Psychopathology Exam 2

An adult client has been experiencing uncontrolled anxiety. His symptoms include edginess, sleep changes, fatigue, and significant distress. To meet the DSM-5 diagnostic criteria for generalized anxiety disorder, these symptoms must be present for at least how many months?

6 months

According to Freud, children who are prevented from expressing id impulses (for example, making mud pies, playing war) are at risk for developing:

anxiety

Research on the cognitive explanation for the development of generalized anxiety shows that people with generalized anxiety symptoms:

are more likely to have fast and strong physical reactions to stress.

GABA has been found to play a causal role in:

generalized anxiety disorder.

GABA acts by:

inhibiting neuronal firing in the brain.

• puts a “brake” on the brain’s excitatory signals

Antidepressant drugs often increase the activity of the neurotransmitters serotonin and:

norepinephrine.

Avery, a 28-year-old woman, tells her therapist that she has an intense fear of snakes. She says she has been afraid of snakes since she was a child. Which additional criterion would suggest that Avery meets the diagnostic criteria for a specific phobia?

refusal to go to certain places where she believes snakes could be present, such as the lake

A person who experiences unpredictable panic attacks combined with dysfunctional behavior and thoughts is probably experiencing:

panic disorder.

Which therapy is an effective long-term, nonpharmacologic treatment for panic attack that involves teaching patients to interpret their physical sensations accurately?

cognitive-behavioral therapy

When would religious rituals and superstitious behavior (such as not stepping on cracks) be considered compulsive behaviors?

when they interfere with daily function and cause distress

Samuel cannot leave for work without going back into his house and making sure that he has taken all of his writing materials. He does this several times before he allows himself to start the car and drive to work. He is frequently late for work because he is so unsure about remembering everything. Samuel is displaying:

a checking compulsion.

Before starting her car, Doris has a habit of always gripping the shift lever and the turn signal lever three times each. She is exhibiting a(n):

touching compulsion.

According to Freud, in which stage of development do obsessive-compulsive disorders originate?

anal

Psychodynamic therapies as a treatment for obsessive-compulsive disorders:

appear to work better when used in the short term rather than in traditional ways

Cognitive-behavioral theorists have found that people who develop obsessive-compulsive disorder also:

believe their thoughts are capable of causing harm to themselves or others.

Describe your understanding of Anxiety and how human physiology responds to stimuli in an attempt to manage it.  Try to include as many details of the process as you can including the interaction between different systems in the body.  5 points

Anxiety can be understood as a broad set of bodily experiences caused by a natural survival response to fear. These bodily experiences may include symptoms such as a heightened heart rate, a tightening of the chest, sweaty hands, and restlessness/shaking. These physiological experiences are responses from our body trying to prepare us to respond to fearful situations. There are a series of cognitive responses that occur in the brain, and are distributed through the autonomic nerbous system that activates these bodily responses in the cardiovasular, muscular, and integumentary systems. In evolutionary terms, these systems are attempting to help us survive, enabling our bodies to jump into fight, flight, freeze, or fawn. The hormone cortisol plays an improtant role in the anxiety process. The primary goal of our bodies implementing such a response is to evade the stressful stimulus causing the fear.

If a person taking lithium began experiencing vomiting, tremors, and seizures, one would suspect that:

the person is experiencing lithium toxicity.

The strongest evidence for the cause of bipolar disorders BEST supports which theoretical perspective?

the biological perspective

Which statement is TRUE regarding the prevalence of bipolar disorder?

It affects millions of people, between 1 and 2.8 percent of all adults.

The difference between bipolar I disorder and bipolar II disorder is the:

severity of the manic episodes.

• bipolar 1 has a distinct period of abnormally elevated mood for at least 1 week

• bipolar 2 has hypomania, which is a lesser form of mania and lasts for 4+ days

According to DSM-5-TR, all of the following are considered symptoms of a manic episode EXCEPT:

suicidal ideation.

Compared with African Americans, non-Hispanic white Americans are:

about as likely to be diagnosed with depression but less likely to have recurrent episodes.

The statement that men and women are equally prone to depression, but clinicians often fail to detect depressive symptoms in men, reflects the _____ theory.

artifact

Compared with people in untroubled marriages, people in troubled marriages are _____ to have a depressive disorder.

substantially more likely

A clinician who looks at the influence of race, living conditions, marital status, and roles on the development of depression would MOST likely subscribe to which theoretical orientation?

sociocultural theoretical orientation

Many victims of spousal abuse stay with their abusers, even though it is obvious to others that they should, and actually could, leave. A good explanation for their behavior is:

learned helplessness.

What kind of clinician would be MOST likely to say, “Tell me about any early losses you experienced” to a client?

psychodynamic clinician

A woman being treated for peripartum depression after the birth of her first child will:

have a 25 to 50 percent chance of experiencing peripartum depression with a later birth.

What does research reveal about the role genetic factors play in unipolar depression?

Researchers have found genes associated with unipolar depression on most of the body's chromosomes.

Family pedigree, twin, and gene studies have been used to look for a predisposition for unipolar depression. These studies have found:

a higher than chance rate of depression among the families of depressed patients.

Which statement about unipolar depression is TRUE?

The large majority of individuals with unipolar depression recover within 6 months, sometimes without treatment.

What makes Bipolar Disorder different from a depressive disorder?  What is the difference between Bipolar I, Bipolar II, and Cyclothymic Disorder?  You must identify a characteristic of each that separates it from the other diagnoses in this question. 5 points

The primary differentiation between Bipolar disorder and a Depressive disorder is the presence of manic episodes. Mania is when an individual experiences an unexpected and unexplained sudden rise in mood - this may take the form of joy, but it may also take the form of extreme anger and irritability. As such, the behavior may take a variety of forms, but the underlying consistency is a rise in activity. Manic people move quickly, as if there isn't enough time to accomplish everything and could be described as flamboyant. Individuals who suffer from bipolar disorder experience a swing between depressive episodes and manic episodes. Those within a depressive state will consistently have low mood and energy and will not swing in the opposite direction like those with bipolar disorder.

Bipolar I and Bipolar II are distinguished by the severity of their manic episodes. In Bipolar I, the patient is struck by a full on, intense manic episode. In Bipolar II, the patient has more mild Manic episodes. In both cases, major depression is present. Cyclothymic disorder is characterized by mild depressive symptoms alongside mild manic symptoms. In short, it can be thought of as a milder form of bipolar disorder. The symptoms often last for at least two years, with interspersed normal moods and behaviors. 

A person who witnessed a horrible car accident and then became unusually anxious and depressed for three weeks is probably experiencing:

acute stress disorder.

• if symptoms persist for more than 1 month, it becomes PTSD

The individuals who are MOST likely (demographics) to experience a psychological stress disorder are:

female or low-income individuals.

A friend says, “If we could just eliminate combat traumas, we could eliminate a great deal of posttraumatic stress disorder.” The BEST response is:

“Yes. However, civilian trauma causes many more cases of PTSD than combat trauma does.”

Researchers have found that in people with PTSD, the interconnection between the amygdala and prefrontal cortex is flawed because:

the amygdala is too active, and the prefrontal cortex is not active enough.

What is one of the roles of the hippocampus?

It communicates with the amygdala to produce the emotional components of memory.

Which child is MOST likely to develop a stress disorder later in life after experiencing a trauma?

a child who lives alone with a single mother who is working multiple jobs

According to developmental psychopathologists, why do children tend to fare worse than adults when faced with an extreme stressor for the first time?

Their stress routes and stress circuits are not yet fully developed.

Which PTSD symptom is most readily controlled with medication?

increased arousal

Compared with covert exposure therapy for combat veterans with posttraumatic stress disorder, virtual reality exposure therapy has been shown to be:

more effective

Max experienced a dissociative fugue for two weeks. What is a common immediate reaction upon “waking” from this state?

confusion

Troy has dissociative identity disorder. All of his subpersonalities talk about and tattle on each other. This is an example of a:

mutually cognizant pattern.

In a case of dissociative identity disorder, Laura is aware of the existence of Jerry and Chris, but Jerry and Chris are not aware of the existence of the other personalities. This form of subpersonality relationship is called:

one-way amnesic.

If you studied for this exam while you were unusually happy, you will probably do best taking it while you are:

unusually happy.

Which of these is the usual goal of therapy for dissociative identity disorders?

merge the subpersonalities into a single identity

Which BEST describes someone experiencing derealization?

The person feels as if the world has changed and become strange or surreal.

Discuss the advantages of using either Psychodynamic Therapy or Cognitive Behavior Therapy in treating a Dissociative Disorder like dissociative identity disorder (DID).  Be sure to note specific reasoning why one therapy might have an advantage over the other.  5 points

As noted by the text, people with Dissociative Identity Disorder often do not recover without treatment because the disorder is so complex. As such, the treatment plan is often quite complex as well. The psychodynamic approach is particularly equipped to tackle this disorder, especially when incorporating compassion with treatment goals such as helping the clients fully recognize the nature of their disorder, recover gaps in their memories, and integrate their various subpersonalities into one functional personality. Such an approach has an advantage over drug therapy because it is often more effective, more long lasting, and has fewer risks of causing undesired side effects. Psychodynamic therapy also has an advantage to hypnotherapy because there is poor research backing up the effectiveness of hypnotherapy and it has been shown to actually create false memories. 

Suicide definition

Self-inflicted death that is intentional, direct, and conscious

Parasuicide definition

A suicidal act, gesture, or attempt that did not result in the death of the person

• failed suicide

Subintentional Death definition

unconscious or indirect behavior that results in the death of oneself

• ex: substance use, risk-taking, inattentiveness to heath

Correlational info - Suicide

• religious affiliation may reduce the rate of suicide

• women 2x as likely as men to attempt

• Men 3x more likely to die when attempt

• 50% of people who die by suicide feel lonely, isolated, and believe they have no close/personal friends

• divorced/unmarried people have a higher rate of suicide than married people

• white Americans are 2x more likely to attempt

• # of clients with suicidal behavior has increased significantly over the past decade (thanks social media)

Suicide Risk Factors

• current/ history of substance use

  • know the reason for the use

• coming off medication? May increase risk

• if currently using drugs, inhibition is lowered, contributes to suicidal actions

• current/history of mental illness

• major depressive disorder

• bipolar disorder

• schizophrenia/delusional disorder

• close to someone who has a history of suicidal behaviors

• history of previous suicidal behaviors

Individual Protective factors against suicide

• effective coping and problem-solving skills

• individual has a reason to live (family, friends, pets)

• strong sense of cultural identity (religion, community)

Relationship protective factors against suicide

support from partners, friends, family

Community protective factors against suicide

• feeling connected to school, community, social institutions

• availability of healthcare

Societal protective factors - suicide

• reduced access to lethal means (guns)

• cultural, moral, religious objections/stigmatize of suicide

Psychodynamic view of suicide

• the real or symbolic loss of a loved one that played a central role in the individual’s identity can contribute to suicide

• the loss of childhood can contribute to suicide

• suicidal people turn negative emotions inward toward the self

Sociocultural view of suicide

• the more a person feels they belong to community and society, the lower their risk of suicide

• egotistic suicides = people feel detached from society, isolated, people who are not well-integrated into any social group

• Altruistic suicides = people feel they are doing society a favor for sacrificing themselves (Kamikaze pilots) - opposite of egotistic suicides

• Anomic Suicides = society fails to provide a supportive environment

Interpersonal view of suicide

• person feels like a burden to others

• they must maintain the capability to carry out the act

Biological view of suicide

• studies have found that if one fraternal twin is suicidal, it is more likely that their twin will also be suicidal

  • suggests biological / genetic component

• Victims of suicide have low serotonin levels

Age and suicide

• athletes retiring or anyone retiring = identity lost

Medical treatments for unsuccessful suicide attempts

First priority is to address medical emergency (blood loss, overdose, loss of O2 to brain)

• after the patient is medically stable:

  • return patient to baseline functioning

  • identify risk factors

  • use CBT to change thought process

Dissociative Amnesia - Diagnostic Criteria

• person cannot recall important life-related information

• is more than simple forgetting

• Causes significant distress and impairment

• these symptoms are not caused by substance or medical conditions

4 Types of Dissociative Amnesia

1- Localized (most common) - person loses all memory of traumatic events for a short period of time

2- selective - person remembers some (not all) events

3 - generalized - person forgets all of the traumatic events as well as early memories, extending to family and friends

4 - continuous - a person forgets all of the traumatic events, earlier events, has trouble forming new memories