Psychopathology and mental health exam two

Mood Disorders, Anxiety Disorders, Anxiety Disorders / OCD, PTSD & Dissociative Disorders, PTSD

type of anxiety disorders

social anxiety, GAD (generalized anxiety disorder), Panic attack disorder

DSM-5 definition of social anxiety

Fear of social evaluation. Fear that they will be socially rejected

Myths about social anxiety:

Statement: Most people with social anxiety are happier alone.Answer: T/F

False — — People with social anxiety crave settings where they will not be judged

Myths about social anxiety:

Statement: People with social anxiety just need to avoid the spotlight .Answer: T/F

False — each situation is independent for the individual

Myths about social anxiety:

Statement: People with social anxiety are just shy.Answer: T/F

False — social anxiety involves intense fear of social situations

what diseases does social anxiety have a high comorbidity with

other anxiety disorders and depression

Is social anxiety chronic?

Yes

What percent of the population suffers from social anxiety?

~12% of the population

when does social anxiety develop

adolescence

which gender suffers from social anxiety more?

Women

What medication can be used to treat social anxiety?

SSRIs- generally helpful in treating social anxiety — used in combination with CBT-

How is CBT used to treat social anxiety?

exposure, rehearsal, roleplay

what are the three psychological treatments for social anxiety?

CBT, social skills training, attention bias modification training

How do therapists use social skill training for social anxiety?

teaching individuals skills ( eye contact, active listening + being assertive)

How do therapists use attention bias modification training for social anxiety

train people to focus on positive instead of negative, app

What is GAD ( generalized anxiety disorder)

frequent and unnatural worry about various aspects of daily life

What does GAD stand for

generalized anxiety disorder

What are the aspects of worry for GAD

negative emotional thoughts, uncontrollable, concerned with possible future dangers

DSM-5 definition of GAD

excessive worry about numerous events at least 50% of the day, more days than not, for at least six months. Must include at least 3 symptoms( bonus: what are the symptoms)

DSM-5 symptoms of GAD

• restlessness

• easily fatigued

• difficulty concentrating or mind going ‘blank’

• irritability

• muscle tension

• sleep disturbance

Question: Can you get diagnosed with GAD if you only have the symptoms during episodes of depression .

No. There must be evidence that GAD exists outside of depressive episodes

What is the prevalence for GAD

~6%

which gender suffers from GAD more?

woman (2:1 vs. men)

what is the heritability of GAD?

~33%

What disorder does GAD have a high comorbidity with

MDD( Major depressive disorder)

Treatments for GAD

CBT, medications, mindfulness based CBT

How is CBT used to treat GAD

goal is to have patients figure out that they are wasting energy by worrying so much. Figure out what triggers for anxiety are

How does mindfulness based cognitive therapy treat GAD

focus on here and now, thoughts + emotions are not facts.

Does CBT help with GAD

Yes. After CBT there is a decrease in activation in the limbic and prefrontal regions

What medications are used to treat GAD?

SSRIs

Are benzo’s good to treat GAD?

NO! they only offer a short term solution and are very addictive.

What is a panic attack?

A sudden onset of intense terror, apprehension, and/or feelings of impending doom.

How long does a panic attack take to peak?

10 minutes

Physical symptoms of panic attacks

rapid heartbeat, shortness of breath, choking, chest pain, dizziness, feeling faint, sweating, chills, trembling, nausea, numbness

Psychological symptoms of a panic attack

• depersonalization

• Derealization

• fear of losing control/ going crazy

• intense fear of dying

what is depersonalization

a feeling of being out of body

what is derealization

feeling like the world isn’t real

what frequently causes the 1st panic attack?

high stress situations

do most adults who have a panic attack develop panic disorder?

no

DSM-5 criteria for panic attack disorder

• recurrent/ unexpected panic attacks

• persistent worry about having panic attacks

• major change in behavior in order to avoid triggers

Treatments for Panic attack disorder

medication, mindfulness, exposure

What medication is used for panic attack disorder

benzodiazepines - come with frequent relapse

How does mindfulness help during a panic attack?

helps to focus on the present moment, and wait for symptoms to lesson

How is exposure used to treat panic attack disorder

real life exposure, imagined exposure, interoceptive exposure ( triggering physical sensations)

what is agoraphobia?

fear of being in situations where you can’t escape

What role do environmental factors play in anxiety disorders

stressful life events precede anxiety + depression

how do people with anxiety perceive threats?

people with anxiety have enhanced perception of threats

what is the general heritability for all anxiety disorders

~30-50%

what system in the brain is most strongly linked with anxiety disorders?

the limbic system(amygdala)

what neurotransmitters are important in anxiety disorders?

serotonin, GABA, norepinephrine

what treatments are the best for anxiety disorders

psychological treatments

How does the DSM-5 define OCD

1. persistent obsessions, compulsions or both

2. time consuming, impairing on daily life( 1hr + per day)

3. not caused by any other substance

4. not related to other mental health conditions

What is an obsession( OCD)

1. Persistent thoughts, urges and images that are unwanted and cause the individual distress.

2. The person tries to silence these thoughts (with compulsions)

What is a compulsion (OCD)

1. repetitive behaviors or mental acts a person feels required to do.

2. meant to reduce distress and prevent feared events from happening (obsessions)

what are some common obsessions?

1. fear of contamination

2. fear of violence (to self and others)

3. sexually taboo/ morality

what are some common compulsions?

1. washing hands

2. apologizing

3. counting

4. organizing

5. repeating

6. checking

what is the difference between an obsession and worry?

An obsession is intense and unwanted random thought. A worry is a more general feeling about the future.

(Worry focuses on self while obsession focuses on attention)

What are the possible causes of OCD?

1. cognitive model

2. neurological factors

3. genetic factors

what is the cognitive model for OCD(causes)

1. By attempting to suppress maladaptive thoughts, they actually become more prevalent.

2. OCD people attend to their worries + obsessions much more than others

3. suggests OCD can be episodic w/ relapses

what are the neurological factors associated with OCD

1. increased activation brain regions

2. increased activation when prevented with stimulus related to an obsession

what regions of the brain are more active for people with OCD?

1. frontal-striatal circuitry

2. anterior cingulate cortex

3. orbiofrontal circuitry

4. caudate nucleus

Heritability of OCD

40-50%

what is ERP

when people with OCD are deliberalty exposed to their triggers in order to desensitize them to committing their compulsions.

what medications are used for OCD

SSRIs

What is the DSM-5 diagnosis for PTSD?

Following a traumatic event, an individual experiences intrusive memories, avoidance behaviors, negative changes in mood, and physical reactions causing extreme distress. Symptoms must persist for at least one month.

What are the symptoms of PTSD?

Intrusive memories, avoidance behaviors, negative changes in mood/ thought, physical and emotional changes

what are intrusive memories (PTSD)

memories about the traumatic event that do not go away. Can show up as flashbacks or nightmares

What are avoidance behaviors

Internal + external avoidance of traumatic memories. ( thoughts, feelings, people, places, or activities)

how are the avoidance behaviors for PTSD different than for OCD?

avoiding distressing memories(PTSD) vs. avoiding distressing thoughts( OCD)

What are the negative changes in mood associated with PTSD?

anhedonia, selective amnesia, persistent self-blame, negative emotional state, feeling disconnected from others

Physical/emotional changes of PTSD

irritability, hyper vigilance, reckless behavior, exaggerated scare response, trouble concentrating, sleep disturbance

What is PTSD caused by?

experiencing trauma

common forms of trauma

combat exposure, sexual assault, terrorist attacks, witnessing death, loss of a loved one.

Social factors for PTSD

lack of social support contributes to a higher risk for PTSD( Vietnam veterans

Biological factors of PTSD

brain differences, family history of PTSD, generally higher state of arousal.

How does the brain change with PTSD?

Hippo campus + amygdala have decreased function and size. (disfunction of memory and emotion regulation)

neurotransmitters involved with PTSD?

cortisol, norepinephrine, serotonin, dopamine

what is comorbid with PTSD?

MDD, substance use disorder, anxiety disorders

Psychological factors for PTSD

dissociation, increased self- blame

How does dissociation affect PTSD

only a short term solution, increases severity of PTSD

How does increased self-blame affect PTSD?

can make symptoms and feelings of PTSD worse.

How is the severity of symptoms related to the type of trauma(PTSD)"?

the severity is correlated with the type of trauma.

medications used to treat PTSD

SSRIs, Benzos(not effective)

Talk therapies used for PTSD

Prolonged exposure, cognitive processing theory, EMDR

What is EMDR

eye-movement desensitization and reprocessing is PTSD CBT therapy with bilateral eye movement

acute stress syndrome

like PTSD but lasts 3 days to 1 month

difference between BD I and BD II

BD I is one manic episode while BD II is only hypomanic episodes

Mania

a period of abnormally elevated/ irritable mood. Increased energy or activity lasting at least a week.

DSM-5 Def of BD

when an individual experiences both manic(or hypomanic) and depressive episodes. Resulting in severe impairment or hospitalization.

Symptoms of mania

• Increased goal-directed activity/ psychomotor agitation

• Talkative and rapid speech

• racing / out-of-control thoughts

• Decreased need for sleep

• Thinking you are superhuman (increased self-esteem).

• Distractibility

• Risky behavior

Hypomania

Like mania but less severe. Only lasts for 4 days. Doesn’t require hospitalization.

Major depressive episode.

At least two weeks with symptoms of depressed mood, loss of pleasure, weight changes, change in diet, sleep disturbances, fatigue, feelings of worthlessness or guilt, difficulty concentrating, and recurrent thoughts of death or suicide.

Biological causes of BD

family risk factors( 70-90% heritable), neurological differences/

heritability of BD

70-90%

What brain regions are decreased with BD

Prefrontal + limbic systems (emotions)

what brain regions are increased with BD

amygdala + striatum (reward centers)

Psychosocial factors for BD

have increased reward sensitivity( why), improbable goal striving

most effective treatment for BD

medication

medications for BD

anti psychotics, mood stabilizers, anti convulsant

can you use anti depressant for BD

no, unless used with mood stabilizers