Obstructive Sleep Apnea hypopnea

-central sleep apnea (CSA):

-sleep-related hypoventilation

Obstructive Sleep Apnea Hypopnea

airflow stops, despite continued activity by respiratory system working (airflow stops, resp system works)

central sleep apnea (CSA):

Respiratory system stops for a brief period

airflow stops due to some type of CNS pathology

sleep-related hypoventilation

decreased breathing during sleep not better explained by another sleep disorder?

airflow does not completely stop, but is reduced

Sexual dysfunction (and its three factors)

the term for issues involving desire, arousal and/or orgasms?

Rate of prevalence of sexual dysfunction on women and men

43% of women & 31% of men in US

Chronic vs acquired

-Chronic: From first sexual encounter

-Acquired: Occurs after a period of normal sexual activity

Generalized vs. Situational

-Generalized occurs every time the individual has sex

-Situational occurs randomly in specific situations